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31 Cards in this Set
- Front
- Back
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How do cerebral tumours present
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Raised ICP - (N&V, photophobia, papilloedema, drowsy)
Seizures Focal neurological signs |
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What is the most common brain tumour in adults
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Glioma (astrocytoma, oligodendrocytoma.... of these Glioblastoma multiforme are the most common)
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What imaging is best for glioblastoma multiforme
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MRI w and w/o contrast
contrast enhancing ring with surounding oedema; hypodense necrotic core |
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What is Rx of Glioblastoma multiforme?
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Surgery - Dx, reduce ICP, aid adjuvant radiotherapy
Radiotherapy - doubles life expectancy to 37 weeks Chemo - may prolong up to a year. Prognosis <1yr |
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Patient presents with a history of seizures developng over a couple of years with recent N&V headache, photophobia. Ct scan shows calcified mass
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Oligodendroglioma
- slow growing, patient may have seizures for many years before raised ICP, 90% will have Ca deposits Rx = debulking surgery; radiotherapy; chemo |
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What cancers commonly metastasize to brain
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Lung
breast melanoma kidney GIT |
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what imaging should be ordered if brain mets suspected
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CT
MRI with gadolinium scan - will show smaller lesions than CT with contrast |
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What is the treatment of Brain mets
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Steroids to control oedema
resection if accessible Removal of a single mass when systemic Ca is being controlled provides significant Sx releif |
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Where are pediatric tumours normally found
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60% in posterior fossa
Brain tumours most common solid tumour in kids cerebellar astrocytoma 30% medulloblastoma 30% ependymoma 20% Raised ICP often - due to blocking of fourth ventricle. |
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Patient presents with tinnitus and unilateral sensorineural hearing loss
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acoustic neuroma
Rx= surgical resection |
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Order of susceptibility to hypopituitarism with pituitary adenoma
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growth hormone, gonadotrophin, corticotrophin, thyroid stimulating hormone
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Woman presents with ammenorhea, galactorrhea, infertility
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Prolactinoma
Rx= dopamine agonist such as bromocryptine |
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when is surgery indicated for pituitary adenomas
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- large tumours - compression of adjacent neural structures, particularly the visual pathways
- growth hormone-secreting tumours causing acro- megaly - ACTH-secreting tumours causing Cushing’s disease - the occasional treatment of a prolactin-secreting ade- noma when the medical treatment using bromocryptine is not tolerated. |
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Clinical presentation of subarachnoid
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- thunderclap headache
- meningism - focal neuro signs most common cause = ruptured berry aneurysm circle of willis Rx = endovascular occlusion (coiling) |
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numbness and tingling in lateral 3.5 digits, worse at night, elicited when tapping median nerve. Wasting of the thenar muscles
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carpal tunnel syndrome
Rx conservative = NSAIDs, splints surgery = division of flexor retinaculum E = f>m, usually bilateral, most common entrapment neuropathy |
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paraesthesia in ring and little finger, wasting of hypothenar eminence,
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Ulnar nerve compression at medial epicondyle.
Rx = NSAIDs , prevent further trauma/entrapment Surgery = nerve decompress and transpostion to front of elbow |
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numbness over dorsal aspect of radial 3.5 digits, wrist drop.
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radial nerve 'saturday night palsy'
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what are the hallmarks of spinal cord compression?
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Pain- local and radicular
progressive limb weakness sensor disturbance at level of compression sphincter distrubance 1. Pain - precedes neuro disturbance, pain radiates to affected dermatome; fexion orextension can reproduce 'electric pain' 2. neuro deficit = motor- paralysis |
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what investigations are useful in spinal cord compression
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MRI - best
CT and Xray show bony destruction as cause |
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surgical management of spinal cord compression
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Decompressive laminectomy (posterior approach)
Vertebrectomy and fusion (anterior approach). |
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causes of spinal cord compression
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Schwannoma (dumbell tumour)
spinal meningioma malignancy (lung, breast, prostate, kidney, myeloma, lymphoma disc prolapse |
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treatment of hydrocephalus
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medical --> acetazolamide (decreases CSF production, frusemide, thiazide.
Surgical --> Serial LPs, ventriculoperitoneal shunt, lumboperitoneal shunt |
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2 types of hydrocephalus
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communicating - absorption blocked at arachnoid granulations (CT= all dilated)
Non comminicating - one of the aqueucts blocked (CT= 3rd and 4th vent dilated. |
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weakened arm flexion, delayed biceps jerk, paraesthesia over thumb. pain down arm, worse with neck extension
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C5-6 disc herniation causing C6 nerve root compression (most common cervical disc herniation)
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sciatic pain, weakened dorsiflexion, weakened hallux extension, sensory loss over dorsum of foot to big toe
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L4-5 disc herniation causing L5 nerve root compression (45% of lumbar herniation)
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Sciatic pain, weakened plantar flexion, sensory loss over lateral foot
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L5-S1 disc herniation causing S1 nerve compression (45% of lumbar disc herniation)
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priniciples of spinal injury management
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Prevention of further injury to the spinal cord
Reduction and stabilisation of bony injuries Prevention of complications resulting from spinal cord injury Rehabilitation. |
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indications for surgical intervention with spinal injury
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progressive neuro deficit
persisting compression instability open injury |
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what can be done to reduce brain swelling in head injury?
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O2 (CO2 increases swelling)
elevate head lower temperature - increased temp raises ICP if severe - lower PaCO2 - mannitol, frusemide - cool to 34* (no steroids) |
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how do subdural haematomas appear on CT
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- concave
hypoechoic if chronic hyperechoic if acute |
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patient falls and hits head CT scan shows hyperdense convex mass.
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extradural haematoma
- usually due to # temporal bone causing torn middle meningeal Rx = urgent craniotomy and clot evacuation if dilated ipsilateral pupil with contralateral paresis - herniation |
