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Flashcards in Cerebral Pathology Deck (37):
1

What is an infarction? What % of strokes are due to infarction? What is the main cause for it?

Tissue death due to lack of O2, 70-80%
Cerebral atherosclerosis (others include embolism from intr/extra cranial plaques)

2

Risk factors for strokes/ TIAs (8)

Same as for formation of atheroma: smoking, DM, OCP, past TIA, FH, alcohol excess, hyperviscosity e.g. polycythaemia, sickle cell anaemia

3

Signs & symptoms of stroke (4)

Sudden onset
FAST - face dropping, Arms, Speech, (time to call)
numbness, loss of vision, dysphagia (depends on territory))

4

Vascular territories commonly affecte in stroke (2)

Anterior vs post territry, commonest = MCA

5

Investigations for stroke (4)

CT/ MRI = find out if haemorrhagic or infarct
IX for vascular risk - BP, FBC, ESR, CxR. ECG, carotid doppler

6

Management of stroke (4)

Aspirin +/- dipyridamole (PDE inhibitor that breaks down cAMP > preventing plt aggregation)
Thrombolytics if

7

Signs & symptoms of TIA (2)

Last

8

Vascular territories affected

Any - usually embolic atherogenic debris from the carotid artery travels to the opthalmic branch of internal carotid

9

Investigations for TIA

Carotid US
Ix for vascular risk - BP, FBC, ESR, glu, lipids, CXR, ECG, carotid doppler

10

Management for TIA

Exactly the same as for stroke, except dont give thrombolytics
Aspirin +/- dipyridamole
+/- carotid endarterectomy
Long term - treat HTN, reduce lipis, anticoag

11

Non traumatic types of haemorrhages (2)

Intraparenchymal
SAH

12

Characteristics of Intraparenchymal haemorrhages (3)

50% due to HTN
abrupt onset, can cause CHARCOT-BOUCHARD microaneurysms (likely to rupture)
Common site - basal ganglia

13

Characteristics of SAH - main cause, gender, symptoms (5)

85% from ruptured berry aneurysms - most at internal carotid bifurcation
F>M usually

14

SAH associations (6)

PKD
Pts with aortic coarctation
Ehler's Danlos
Vascular abnormalities - AV malformations, capillary telengactasia, venous & cavernous angiomas

15

Traumatic types of haemorrhage (3)

Extradural haemorrhage
Subdural haemorrhage
Traumatic parenchymal injury

16

Extradural haemorrhage characteristics (3)

Skull fracture > ruptured middle meningeal artery > rapid arterial bleed - lucid interval then LOC

17

Subdural haemorrhage characteristics (4)

Prev history of minor trauma > damaged bridging veins with slow venous bleed.
Elderly/ alcoholic
associated with brain atrophy, fluctuating consciousness

18

Traumatic parenchymal injuries: concussion, diffuse axonal injury, contusion. Characteristics

Concussion - Transient LoC + paralysis, recovery in hours/ days
Diffuse axonal injury - vegetative state post traumatic dementia
Contusions - brain contacts the skull +/- fracture
Coup - where impact occur - contracoup is opposite to region of impact

19

Increased ICP causes (3)

Oedema
SOL
Both > herniation

20

Systemic symptoms of bacterial meningitis (4)

Marked systemic symptoms:
rash, drowsy, fever, septic shock, coma

21

Systemic symptoms of viral meningitis (2)

Mild systemic symtoms:
not unwell, rash unusual

22

Meningism features (4)

Headache
photophobia
stiff neck
Kernig's sign +ve

23

CSF characteristics with a viral infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

Clear usually
Lymphocytes
Normal > 40
normal or slightly elevated but

24

CSF characteristics with a TB infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

FIBRIN web
Lymphocytes
Reduced

25

CSF characteristics with a pyogenic infection: appearance, predominant cell, glucose (40-90), protein (15-45), bacteria

Turbid
Neutrophils
reduced 250
bacteria seen in smear and culture

26

Causative bacterial pathogens of cerebral infection in neonates (3)

GBS
E. Coli
Listeria

27

Causative viral pathogens of cerebral infection in neonates (4)

Echovirus
Coxsackie's virus
Mumps virus
HIV

28

Causative bacterial pathogens of cerebral infection in 1 month to 6 yrs (1)

Strep. Pneumonia (haemophilus influenza)

29

Causative bacterial pathogens of cerebral infection in young adults + adoloscents (2)

Strep. Pneumoniae
Neisseria Meningitidus

30

Causative bacterial pathogens of cerebral infection in Elderly (2)

Strep. Pneumoniae
Gram -ve bacilli e.g. E. Coli

31

Causes of viral encephalitis (2)

HSV 1
Rabies

32

Symptoms of viral encephalitis (4)

Drowsiness, seizures
behavioural change
headache, fever

33

Brain tumours are most commonly primary or secondary?

Secondary mets; most commonly from lung, breast, malignant melanoma

34

Characteristics of brain tumours (3)

Well demarcated
solitary/ multiple with
surrounding oedema

35

Primary tumours originating in the brain, spinal cord or meninges commonly metastasize outside CNS. T or F?

F

36

Commonest group of primary brain tumours?

Astrocytomas

37

Buzz words to identify brain tumours:
NF2
Ventricular tumour, hydrocephalus
Indolent, childhood
Soft, gelatinous, calcified

Meningoma
ependymoma
Pilocytic astrocytoma
Oligodendroma