Cerebral Edema, Hydrocephalus & Raised Intracranial Pressure & Herniation Flashcards Preview

2H. Pathology- CNS > Cerebral Edema, Hydrocephalus & Raised Intracranial Pressure & Herniation > Flashcards

Flashcards in Cerebral Edema, Hydrocephalus & Raised Intracranial Pressure & Herniation Deck (31)
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The brain and spinal cord are protected by the rigid compartment defined by the __________, ________,and ____________

skull, vertebral
bodies, and dura mater.


Generalized brain edema, increased CSF volume (hydrocephalus),
and focally expanding mass lesions
may increase ____________. Depending on the
degree and rapidity of this increase and the nature of the underlying lesion, the consequences
range from subtle neurologic deficits to death.

intracranial pressure


Cerebral edema or, more precisely, brain parenchymal edema, is of two principal types:

  1. Vasogenic edema
  2. Cytotoxic edema


Vasogenic edema is caused by __________ and ____________, allowing fluid to shift from the intravascular compartment to the intercellular
spaces of the brain

  1. blood-brain barrier disruption and
  2. increased vascular permeability


The paucity of_________greatly impairs the resorption of excess
extracellular fluid



Walang lymphatics okay?


Vasogenic edema may be either___________ or ____________

  •  localized (e.g., adjacent to inflammation or neoplasms) or
  • generalized


What is  Cytotoxic edema ?

It is an increase in intracellular fluid secondary to neuronal, glial, or
endothelial cell membrane injury, as might be encountered in someone with a
generalized hypoxic/ischemic insult or with metabolic damage.


In practice, conditions associated with _________ often have elements of both
vasogenic and cytotoxic edema.

generalized edema


____________ occurs especially around the lateral ventricles when
an increase in intravascular pressure causes an abnormal flow of fluid from the intraventricular
CSF across the ependymal lining to the periventricular white matter.

Interstitial edema (hydrocephalic edema)


 In generalized edema, the
gyri gross appearance are___________.

As the brain expands, herniation may occur.

flattened, the intervening sulci are narrowed, and the ventricular cavities are


The __________ within the ventricular system produces CSF, which normally circulates
through the ventricular system
and enters the cisterna magna at the base of the brain stem
through the foramina of Luschka
and Magendie.

choroid plexus


Subarachnoid CSF bathes the superior
cerebral convexities and is absorbed by the arachnoid granulations.________ refers to
the accumulation of excessive CSF within the ventricular system ( Fig. 28-2 ).





In hydrocephalus the most cases occur
as a consequence of_____________-;

 impaired flow and resorption of CSF


 only rarely is overproduction the
cause of hydrocephalus (e.g., with ________________). 

tumors of the choroid plexus


When hydrocephalus develops in infancy before closure of the cranial sutures, there is
________________, manifested by an increase in head circumference

enlargement of the head


developing after infancy when sutures are closed  in contrast, is associated with___________________, without a change in head circumference.

 expansion of the ventricles and
increased intracranial pressure


 If only a portion of the
ventricular system is enlarged because of excess CSF, as may occur because of a mass in the
third ventricle, the pattern is called_______________


 noncommunicating hydrocephalus.


In______________ there is enlargement of the entire ventricular system

communicating hydrocephalus


So what is the difference between communicating and noncommunicating hydrocephalus?

Communicating = ENTIRE

Noncommunicating= A part only


The term hydrocephalus
ex vacuo refers to _______________________

dilation of the ventricular system with a compensatory increase in CSF
volume secondary to a loss of brain parenchyma.


When the volume of the brain increases beyond the limit permitted by compression of veins and
displacement of CSF, the pressure within the skull will increase.

Most cases are associated with
a _________________

mass effect, either diffuse, as in generalized brain edema, or focal, as with tumors,
abscesses, or hemorrhages


Elevated intracranial pressure may also reduce perfusion of the
brain, further exacerbating cerebral edema. Because the cranial vault is divided by ____________, localized expansion of the brain may cause it to be displaced in
relation to these partitions. If the expansion is sufficiently severe, a herniation syndrome may

rigid dural
folds (the falx and tentorium)


Subfalcine (cingulate) herniation occurs when _____________ of a
cerebral hemisphere displaces the cingulate gyrus under the falx cerebri. This may lead
to compression of branches of the anterior cerebral artery.

unilateral or asymmetric expansion


Transtentorial (uncinate, mesial temporal) herniation occurs when the_______________.


 medial aspect of
the temporal lobe is compressed against the free margin of the tentorium


increasing displacement of the temporal lobe, the third cranial nerve is compromised,
resulting in________________.


 pupillary dilation and impairment of ocular movements on the side of the


The posterior cerebral artery may also be compressed, resulting in______________


injury to the territory supplied by that vessel, including the primary visual cortex. 


the extent of herniation is large enough the contralateral cerebral peduncle may be
compressed, resulting in hemiparesis ipsilateral to the side of the herniation; the change
in the peduncle in this setting is known as _____________ 

Kernohan's notch.


Progression of
transtentorial herniation is often accompanied by hemorrhagic lesions in the midbrain
and pons, termed _____________( Fig. 28-4 ).


secondary brainstem, or Duret, hemorrhages 


Describe the Duret, hemorrhages 

linear or flame-shaped lesions usually occur in the midline and paramedian regions and
are believed to be due to distortion or tearing of penetrating veins and arteries
supplying the upper brainstem.


Tonsillar herniation refers to ___________. This pattern of herniation is life-threatening because it causes brainstem
compression and compromises vital respiratory and cardiac centers in the medulla

displacement of the cerebellar tonsils through the foramen