Pathologies Of The Nervous System

Front 1

• What is a coma?

Back 1

a coma is when the person has lost consciousness, does not respond to verbal or painful stimuli, body is limp/ flaccid and some reflexes are present

Front 2

• What is another term for a coma?

Back 2

MSC- minimal conscious state

Front 3

• What does it mean when a person is in a vegetative state?

Back 3

they lack higher cognitive function, can not engage in their environment, unresponsive to stimuli but their brain stem functions (i.e. cardiovascular, respiratory etc.) functions continue

Front 4

• What does a locked in state mean?

Back 4

the person is able to think and is aware of his surroundings but is paralyzed and is not able to communicate or physically respond to his surroundings

Front 5

• Brain death

Back 5

cessation of brain function, in both the cortex and brainstem (cant breathe on their own), become donor candidates

Front 6

• What is the % of misdiagnosis between a coma and vegetative state?

Back 6

40%

Front 7

• What do most serious brain disorders result in?

Back 7

increased intracranial pressure which is caused by edema of the brain, tumors, hemorrhage, and ventricular disorders

Front 8

• What are some early stage symptoms of nervous system related disorders?

Back 8

headaches, vomiting, dizziness, papilledema (pressure+ swelling of the optic nerve), fixed and dilated pupils

Front 9

• What are some late-stage symptoms of nervous disorders?

Back 9

drowsiness, seizures and comas

Front 10

• What are some common locations for herniations (increased intracranial pressure)?

Back 10

medial region of cerebrum, medial aspect of the temporal lobe, cerebellar tonsils (bottom of cerebrum)

Front 11

• What are intracranial neoplasms?

Back 11

brain tumors

Front 12

• What are some clinical features of intracranial neoplasms?

Back 12

seizures, gradual neurological deficits (i.e. difficulty thinking, slow comprehension etc.)

Front 13

• What are the clinical features of intracranial neoplasms dependent on?

Back 13

tumor location and the site of the resulting mass effect

Front 14

• What are some methods of detection of intracranial neoplasms?

Back 14

MRI, CT, PET Scan (can demonstrate metabolic activity [blood intake] and physiology

Front 15

• What is the most common type of brain tumor?

Back 15

Glioma [brain tumor that arises from glial cells]

Front 16

• What is the least malignant form of a glioma?

Back 16

Atrocytoma

Front 17

• Where are Atrocytomas found?

Back 17

Cerebrum, cerebellum, the thalamus, the optic chiasm, the pons

Front 18

• What is the highly malignant form of a glioma?

Back 18

Glioblastoma

Front 19

• Where are Glioblastomas found?

Back 19

Cerebrum, brain stem, cerebellum

Front 20

• How do Glioma’s spread?

Back 20

directly from one hemisphere to another through the white matter tracts of the corpus callosum

Front 21

• What age group is more likely to develop a glioma?

Back 21

middle age group, below the age of 30 is rare

Front 22

• Radiographic Appearances of Glioma’s?

Back 22

[non contrast CT]; m/c seen as single, non homogenous masses with edema seen in adjacent white matter structures; [after contrast adm. CT]; gliomas show enhancement from contrast, the more malignant the tumor the greater the advancement

Front 23

• Treatment options for Gliomas?

Back 23

if Atrocytomas (very little malignancy), then surgery and radiation therapy *good 5yr survival rate

Front 24

• What is a meningioma?

Back 24

tumors that arise from the meninges, usually benign in nature

Front 25

• Where are meningioma’s found?

Back 25

meninges of the spinal cord, parasagittal region; lateral convexities of the hemispheres; venous channels/ base of skull; posterior fossa

Front 26

• What are the features of a meningioma?

Back 26

benign, slow growing and sharply defined on images, can range from pea to potato size

Front 27

• Do meningioma’s infiltrate the nervous system?

Back 27

no, they displace it

Front 28

• What is Acoustic Neuroma?

Back 28

a benign tumor that develops around the vestibulocochlear nerve

Front 29

• What is the location of an acoustic neuroma?

