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93 Cards in this Set

  • Front
  • Back
What is herniation?
The protrusion of an organ through the structure that normally contains it
What is a common cause of brain herniation?
Cerebral edema or trauma
What is a subfalcine herniation?
Occurs when the edema occurs supratentorially in one hemisphere
What is a subfalcine herniation often accompanied by?
A midline shift compressing the anterior horn of the lateral ventricle
What is significant about a uncinate or parahippocampal herniation?
It can compress CN3, the PCA, and the midbrain
What would the symptoms of an uncal herniation be?
Deviation of the eye, ptosis, and pupillary dilation
Can also damage the primary visual cortex and the descending motor pathways if herniation is large enough
What are "Duret" hemorrhages?
Tearing of penetrating veins and arteries supplying the upper brainstem
What are Duret hemorrhages usually due to?
Uncal herniation
What is a tonsillar herniation?
Displacement of the cerebellar tonsils through the foramen magnum
Why is a tonsillar herniation such a big deal?
It compresses the medulla which contains the respiratory, cardiac and consciousness centers
What is a contusion?
A bruise in the brain and occur in response to a blow to the surface of the brain
What is a coup?
Direct injury to the brain--A cocnut falling on someone's head breaks the skull and depressed it inward
What is a contracoup?
Usually occurs during a fall--the brain crashes into the skull and continues to bounce around for a little bit after the fall
What artery is involved with an epidural hematoma?
Middle menigeal artery
What are epidural hematomas typically involved with?
Skull fractures
Do epidural hematomas occur quickly or slowly?
Quickly--neurosurgical emergency
What artery is a subdural hematoma typically associated with?
By torn bridging veins
Do subdural hematomas grow slowly or quickly?
Slowly--they have a much larger space to grow in
What is a subarachnoid hemorrhage?
Blood accumulating in the subarachnoid space--usually from corticol veins
What are the major symptoms of a subarachonid hemorrhage?
"Worst headache of my life"; nuchal rigidity
What are most cases of significant subarachnoid hemorrhages assoiciated with?
Ruptured Berry aneurysms--not trauma
What is hypoxia?
Lack of oxygen
What particular areas are vulnerable to ischemia/hypoxia?
Purkinjie cells
Hippocampus--Sommer's sector
Watershed areas
What is the most common cause of ischemic infarction?
Cerebral atherosclerosis
What are most large infarcts in the brain caused by?
Thromboembolic occlusion in the MCA
What are lacunar infarcts?
Small infarcts that result from small vessel ateriosclerosis--usually due to hypertension
What is an intracerebral hemorrhage most commonly associated with?
What is another cause of intracerebral hemorrhage?
What is an embolic stroke caused from?
Ruptured plaques, cardiac thrombi, valvular disease
Are you still able to view the tissues in an embolic stroke?
Where do cerebral aneurysms usually occur?
At bifurcations of vessels
What is an arteriovenous malformation?
Congenital--a tangle of vascular channels--superficial
What is a cavernous hemangioma?
Greatly distended, loosely organized vascular channels--back to back thin walled vessels--usuually asymptomatic
What is a germinal matrix hemorrhage?
Rupture of the small vessels due to large swings in blood flow in the germinal matrix
Where is the germinal matrix located?
Between the caudate and the thalamus
What gestation is the germinal matrix present for?
13th through the 34th weeks
Who is at risk for a germinal matrix hemorrhage?
Any baby born at 34 weeks or less
What is Periventricular Leukomalacia?
Watershed infarctions in the ACA and MCA of a neonate
What causes a periventricular leukomalacia?
Anything that can cause hypoxia in fetus
What is Caput succedaneum?
Blood that accumulates in the skin of the scalp
What is a subgleal hemorrhage?
Blood accumulating just beneath the skin of the scalp
What is a cephalhematoma?
Blood accumulating in the external periosteum of the skull
What can tears in the falx cerebri and tentorium cerebelli cause during delivery?
Subdural or epidural hemorrhage--vary in severity
What types of palsy can a shoulder dystocia cause?
Erb's palsy--damage to upper brachial plexus

Klumpke's palsy--damage to lower brachial plexus (involving the hand and the wrist)
What is Kernicterus?
Unconjugaed bilirubin crossing the blood brain barrier
What neurons are being lost in Alzheimer's?
