CNS Trauma

Question 1

Excess fluid in brain parenchyma

Answer 1

Cerebral oedema

Question 2

Enlarged cerebral ventricles
Elderly
Triad of: Dementia, apraxic gait, urinary incontinence

Answer 2

Normal pressure hydrocephalus

Question 3

Obstructed CSF flow

Physical blockage

Answer 3

Non-communicating hydrocephalus

Question 4

No obstruction to CSF flow

Lack of CSF absorption - meningitis, SAH

Answer 4

Communicating hydrocephalus

Question 5

Raised ICP can result in…

Answer 5

Herniation

Question 6

Normal ICP

Answer 6

7-15mmHg

Question 7

3 main types of herniation

Answer 7

Subfalcine (under falx cerebri - most common)
Transtentorial (inner part of temporal lobe (uncus) compresses brainstem)
Tonsilar (coning - cerebellum through foramen magnum)

Question 8

Cerebellum through foramen magnum (coning)

Answer 8

Tonsilar herniation

Question 9

Uncus (inner temporal lobe) pushes into brainstem

Answer 9

Transtentorial herniation

Question 10

Brain pushes under falx cerebri

Most common type of herniation

Answer 10

Subfalcine herniation

Question 11

Stroke symptoms <24h
Resolves without permanent brain damage
Amaurosis fugax (blurred vision)

Answer 11

TIA

Question 12

Headache, seizure, focal neurology (if severe - vomiting, LOC)

Answer 12

Haemorrhage

Question 13

Rupture of small parenchymal vessel
Basal ganglia
Hypertension

Answer 13

Non-traumatic intra-parenchymal haemorrhage

Question 14

High pressure system between artery and vein prone to rupture
Massive bleeding

Answer 14

Arteriovenous malformation

Question 15

Lesion of closely packed vessels with no parenchyma in between
Low pressure recurrent bleeds

Answer 15

Cavernous angioma

Question 16

Rupture of Berry aneurysm (80% internal carotid bifurcation)
THUNDERCLAP headache
Xanthochromia on LP

Answer 16

SAH

Question 17

Most common site of Berry aneurysm formation

Answer 17

Internal carotid artery bifurcation

Question 18

Tissue necrosis
Permanent damage in affected area
No recovery

Answer 18

Cerebral infarct

Question 19

Fewer macrophages
Limited tissue damage
Partial recovery

Answer 19

Cerebral haemorrhage

Question 20

Direct collision of brain with skull vs. rebound collision of brain with skull

Answer 20

Coup vs. countecoup

Question 21

Panda eyes
Otorrhoea, rhinorrhoea (straw coloured CSF leaking)
BBB broken - infection risk

Answer 21

Basal skull fracture

Question 22

Injury to axons from shear force

Commonest cause of coma

Answer 22

Diffuse axonal injury

Question 23

Repetitive traumatic brain injury (boxers, American football)
Tauopathy
Neurodegenerative disease
Suicide risk
Autopsy diagnosis

Answer 23

Chronic traumatic encephalopathy

Question 24

Lucid interval then loss of consciousness
Middle meningeal artery
Biconvex lens on CT

Answer 24

Extradural haemorrhage

Question 25

Associated with polycystic kidney disease

Answer 25

SAH (Berry aneurysms)

Question 26

Lucid interval then increasing headache + confusion Between dura mater + arachnoid mater Bridging veins Crescent-shaped on CT

Answer 26

Subdural haemorrhage

Question 27

Weakness, nystagmus, blurred vision, intention tremor

Answer 27

MS

Question 28

Contralateral LEG paralysis | Cognitive deficits

Answer 28

ACA stroke

Question 29

Contralateral FACE + ARM paralysis Dominant side affected - aphasia Non-dominant side affected - neglect Eye deviates towards side of lesion

Answer 29

MCA stroke

Question 30

Occipital - Contralateral hemianopia Midbrain - CNIII and IV palsy incl. pupil changes Thalamic - amnesia, decreased LOC

Answer 30

PCA stroke

Question 31

Sensory deficits - pain + temperature Cross body - ipsilateral face, contralateral trunk + limbs Ataxia + nystagmus

Answer 31

PICA stroke (Wallenberg syndrome or lateral medullary syndrome)

Question 32

Small infarcts in deep penetrating arteries of deep brain structures (basal ganglia, pons, internal capsule, thalamus) Different syndromes 1. Pure motor (contralateral arm, leg, face) - most common, posterior limb of internal capsule 2. Pure sensory (hemisensory loss) - ventral thalamic 3. Ataxic hemiparesis (ipsilateral ataxia + leg paresis) - ventral pons or internal capsule 4. Dysarthria-clumsy hand syndrome (hand weakness, clumsiness, dysarthria, facial weakness, clumsiness) - ventral pons or genu of internal capsule

Answer 32

Lacunar stroke

Question 33

Anterior spinal artery Hypoglossal nerve Tongue deviation (ipsilateral tongue weakness)

Answer 33

Medial medullary syndrome stroke

Question 34

Locked in syndrome

Answer 34

Proximal basilar artery stroke

Question 35

Unconscious Collapsed at home Pin-point pupils

Answer 35

Brain stem infarction

Question 36

History of strokes + TIAs | Now aggressive + forgetful

Answer 36

Vascular dementia

Question 37

Blurred vision + vomiting Diabetic Localised to upper anterior head

Answer 37

Glaucoma

Question 38

Obese | Worsening headaches worse in morning

Answer 38

Benign intracranial HTN