ICP, hydrocephalus, TBI, Seizure Flashcards
(98 cards)
1
Q
Blood is _ dense than gray/white matter, meaning it will be _ on CT scan
A
Blood is more dense than gray/white matter, meaning it will be bright on CT scan
2
Q
Name some things that will appear “bright” (hyperdense) on CT
A
Bone
Blood
Bullet
Contrast
3
Q
ID the blood vessels shown
A
4
Q
ID the structures
A
5
Q
ID the structures
A
6
Q
ID the structures
A
7
Q
ID the structures
A
8
Q
ID which is T1 and T2
A
9
Q
ID type of scan
A
T2 flair
10
Q
_ edema is caused by intracellular accumulation of fluid secondary to derangements of cellular metabolism that alter ionic gradients
A
Cytotoxic edema is caused by intracellular accumulation of fluid secondary to derangements of cellular metabolism that alter ionic gradients
* Generally affects white and gray matter
* Ex: ischemic stroke, hepatic encephalopathy, cardiac arrest
11
Q
_ edema is caused by extracellular accumulation of fluid secondary to a dysfunction of the blood brain barrier leading to extravasation of ions from plasma (with water following)
A
Vasogenic edema is caused by extracellular accumulation of fluid secondary to a dysfunction of the blood brain barrier leading to extravasation of ions from plasma (with water following)
* Generally effects white matter
* Brain tumor, Posterior reversible encephalopathy syndrome
12
Q
_ edema occurs due to displacement of CSF from the ventricular space into the brain interstitium
A
Hydrostatic edema occurs due to displacement of CSF from the ventricular space into the brain interstitium
* Affects the ependymal surface and horns of ventricles
* Ex: hydrocephalus
13
Q
_ edema occurs due to osmotic gradient between brain and serum that favors water entry to brain; occurs after hypertonic therapy, water intoxication, etc
A
Osmotic edema occurs due to osmotic gradient between brain and serum that favors water entry to brain; occurs after hypertonic therapy, water intoxication, etc
* Affects the gray/white matter diffusely
14
Q
A patient who is awake and has a unilateral dilated pupil may have _
A
A patient who is awake and has a unilateral dilated pupil may have compression of CN III (aneurysm) or albuterol toxicity
* Patients who have herniated are never awake and alert
15
Q
How can a tumor lead to brain herniation?
A
An expanding supratentorial mass lesion leads to displacement of CSF and then brain tissue into an adjacent intracranial compartment
16
Q
Cingulate herniation means brain tissue shifts under the _
A
Cingulate herniation means brain tissue shifts under the falx
* Also called subfalcine herniation
17
Q
Central herniation means _
A
Central herniation means downward transtentorial herniation has occured
18
Q
_ herniation is movement of brain tissue over the edge of the tentorium
A
Uncal herniation is movement of brain tissue over the edge of the tentorium
19
Q
Cerebral tonsillar herniation involves a downward shift into the _
A
Cerebral tonsillar herniation involves a downward shift into the foramen magnum
20
Q
Cingulate, transtentorial, uncal, and tonsillar herniation will lead to coma and death once the herniation produces _
A
Cingulate, transtentorial, uncal, and tonsillar herniation will lead to coma and death once the herniation produces brain stem compression
21
Q
ID the central herniation
A
22
Q
Subfalcine herniation causes compression of [vessel]
A
Subfalcine herniation causes compression of anterior cerebral artery (ACA)
* Leads to ischemia/infarction in ACA –> contralateral leg weakness
23
Q
The uncus found at the [location]
A
The uncus found at the medial temporal lobe
24
Q
A lesion that increases intracranial pressure can push the uncus on the lesion side through the _ (hole in tentorium cerebelli)
A
A lesion that increases intracranial pressure can push the uncus on the lesion side through the tentorial notch (hole in tentorium cerebelli)
25
Inside the tentorial notch is the _ ; which means it can be compressed in uncal herniation
Inside the tentorial notch is the **midbrain** ; which means it can be compressed in uncal herniation
* *Ipsilateral midbrain is affected*
* *Ipsilateral oculomotor nerve affected*
26
Uncal herniation will present with decreased consciousness due to compression of the _
Uncal herniation will present with decreased consciousness due to compression of the **midbrain reticular formation**
27
Uncal herniation presents with [pupil finding] due to compression of _
Uncal herniation presents with **ipsilateral dilated pupil** due to compression of **CN III parasympathetic fibers**
* Eye can also be down and out
28
Compression of the ipsilateral cerebral peduncle by uncal herniation can cause [manifestation]
Compression of the ipsilateral cerebral peduncle by uncal herniation can cause **contralateral hemiplegia**
29
_ are not true herniations because the patient remains awake
**Tonsillar herniation** are not true herniations because the patient remains awake; they are an exception
* Chiari I have tonsillar displacement
* Often will present with flaccidity, neck pain/stiffness
30
Central (transtentorial) herniations can occur secondary to _
Central (transtentorial) herniations can occur secondary to **parasagittal or bilateral supratentorial masses**
* *Can be a mass in the frontal, parietal, occipital lobe*
* *Causes caudal displacement of the diencephalon, midbrain, pons*
31
Uncal herniation can result from mass lesion in the _ lobe or middle fossa
Uncal herniation can result from mass lesion in the **temporal lobe** or middle fossa
32
Uncal herniation may compress [vessel]
Uncal herniation may compress the **PCA**
33
Patients with central herniations often present in coma with _ posturing
Patients with central herniations often present in coma with **decerebrate posturing**
* *Affects the midbrain and pons and ascending reticular activating system*
34
Cerebral perfusion pressure = [equation]
Cerebral perfusion pressure = **MAP - ICP**
35
What are some signs of early elevated ICP?