Back 29

they arise from schwann cells (cells that myelinate the 8th cranial nerve), and affect the vestibular portion of the 8th nerve within the internal auditory canal

Front 30

• What is the age range of acoustic neuroma?

Back 30

does not occur before the ages of 50-60, 1/1000 odds

Front 31

• What is a Pituitary Adenoma?

Back 31

(commonly benign) tumors that occur within the pituitary gland (anterior lobe)

Front 32

• What is a Chromophobe Adenoma?

Back 32

ballooning of the sella turcica, exerting pressure on the cranial nerves and the optic chiasm

Front 33

• What is an Acidophil Adenoma?

Back 33

a tumor that results in anterior pituitary hyper function (causing acromegaly)

Front 34

• What is a Basophil adenoma?

Back 34

tumor which results in Cushing’s syndrome (adrenals producing extremely high levels of the cortisol hormone) and increases thyroid function

Front 35

• What is Metastatic Carcinoma of the brain?

Back 35

Cancer that has reached the brain through hematogenous spread from another part of the body

Front 36

• What is another way cancer can spread to the brain, if through hematogenous?

Back 36

can spread from the nasopharynx through foramina, or direct invasion to the brain from the bone

Front 37

• What are the most common neoplasms that spread to the brain?

Back 37

Neoplasms that arose from the lung and breast

Front 38

• What are examples of cancer that can result in brain metastasis?

Back 38

melanomas, colon cancer, testicular cancer and kidney cancer

Front 39

• What are the radiographic appearances of metastatic carcinoma of the brain?

Back 39

usually appears as a single or multiple lesions, commonly located at the junction between grey and white matter

Front 40

• What are the treatment options for metastatic carcinoma?

Back 40

if single lesion, then surgical resection; if multiple lesions, then whole brain radiation/ chemotherapy

Front 41

• What is the most important part that influences the effects of brain trauma?

Back 41

the skull

Front 42

• What are Epidural/ Extradural Hematomas?

Back 42

localized collection of blood between the dura and the cranial bone

Front 43

• What are epidural bleeds usually caused by?

Back 43

a temporal skull fracture or trauma to the parieto-temporal region *tears the middle meningeal artery

Front 44

• What are some s/s of an epidural hematoma?

Back 44

caused by head injury, followed by a brief loss of consciousness and a lucid period after regaining it, dialated pupils, weakness of both brain hemispheres

Front 45

• What are the treatment options for an epidural hematoma?

Back 45

evacuation of the clot, ligation

Front 46

• What are the rad app of an epidural hematoma?

Back 46

biconvex/lens shaped/ sharp margins, and dense compared to normal brain tissue

Front 47

• What is a subdural hematoma?

Back 47

when blood fills the dura and arachnoid space of the brain

Front 48

• How does the subdural hematoma occur?

Back 48

a head injury where the brain moves suddenly in relation to the skull, resulting in tears of veins between the sura and arachnoid space

Front 49

• What types of symptoms are present when a patient has a subdural hematoma?

Back 49

gradual onset symptoms; headache, agitation, confusion, drowsiness, and gradual neural deficiency

Front 50

• What are the symptoms classified as?

Back 50

1) acute (symptoms seen within 24h) 2) Subacute (seen 2-10 days after accident) and 3) Chronic (symptoms arise several weeks later)

Front 51

• Subdural Hematoma radiographic appearances

Back 51

skull is not always fractured, HD crescent shaped lesion adj to inner skull table, usually displacing midline structures

Front 52

• What are cerebro-vascular accidents?

Back 52

loss of brain fxn due to a disturbance in the blood supply to the brain (stroke)

Front 53

• What are the major causes of death involving CVAs?

Back 53

hemorrhage or infarction

Front 54

• What are some contributing factors to CVAs?

Back 54

hypertension and atherosclerosis

Front 55

• What is the most commonly affected vessel for a CVA?

Back 55

internal carotid artery

Front 56

• What is the precursor to a CVA?

Back 56

TIMA (transient ischemic attack)

Front 57

• What are the 4 principle types of CVAs?

