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4th year > neurology > Flashcards

neurology Flashcards

1
Q

What is an extradural haematoma?

A

Bleeding between the dura mater and skull

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2
Q

What is a subdural haematoma?

A

Bleeding into the outermost meningeal layer

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3
Q

What is a subarachnoid haemorrhage?

A

Bleeding in the subarachnoid space

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4
Q

What is an intracerebral haemorrhage (interparenchymal)?

A

Collection of blood within the substance of the brain

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5
Q

What are contusion brain injuries?

A

Small haemorrhages near the skull in the area of coupe and contra-coupe

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6
Q

What is diffuse axonal injury?

A

Diffuse shearing of axonal tracts of white matter

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7
Q

What mechanism of injuries are most likely to cause an extradural haematoma?

A

Acceleration-deceleration trauma
Blow to side of head

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8
Q

What is the most common area of the brain for extradural haematomas to occur, and which vessel is likely to rupture?

A

Temporal region - skull fractures cause rupture of middle meningeal artery

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9
Q

Which intracranial bleed is the following history typical of: young patient with traumatic head injury and ongoing headache has period of improved neurological symptoms and consciousness, followed by rapid decline over hours

A

Extradural haematoma

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10
Q

Which vessel usually ruptures to cause a subdural haematoma?

A

Bridging veins

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11
Q

What are risk factors for subdural haematoma?

A

Old age
Alcoholism
Anticoagulation

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12
Q

Which intracranial bleed can be either acute or chronic?

A

Subdural haematoma

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13
Q

What are the features of acute and chronic subdural haematomas?

A

Acute - fresh blood, commonly caused by high-impact trauma, may be fluctuating consciousness
Chronic - collection of blood for weeks-months, long history of progressive confusion, reduced consciousness or neurological deficit

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14
Q

What is the most common cause of subarachnoid haemorrhages?

A

Spontaneous rupture of cerebral (berry) aneurysm

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15
Q

What are the causes/risk factors of intracerebral haematoma

A

Hypertension
Vascular lesion (aneurism, arteriovenous malformation)
Cerebral amyloid angiopathy
Trauma
Brain tumour
Infarct (often stroke patients undergoing thrombolysis)

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16
Q

What is the presentation of an intracerebral haematoma?

A

Similar to an ischaemic stroke
Decrease in consciousness

17
Q

What complication of intracerebral haematoma can develop later?

A

Hydrocephalus

18
Q

What is an important complication of subarachnoid haemorrhage presenting with fever, headache, nausea and vomiting, muscle cramps, muscle weakness and confusion?

A

Hyponatraemia caused by SIADH

19
Q

When does secondary brain injury occur in an intracranial bleed?

A

When cerebral oedema, ischaemia, infection, tonsillar or tectorial herniation exacerbates the original injury

20
Q

What is the Cushing’s reflex in intracranial bleeds?

A

Hypertension and bradycardia - occurs late and is usually a pre-terminal event

21
Q

What does unilaterally dilated pupils with a sluggish or fixed light response indicate in head trauma?

A

CN III compression secondary to tectorial (uncal) herniation

22
Q

What does bilaterally dilated pupils with a sluggish or fixed light response indicate in head trauma?

A

Poor CNS perfusion
Bilateral CN III palsy

23
Q

What does unilaterally dilated or equal pupils with an RAPD indicate in head trauma?

A

Unilateral optic nerve dysfunction or retinal dysfunction

24
Q

What does bilaterally constricted pupils indicate in head trauma?

A

Opiates
Pontine lesions
Metabolic encephalopathy

25
Q

What does unilaterally constricted pupils with a preserved light response indicate in head trauma?

A

Sympathetic pathway disruption

26
Q

What is the classification for GCS?

A

Eyes
- No response - 1
- Open to pain - 2
- Open to voice - 3
- Spontaneous - 4
Verbal response
- None - 1
- Incomprehensible sounds - 2
- Inappropriate words - 3
- Confused - 4
- Orientated - 5
Motor response
- None - 1
- Extends - 2
- Abnormal flexion - 3
- Normal flexion - 4
- Localises pain - 5
- Obeys commands - 6

27
Q

What are the NICE indications for a non-contrast CT within 1 hour following head trauma?

A

GCS <13 on initial assessment
GCS <15 at 2 hours post-injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture - haemotympanum (blood in the middle ear), ‘panda’ eyes, CSF leakage from the ear or nose, Battle’s sign
Post traumatic seizure
Focal neurological deficit
More than one episode of vomiting

28
Q

What are the NICE indications for a non-contrast CT within 8 hour following head trauma?

A

Any patient on warfarin
Adults with the following who have lost consciousness or experienced amnesia following injury:
- Bleeding or clotting disorders, anticoagulants
- Age 65 or older
- More than 30 minutes retrograde amnesia of events before the head injury

29
Q

What intracranial bleed causes a hyperdense area that is biconvex and limited by cranial sutures?

A

Extradural haematoma

30
Q

What intracranial bleed causes a HYPERdense area that is crescent shaped and NOT limited by cranial sutures?

A

Acute subdural haematoma

31
Q

What intracranial bleed causes a HYPOdense area that is crescent shaped and NOT limited by cranial sutures?

A

Chronic subdural haematoma

32
Q

What intracranial bleed causes a hyperdense area within the substance of the brain?

A

Subarachnoid haemorrhage

33
Q

When is IV mannitol used in management of intracranial bleeds?

A

Where there is life-threatening rising ICP, such as in extradural haematoma
While theatre is prepared or transfer arranged

34
Q

When might decompressive craniotomy be used in management of intracranial bleeds?

A

Diffuse cerebral oedema

35
Q

When might exploratory Burr holes be used in management of intracranial bleeds?

A

Not much - except where scanning may be unavailable to facilitate creation of formal craniotomy flap

36
Q

When might surgical reduction and debridement be used in management of intracranial bleeds?

A

For depressed skull fractures that are open

37
Q

How might closed skull fractures with minimal displacement be managed?

A

Non-operatively - close monitoring and repeat imaging

38
Q

When is ICP monitoring done?

A

Appropriate for GCS 3-8 and normal CT scan
Mandatory for GCS 3-8 and abnormal CT scan

39
Q
A

4th year (5 decks)

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