Brain Masterclass Flashcards

1
Q

What is 1st line when looking at the brain?

A

CT; fast, well tolerated, with or without IV contrast

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2
Q

What is MRI better for in terms of brain imaging?

A

Better soft tissue resolution
Longer duration
Contra-indicated for some
With or without TV contrast

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3
Q

What is an ischaemic stroke?

A

Suddent cessation of adequate amounts of blood to the brain

Can be divided according to the territory affected or mechanism

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4
Q

How do ischaemic strokes tend to present?

A

Rapid onset neurological deficit, which is determined by the area of brain involved
Deprivation of oxygen and glucose
Initiates a cascade of events at a cellular level which can lead to gliosis and liquefactive necrosis

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5
Q

What is the end point of a stroke?

A

Gliosis

Liquefactive necrosis

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6
Q

What conditions can lead to cardiac embolism?

A

Atrial fibrillation
Ventricular aneurysm
Endocarditis

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7
Q

What can lead to embolisms?

A
Cardiac emoblism 
Paradoxial 
Atheroscelrotic
Fat
Air
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8
Q

What area of the brain is most affected by hypertensive haemorrhagic strokes?

A

Basal ganglia

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9
Q

Imaging of choice in acute stroke?

A

Non contrast CT

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10
Q

Why is a non contrast CT performed in acute stroke?

A

Exclude haemorrhage and confirm ischaemia

Permits RAPID treatment e.g. thrombolysis or thrombectomy

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11
Q

Early findings on CT of an ischaemic stroke?

A

Hyperdense segment of a vessel, direct visualisation of the intravascular thrombus/ embolus and as such is visible immediately

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12
Q

What findings are seen within a few hours of an ischaemic stroke?

A

Loss of grey white matter differentiation and hypoattenuation of deep nuclei
Cortical hypodensity with assoc parenchymal swelling with resultant gyral effacement

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13
Q

What will happen with the hypodensity seen in ischaemic stroke as time progresses?

A

More marked resulting in a mass effect

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14
Q

What are the end stages appearances of an ischaemic stroke on CT?

A

Gliosis as a region of low density with volume loss

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15
Q

What are the different types of extra-axial intracranial haemorrhages?

A

Extradural
Subdural
Subarachnoid

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16
Q

What colour will blood appear on a CT scan?

A

White

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17
Q

What will an intra-axial hemorrhage appear like on a CT?

A

LOBAR haematoma

Midline shift may be present

18
Q

Where is the blood in an extradural haemorrhage?

A

Between inner layer of skull and outer layer of dura

19
Q

What are extradural haemorrhages commonly assoc with?

A

Trauma

Skull #

20
Q

What is the source of bleeding in an extradural haemorrhage?

A

Arterial

Torn middle meningeal artery

21
Q

What shape is the haemorrhage seen in an extradural haemorrhage?

A

BICONVEX
Can cause mass effect with herniation
Limited by cranial sutures

22
Q

Where is the blood collection in a subdural haemorrhage?

A

Subdural space, the potential space between the dura and the arachnoid mater

23
Q

What is the mainstay of investigation in subdural haemorrhages?

A

CT

24
Q

What causes subdural haemorrhages?

A

Infants; NAI (shaken baby syndrome)
Young Adults; RTA
Elderly; falls (tearing of bridging veins)

25
Q

What shape is the subdural haemorrhage?

A

Semilunar
Crosses sutures
Mass effect

26
Q

Where is the blood in a SAH?

A

Subarachnoid space;

Between arachnoid and pia

27
Q

What are 85% of SAH due to?

A

Ruptured berry aneurysm

28
Q

Where will blood be seen in a SAH?

A

Suprasellar cistern
Sylvian fissure
Sulci

29
Q

What is the gold standard for SAH?

A

CT cerebral angiogram

30
Q

What are common complications of SAH?

A

Hydrocephalus
Vasospasm
Infarction

31
Q

What make up the majority of brain tumours in adults?

A

Metastatic disease

32
Q

What makes up the majority of brain tumours in children?

A

Primary tumours

33
Q

What areas of the body will metastasise to the brain?

A
Lung
Breast
Melanoma
Renal cell
Colorectal
34
Q

What is the first test when suspected intracranial mass?

A

CT
Hypo or hyperdense
Determines oedema/ mass effect

35
Q

What are the features of mets in the brain?

A
Supra or infra tentorial 
Usually multiple
Lots of oedema
Lots of mass effect
Avidly enhance
36
Q

What type of herniation results in “coning”?

A

Tentorial herniation; descent of cerebellar tonsils below the foramen magnum compressing the brain stem against the clivus

37
Q

What is the spinal cord contained within?

A

Thecal sac

38
Q

Where does the spinal cord extend to - from?

A

Corticomedullary junction at the foramen magnum of the skull down to the tip of the conus medullaris (L1)

39
Q

What can cause spinal cord compression?

A
IV disc; protrusion, extrusion, discitis, osteomyelitis 
Vertebral; trauma, tumour 
Epidural space; abscess, haematoma 
Dura; spinal meningioma 
Intradural space; nerve sheath tumour
40
Q

What is the investigation of choice in spinal cord compression?

A

MRI spine

41
Q

What are red flags in terms of back pain?

A
History of malignancy 
Major trauma
Thoracic/ radicular pain 
Constant, progressive, non-mechanical pain
Widespread neurological signs
Loss of power in lower limbs
Loss of sensation; saddle anaesthesia
Urinary retention