Loss of cerebral cortical neurons
Is the brain of an Alzheimer's patient usually smaller or larger than normal?
Usually atrophic--smaller than normal
What areas of the brain are extensively involved in Alzheimer's?
The association cortex and the hippocampus
What accumulates in the brain in Alzheimer's disease?
Plaques and tangles
What are plaques made of?
What are tangles made of?
Abnormal intracellular accumulations of Tau--microtubules
What is Pick's disease?
Similar to Alzheimer's but involves the frontal and temporal cortex
What type of symptoms do patients with Pick's disease have?
Inappropriate behavior--severe personality changes
What part of the brain is messed up in Parkinson's disease?
The substantia nigra--loss of production of dopamine
What part of the brain is affected in Huntington's diease?
Loss of the caudate nucleus
What is the classic symptom of Huntington's disease?
Chorea--involuntary muscular twitching
What is Amyotrohpic Lateral Sclerosis?
Gradual loss of alpha motor neurons in the anterior horn causing atrophy of the muscles
What is a classic example of a chronic demyelinating disease?
Multiple sclerosis
How does the disease progression of MS typically occur?
Remitting and relapsing
What is the most common area of involvement of the brain in MS?
The periventricular white matter
What are the typical findings of acute bacterial meningitis in a CSF sample?
Decreased glucose
Increased protein
Increased pressure
What are two classic signs of meningitis?
When head is raised, the knee bends (B's sign) and resistance to straighten the leg (K's sign)
What is aseptic meningitis?
Acute viral meningitis
What does a CSF profile of a patient with viral meningitis look like?
Increased lymphocytes
Normal pressure
Normal protein
Normal glucose
Negative culture
What is extremely important to do before doing a spinal tap on a patient?
Rule out herniation
What are the symptoms of acute bacterial meningitis?
Fever, HA, lethargy, URTI
What are the symptoms of chronic menigitis?
Fever, HA, MS changes, cranial nerve deficits evolving over weeks to months
What are the typical causative agents of Chronic Meningitis?
TB and cryptococcus
What is the most common fungal infection of the CNS?
Cyptococcus--usually in debilitated patients
What are the three classic manifestations of Neurosyphilis?
Menigovascular syphilis, general paresis, tabes dorsalis
What is tabes dorsalis?
Degeneration of the dorsal columns
What are the symptoms of tabes dorsalis?
Pain, ataxia, urinary incontinence, absent deep tendon reflexes, impaired sensation in the lower extremities
Where does a cerebral abscess usually occur?
At the junction of the gray and white matter
What usually causes a cerebral abscess?
It is usually secondary to an infection elsewhere
What usually causes fungal cerebritis?
Candida and Aspergillus--usually due to long-term antibiotic and steroid use, indwelling catheters, immunocompromised state, etc
What is cystercercosis?
CNS disease caused by ingestion of raw pork (T. solium)--seizures, obstruction of CSF
What is the most common cause of acute viral encephalitis?
What is SSPE typically assoicated with?
Post infection of Measles--typically affects children
What are the signs and symptoms of SSPE?
Progressive dementia and neurologic decline--related to lack of the M protein
How does primary CNS lymphoma typically present?
As single or multiple intracerbral masses
What is CNS lymphoma almost always?
A high grade B cell lymphoma
What is responsible for spongiform encephalopathies?
Prions--very long incubation period and very contagious
What is the stain GFAP and what is it used for?
Glial fibrillary acidic protein--identifies an intermediate filament protein only found in astrocytes--helps to identify neoplasms
What marker is helpful in identifying adenocarcinomas and metatstaic carcinoma?
How are benign CNS tumors characterized?
By displacment of tissue--tumor usually pushes the CNS tissue away from the tumor
What type of tumors often spread to the CNS and float around and settle out somewhere distant from the site?
What is Glioblastoma Multiforme?
High=grade malignant lesion with survival of less than a year
What kind of lesion is a glioblastoma multiforme?
A rign enhancing lesion
Are meningiomas benign or malignant lesions?
Do menigiomas have a good or bad prognosis?
Excellent prognosis
What type of bodies are seen in menigiomas?
Psammoma bodies
What cranial nerve does a schwannomas usually involve?
Cranial nerve 8
What type of tumors typically metastisize to the brain?
Lung, kidney, breast, colon, or melanoma