Early elevated ICP signs...
* Headache
* Diplopia
* Vomiting
* Lethargy
* Photophobia
* Nystagmus
* Seizure
36
Cushings triad can occur in "late" elevated ICP; it includes _ , _ , _
Cushings triad can occur in "late" elevated ICP; it includes **increased systolic BP** , **bradycardia** , **irregular respirations**
37
Kernohan's phenomenon explains why patients can get _ lesional hemiparesis
Kernohan's phenomenon explains why patients can get **ipsilesional** hemiparesis
* Lesion shifts brain towards the opposite side
* Opposide side of brain presses up against kernohan's notch and causes ipsilesional motor deficits
38
Elevated ICP can cause both ipsilesional and contralesional pupil changes; _ comes first
Elevated ICP can cause both ipsilesional and contralesional pupil changes; **ipsilesional** comes first
39
Recall that excess CSF gets reabsorbed into the venous circulation via _
Recall that excess CSF gets reabsorbed into the venous circulation via **arachnoid granulations**
40
Name 4 important cisterns (areas where the subarachnoid space enlarges)
1. **Cerebellomedullary cistern** (aka cisterna magna- largest)
2. **Quadrigeminal cistern**
3. **Pontomedullary cistern**
4. **Interpeduncular cistern**
41
ID the arrows
42
_ is the enlargement of one or more ventricles caused by obstruction of the bulk flow of CSF
**Hydrocephalus** is the enlargement of one or more ventricles caused by obstruction of the bulk flow of CSF
43
Non-communicating hydrocephalus means _
Non-communicating hydrocephalus means **the obstruction is within the ventricular system** (eg aqueductal stenosis)
44
Communicating hydrocephalus means _
Communicating hydrocephalus means **obstruction is within the subarachnoid space/arachnoid vili**
* It is a resorption issue
45
_ is ventriculomegaly that results from loss of brain tissue (brain atrophy)
**Hydrocephalus ex vacuo** is ventriculomegaly that results from loss of brain tissue (brain atrophy)
46
_ is a cause of hydrocephalus that involves hypoplasia of the vermis, cystic dilation of the fourth ventricle, and enlargement of posterior fossa
**Dandy walker malformation** is a cause of hydrocephalus that involves hypoplasia of the vermis, cystic dilation of the fourth ventricle, and enlargement of posterior fossa
47
_ can result from a congenitally malformed cerebral aqueduct or acquired stenosis; it causes hydrocephalus
**Aqueductal stenosis** can result from a congenitally malformed cerebral aqueduct or acquired stenosis; it causes hydrocephalus
48
Normal pressure hydrocephalus affects [demographic] and is defined as _
Normal pressure hydrocephalus affects the **elderly** and is defined as **only a transient increase in CSF pressure that does not actually cause increased subarachnoid space volume**
* Expansion of the ventricles distorts fibers of the *corona radiata*
* It is idiopathic
49
The manifestations of normal pressure hydrocephalus can be remembered by the mneumonic _
The manifestations of normal pressure hydrocephalus can be remembered by the mneumonic **wet, wacky, wobbly**
* Urinary incontinence
* Gait apraxia
* Cognitive dysfunction
*These symptoms can be reversed with CSF drainage via lumbar puncture or shunt*
50
TBI is defined as _
TBI is defined as **alteration in brain function or pathology caused by an external force**
* Must have traumatic mechanism and neuro deficits
* Use GCS: 15 is normal
51
First order sympathetic neurons are found in [location]
First order sympathetic neurons are found in **hypothalamus -> descending brainstem to C8-T2**
52
Second order neurons of the sympathetic system (going to eye) are found in [location]
Second order neurons are found in **exiting T1, ascending in sympathetic trunk (near lung apex/ subclavian vessels)**
53
Third order neurons of the sympathetic system are found in [location]
Third order neurons of the sympathetic system are found in **traveling to effector muscle**
* E.g to the eye it is the **long ciliary nerve**
* Travels along the internal carotid artery, through cavernous sinus to the smooth muscle of the eyelids
54
Sympathetic innervation to the pupil is carried by the (long/short) ciliary nerve
Sympathetic innervation to the pupil is carried by the **long** ciliary nerve
* *Long ciliary nerve makes pupil longer*
55
The first order neuron of the parasympathetic system (to the eye) is found in the [location]
The first order neuron of the parasympathetic system (to the eye) is found in the **ciliary ganglion**
* Travels from EW nucleus --> exits midbrain with CN III
56
The second order neuron of the PS (to the eye) is found in the [location]
The second order neuron of the PS (to the eye) is found in the **short ciliary nerve --> sphincter pupillae**
* *Short ciliary nerves shorten the pupil*
57
Diagnosis?
