Raised ICP Pathology

Question 1

What is normal ICP?

Answer 1

5-13mmHg

Question 2

What is normal number of lymphocytes in CSF?

Answer 2

<4 cells/ml

Question 3

What is the normal protein in CSF?

Answer 3

<0.4g/l

Question 4

What is normal glucose in the CSF

Answer 4

> 2.2mmol/l

Question 5

What are hte causes of hydrocephalus?

Answer 5

obstruction of CSF eg inflammation, pus and tumours; decreased resoption of CSF- post SAH or meningitis; overproduction of CSF- rare- tumours of choroid plexus

Question 6

How is hydrocephalus classified?

Answer 6

non-communicating adn communicating hydrocephalus

Question 7

What is non-communicating hydrocephalus?

Answer 7

obstruction to flow of CSF occurs within ventricular system

Question 8

What is communicating hydrocephalus?

Answer 8

obstruction to flow of CSF outside of ventricular system eg in subarachnoid space or arachnoid granulations

Question 9

What happens to the brain with hydrocephalus?

Answer 9

expansion of hte ventricles; flattening of the dyrae; fullness of the sulci and riased ICP

Question 10

What is hydrocephalus ex vacuo?

Answer 10

dilation of the ventricular system and a compensatory increase in CSF volume secondary to loss of brain parenchyma

Question 11

What is a subfalcine hernation?

Answer 11

unilateral or asymmetric expansion of cerebral hemisphere displaces the cingulate gyrus under the falx cerebri

Question 12

What happens in a tentorial hernation?

Answer 12

medial aspect of temporal lobe (hippocampus) herniates over the tentorium cerebelli

Question 13

What is tonsillar herniation?

Answer 13

displacement of cerebellar tonsila through the foramen magnum

Question 14

What is the consequences of tonsillar hernation?

Answer 14

brainstem compression and vital respiratory centresi nthe medulla

Question 15

What is a consequence of tentorial herniation?

Answer 15

compression ipsilateral CNIII and its parasympathetic fibres

Question 16

What is a consequence of subfalcine hernation?

Answer 16

compression of the anterior cerebral artery and weakness and /or sensory loss in leg

Question 17

What are the features of an ICP induced headache?

Answer 17

worse on lying down; coughing; sneezing and straining

Question 18

Where do tumours o the brain in children arise?

Answer 18

mostly below the tentorium cerebelli

Question 19

Where do CNS tumours in adults tend to arise?

Answer 19

above the tentorium cerebelli

Question 20

What are hte most common origins of brain metastates?

Answer 20

breast; bronchus; kidney; thryoid; colon and melanoma

Question 21

What is the most common priamry malignant intracranial tumour in adults and children?

Answer 21

astrocytoma

Question 22

what is the second most common malignant primary intracranila tumour in children?

Answer 22

medulloblastoma

Question 23

hwat is the most common primary benign intracranial tumour in adults?

Answer 23

meningioma

Question 24

What is the most common benign intracranial tumour in children?

Answer 24

craniophayrngioma

Question 25

What type of astrocytoma do only children get?

Answer 25

grade 1 pilocytic astroctyoma

Question 26

What do tumour cells relase that leads to neoangiogenesis?

Answer 26

VEFG secretion

Question 27

Where are medulloblastomas found?

Answer 27

midline of the cerebellum

Question 28

What is the treatment for medulloblastoma

Answer 28

is very radiosensitive- radiotherpay

Question 29

What do medulloblastomas look like histopathologically?

Answer 29

undifferentiated embryonic/fetal cells

Question 30

What tends to cause single abscesses?

Answer 30

local extension or direct implantation- tend to occur adjacent to source

Question 31

what causes multiple brain abscesses?

Answer 31

haematogenous spread

Question 32

Where can abscesses locally ectend from?

Answer 32

chronic otitis media; mastoiditis; paranasla sinusitis

Question 33

How does e.coli appear on gram stain?

Answer 33

gram ive rods

Question 34

How does h.influenzae appear on gram stain?

Answer 34

gram negative cocco-baciili

Question 35

How does neisterria meningitides appear on gram stain?

Answer 35

gram negative diplococci

Question 36

How does strep. pneumoniae appear on gram stain?

Answer 36

gram +ve cocci in chains

Question 37

How does listeria monocytogenes appear on gram stain?

Answer 37

gram +ve rods

Question 38

What happens with high veolcity head injury?

Answer 38

cavitation occurs- small bubbles appearing at low pressure

Question 39

How are non-missile injuries caused?

Answer 39

sudden acceleration and/or deceleration

Question 40

What are primary injuries to the brain?

Answer 40

shear injury to axons and contusions due to compressive strain, cavitation or surface lacerations of brain parenchyma

Question 41

What is a linear skull #?

Answer 41

striaght sharp # line, that may cross sutures(diastatic #)

Question 42

WHat is a compound skull #?

Answer 42

associated with full thickness scalp lacs

Question 43

What does a linear # increase the chance of?

Answer 43

a haematoma being present

Question 44

What are coup and contracoup injuries?

Answer 44

coup injury occurs at point of impact whereas contracoup occur diametrically opposite the point of impact

Question 45

Are coup or contracoup injuries usually worse?

Answer 45

contracoup

Question 46

What is the most importnant type of brain damage due to blunt injury?

Answer 46

diffuse axonal injury

Question 47

what is diffuse axonal injury?

Answer 47

widespread disruption of axons due to shear strains tearing axons at the immediate time of acceleration/deceleration

Question 48

Wher does diffuse axonal injury most commonly happen?

Answer 48

in central structures due to cerebral hemispheres moving a different rates relative to each other when exposed to forces

Question 49

Waht is the pathological hallmark of diffuse axonal injury?

Answer 49

axonal bulbing and blebbing of the truncated axons

Question 50

What is a burst lobe?

Answer 50

a gross contusion that involves disruption of much of the frontal and temporal lobes and is associated iwth a significant degree of haemorrhage

Question 51

Why are the elderly more at risk of subdural haemorrhage?

Answer 51

age related strophy of hte brain puts more pressure on the briding veins and brain is more mobile in cranium meaning higher chance of rupture of one of these bridging veins

Question 52

What are the chronic subdural haemorrhages composed of?

Answer 52

liquefied blood/yellow-tinged fluid separated from inner surface of dura mater and underlying brain by a neomembrane (granulation tissue and mature collagen)