Back 57

Intraparenchymal/ Cerebral Hemorrhage, Subarachnoid Hemorrhage, Thrombotic Infarction, Embolic Infarction

Front 58

• What are the 5 warning signs and symptoms of a stroke?

Back 58

sudden numbness/ weakness on the face or one side of the body, sudden confusion or difficulty speaking, sudden trouble seeing through one or both eyes, sudden trouble walking, dizziness, or loss of balance, sudden severe headache w/ no known cause

Front 59

• What are some causes of Intraparenchymal Hemorrhage?

Back 59

trauma, hypertension, atherosclerosis, A/V formation

Front 60

• Where are Intraparenchymal hemorrhages located?

Back 60

mainly in the basal ganglia of the cerebrum (80%), often within the middle cerebral artery

Front 61

• What is the progression of an Intraparenchymal hemorrhage?

Back 61

sudden, dramatic, highly lethal

Front 62

• What are some methods of evaluating Intraparenchymal Hemorrhaging?

Back 62

MRI, non contrast CT, Doppler Ultrasound

Front 63

• Rad Appearances of a Cerebral Hemorrhage

Back 63

homogenous dense clot that has entered the ventricular system of the brain

Front 64

• What are some causes of Subarachnoid Hemorrhaging?

Back 64

a ruptured vessel, usually a berry aneurysm, spilling into the subarachnoid space

Front 65

• Common locations for a subarachnoid hemorrahage?

Back 65

circle of wilis

Front 66

• What is the progression for a subarachnoid hemorrhage?

Back 66

painful headache→ rapid loss of consciousness→ possibly death

Front 67

• What are some methods of evaluation subarachnoid hemorrhaging?

Back 67

MRI/CT, MR angio

Front 68

• What are some treatment options for Subarachnoid Hemorrhaging?

Back 68

evacuation of the clot + ligation of aneurysm

Front 69

• What are the two main things that can occlude a vessel?

Back 69

Thrombus and an embolus

Front 70

• Why is a thrombotic infarction the least lethal type of infarction?

Back 70

because occlusion caused by a thrombus develops slowly, time for collaterals to form ( time for warning signs to develop)

Front 71

• When can a thrombus start/ occur?

Back 71

sleep/ on awakening (during time of decreased BP)

Front 72

• What is the treatment for a thrombotic infarction?

Back 72

surgical correction of the vessel, removal of the arthrosclerosis segment, anticoagulation therapy

Front 73

• Is it better for a clot to be an embolus or a thrombus?

Back 73

thrombus

Front 74

• What is an embolic infarction?

Back 74

when a clot from a cardiovascular disease travels and blocks a vessel that supplies blood to the brain (anterior or posterior carotid artery)

Front 75

• What is the progression of an embolic infarction?

Back 75

sudden occlusion, no TIA, often during period of activity that involve increased blood flow

Front 76

• What is a treatment option for an embolic infarction?

Back 76

surgery, anticoagulation

Front 77

• What is the sound heard during an ultrasound examination that is the occurrence of an embolus breaking off a thrombotic point?

Back 77

brewy’s

Front 78

• What is Hydrocephalus?

Back 78

abnormal accumilation of CSF within the ventricles of the brain

Front 79

• What can cause Hydrocephalus?

Back 79

overproduction of CSF (caused bya rare tumor in the choroid plexus), obstruction of CSF flow (m/c), defective absorption of CSF (meningitis)

Front 80

• What are the two classifications of Hydrocephalus?

Back 80

communicating and non communicating

Front 81

• What does communicating hydrocephalus mean?

Back 81

it means there is free communication betweent he ventricle and the subarachnoid space, meaning it is either caused by overproduction (tumor in choroid plexus) or decreased absorption rate (meningitis)

Front 82

• What does non communicating hydrocephalus mean?

Back 82

there is an obstruction between the ventricle and subarachnoid space *m/c

Front 83

• How is hydrocephalus assessed?

Back 83

through dialated ventricles on CT/MRI scans

Front 84

• What are treatment options for hydrocephalus?

Back 84

surgical placement of a shunt betweent he ventricles and the heart or peritoneal cavity