NEURO 2: CEREBROVASCULAR DISEASE, CNS INFECTION, ICP, HYDROCEPHALUS

Question 1

What causes cerebral aneurysm?

Answer 1

Congenital lesion in the medial layer of a cerebral blood vessel causes weakness and ballooning of the vessel

Question 2

What is the term for the feeling of stiff neck before rupture of a cerebral aneurysm, and what causes it?

Answer 2

Menigismus: irritation of the meninges due to blood leaking into the CSF

Question 3

What are 3 consequences of rupture of cerebral aneurysm?

Answer 3

1. Increased intracranial pressure
2. Vasospasm
3. Hydrocephalus

Question 4

What is the term for a procedure to treat cerebral aneurysm by threading a wire into the area of outpouching, which acts as a thrombogenic?

Answer 4

Endovascular coiling

Question 5

What is the term for a procedure where a clip is placed to cut off the cerebral aneurysm from blood supply?

Answer 5

Aneurysm clipping

Question 6

What are 2 ways to manage vasospasm after cerebral aneurysm rupture?

Answer 6

1. IV fluids to maintain blood volume
2. Calcium channel blockers

Question 7

Why are analgesics, laxatives, antitussives, and antiemetics used in management of patients with cerebral aneurysm?

Answer 7

Important to prevent straining or coughing to avoid rupture

Question 8

Why does aryteriovenous malformation cause enlargement of veins?

Answer 8

Lack of capillary bed, so blood flows directly from arteries (high pressure) to veins (weaker vessels)

Question 9

What are 3 consequences of AVM?

Answer 9

1. Rupture
2. Compression to surrounding tissue
3. Vascular steal

Question 10

What is the term for an audible whooshing noise heard with stethoscope placed against the head in some cases of AVM?

Answer 10

Bruit

Question 11

What is the term for a procedure where a catheter is threaded into the AVM so a substance can be injected to seal it off from blood supply?

Answer 11

Endovascular embolization

Question 12

What are 2 other ways AVM can be treated?

Answer 12

Surgical excision and irradiation

Question 13

Which pathogen is the most common cause of meningitis, and where does is usually reside in humans?

Answer 13

Streptococcus pneumoniae

Normal inhabitant of nasopharynx

Question 14

What are 3 potential causes for bacterial meningitis?

Answer 14

1. Blood infection
2. Neurosurgery
3. Head trauma

Question 15

What are 2 areas of the blood brain barrier that are considered “weak?”

Answer 15

Choroid plexus
Circumventricular organs

Question 16

In infants with bacterial meningitis, what is the term for reflex flexion of the hips when the neck is forcibly flexed?

Answer 16

Brudzinski neck sign

Question 17

In infants with bacterial meningitis, what is the term for the inability to straighten the leg when the hip is flexed 90 degrees?

Answer 17

Kernig sign

Question 18

What characteristics of CSF taken by a lumbar puncture would indicate bacterial meningitis?

Answer 18

1. Increased protein and WBCs
2. Decreased glucose
3. Culture & sensitivity grows pathogen

Question 19

What 3 characteristics of CSF taken by a lumbar puncture would indicate bacterial meningitis?

Answer 19

1. Increased protein and WBCs
2. Decreased glucose
3. Presence of pathogen on culture & sensitivity

Question 20

Which viruses most commonly cause encephalitis?

Answer 20

Herpes simplex virus, West Nile virus

Question 21

Where does herpes simplex virus normally lay dormant in people who had previous infection?

Answer 21

Trigeminal ganglion

Question 22

What ocular change is associated with increased intracranial pressure, and why?

Answer 22

Blurred vision, caused by edema of the optic disc (papilledema)

Question 23

How is ICP monitored in hospital?

Answer 23

Intraventricular catheter

Question 23

What are 3 surgical procedures used to treat increased intracranial pressure depending on the cause?

Answer 23

1. Lesion removal
2. Shunt insertion
3. Decompressive craniectomy

Question 24

What are 4 medical treatments used to treat intracranial pressure depending on the cause?

Answer 24

1. Hyperventilation to induce vasoconstriction
2. Hypertonic fluid infusion
3. Barbiturate-induced coma
4. Head-up and neutral body positions

Question 25

What are 3 kinds of hydrocephalus, and how do they differ?

Answer 25

1. Obstructive (non-communicating): block of CSF flow between ventricles
2. Non-obstructive (communicating): impaired CSF flow outside ventricles, but flow between ventricles remains open
3. Normal pressure: increased CSF volume causes loss of brain tissue

Question 26

Which type of hydrocephalus is most common in children?

Answer 26

Obstructive (non-communicating) hydrocephalus

Question 27

Which type of hydrocephalus is most common in older adults?

Answer 27

Normal pressure hydrocephalus

Question 28

What is the triad of early symptoms that could indicate normal pressure hydrocephalus?

Answer 28

1. Gait instability
2. Urinary incontinence
3. Cognitive impairment

Question 29

What is the term for a procedure where CSF is drained into the peritoneal cavity?

Answer 29

Ventriculoperitoneal shunt

Question 30

What is the term for a procedure where CSF is drained from the third ventricle into the basal cisterns?

Answer 30

Endoscopic third ventriculostomy