**Diffuse axonal injury**
Arrows point to blood
58
_ injuries occur when there is blunt force to one side of the skull followed by injury to the opposite side due to inertia of the brain
**Coup countercoup** injuries occur when there is blunt force to one side of the skull followed by injury to the opposite side due to inertia of the brain
59
Fracture at the _ can result in CSF leakage through the nose and anosmia
Fracture at the **cribiform plate** can result in CSF leakage through the nose and anosmia
60
Define seizure:
Define seizure: **transient alteration in behavior due to abnormal, synchronized, high-frequency neuronal firing**
61
_ is a chronic condition of recurrent unprovoked seizures
**Epilepsy** is a chronic condition of recurrent unprovoked seizures
62
_ is defined by a continuous seizure for > 5 minutes or multiple seizures without complete recovery of consciousness
**Status epilepticus** is defined by a continuous seizure for > 5 minutes or multiple seizures without complete recovery of consciousness
63
Etiologies of seizure:
Etiologies of seizure:
* Metabolic (eg ion channelopathies)
* Toxic (drugs)
* Withdrawal (alcohol, benzos)
* Structural abnormalities
* Tumor
* Stroke
* Infection
* Genetic
64
Define febrile seizures and most common demographic
Febrile seizures **only occur with fever** (self-limiting)
* Most common type in children
* Treat: acetaminophen
65
Petit-mal seizures are another name for _
Petit-mal seizures are another name for **Absence seizures**
66
Child who appears to be daydreaming and shows 3 Hz spike and waves on EEG most likely has [seizures]
Child who appears to be daydreaming and shows 3 Hz spike and waves on EEG most likely has **absence seizures**
67
We treat absence epilepsy with [drug]
We treat absence epilepsy with **ethosuximide**
68
Management for status epilepticus often starts with [medical management]
Management for status epilepticus often starts with **benzodiazepine**
* Lorazepam, diazepam, midazolam
69
_ are attacks that look like seizures but do not show abnormal brain activity on EEG; often caused by emotions, stress, etc
**Psychogenic non-epileptic seizures** are attacks that look like seizures but do not show abnormal brain activity on EEG; often caused by emotions, stress, etc
70
_ seizures can often present with deja vu or oflactory/gustatory/auditory hallucinations
**Focal aware** seizures can often present with deja vu or oflactory/gustatory/auditory hallucinations
71
[Seizure category] always impair consciousness and can involve myoclonic jerks or staring
**Generalized seizures** always impair consciousness and can involve myoclonic jerks or staring
72
Syncope is a transient loss of consciousness due to _
Syncope is a transient loss of consciousness due to **reduced cerebral blood flow from impaired autoregulation**
* Causes: vasovagal, orthostatic hypotension, carotid stenosis, cardiac disease
73
_ is a condition of sudden onset confusion, memory loss, and anterograde amnesia that resolves in 2 hours
**Transient global amnesia** is a condition of sudden onset confusion, memory loss, and anterograde amnesia that resolves in 2 hours
* Hippocampal dysfunction
* Person will be fully alert to self but disoriented to place
* Self-limiting; risk factors = age and migraine history
74
Name (4) broad spectrum seizure drugs
Name (4) broad spectrum seizure drugs
1. **Valproate**
2. **Lamotrigine**
3. **Levetiracetam**
4. **Topiramate**
75
Many anti-seizure drugs like [list drugs] work by blocking VG Na+ channels and thus decreasing glutamate release at the presynaptic membrane
Many anti-seizure drugs like **valproate, topiramate, lamotrigine, carbamazepine, phenytoin, fosphenytoin** work by blocking VG Na+ channels and thus decreasing glutamate release at the presynaptic membrane
76
Gabapentin also inhibits glutamate release at the presynaptic membrane; however it does this via _
Gabapentin also inhibits glutamate release at the presynaptic membrane; however it does this via **inhibiting Ca2+ channel**
* *Specifically L-type channels*
* Note that valproate can also do this somewhat
77
Levetiracetam work by [mechanism], decreasing glutamate release from pre-synaptic membrane
Levetiracetam work by **inhibiting SV2A**, decreasing glutamate release from pre-synaptic membrane
78
Gabapentin affects (glutamate/GABA) signaling
Gabapentin affects **glutamate** signaling
* Blocks Ca2+ channels, inhibiting glutamate release
* It is named because of structural resemblence of GABA
79
Phenytoin _ CYP450
Phenytoin **induces** CYP450
* Thus speeding up metabolism of drugs, making them less effective
80
_ is an anti-seizure medication that causes gingival hyperplasia
**Phenytoin** is an anti-seizure medication that causes gingival hyperplasia
81
IV phenytoin should not be used because of _ syndrome
IV phenytoin should not be used because of **purple glove syndrome**
* *Instead use IV fosphenytoin for status epilepticus*
82
Phenytoin exhibits _ clearance kinetics
Phenytoin exhibits **dose-dependent** clearance kinetics
* At a high dose, phenytoin time of clearance is proportional to the dose so dose loading can be very dangerous
83
[anti-seizure drug] needs to be carefully monitored at high doses due to zero order clearance kinetics
**Phenytoin** needs to be carefully monitored at high doses due to zero order clearance kinetics
84
Phenytoin and _ are two seizure medications that induce CYP450
Phenytoin and **carbamazepine** are two seizure medications that induce CYP450
85
_ is a seizure medication that inhibits CYP450
**Valproate** is a seizure medication that inhibits CYP450
86
_ and _ are two seizure drugs that inhibit post-synaptic glutamate signaling
**Topiramate** and **Ethosuximide** are two seizure drugs that inhibit post-synaptic glutamate signaling
87
Ethosuximide works by [MoA]
Ethosuximide works by **blocking T-type Ca2+ channels**
* On the post-synaptic membrane
88
Topiramate works by [MoA] *at the post-synaptic membrane*
Topiramate works by **blocking ligand-gated Na+ channel (AMPA)** *at the post-synaptic membrane*
* Recall that at the pre-synaptic membrane it blocks VG Na+ channels
89
_ and _ are two seizure drugs that act as presynaptic potentiators of GABA release
**Vigabatrin** and **Tiagabine** are two seizure drugs that act as presynaptic potentiators of GABA release
* *Valproate also does this somewhat*
90
_ blocks the GABA reuptake channel, GAT-1
**Tiagabine** blocks the GABA reuptake channel, GAT-1
91
_ blocks GABA breakdown by GABA transaminase
**Vigabatrin** blocks GABA breakdown by GABA transaminase
92
The actual mechanism by which GABA is inhibitory is by _
The actual mechanism by which GABA is inhibitory is by **Increasing Cl- influx and inducing post-synaptic hyperpolarization**
93
Benzos and Barbiturates potentiate GABA action at the _ synaptic membrane
Benzos and Barbiturates potentiate GABA action at the **post-synaptic** membrane
94
[Seizure drug] has a black box warning for causing hypotension and arrhythmias with rapid infusion
**Phenytoin** has a black box warning for causing hypotension and arrhythmias with rapid infusion
95
[Seizure drug] has a black box warning for causing dyscrasias (aplastic anemia and agranulocytosis)
**Carbamazepine** has a black box warning for causing dyscrasias (aplastic anemia and agranulocytosis)
96
[Seizure drug] has black box warning for causing SJS
**Lamotrigine** has black box warning for causing SJS
97
[Seizure drug] has black box warning for causing permanent vision loss
**Vigabatrin** has black box warning for causing permanent vision loss
* "Very bad vision"
98
[Seizure drug] has black box warning for hepatotoxicity, pancreatitis, spina bifida
**Valproate** has black box warning for hepatotoxicity, pancreatitis, spina bifida
