stroke

Question 1

what factors are involved I maintaining cerebral perfusion pressure

Answer 1

pH and O2 drop and CO2 raise = vasodilation; opposite vasoconstriction in high CPP

Question 2

define CPP

Answer 2

net pressure gradient causing cerebral blood flow to the brain i.e. mean arterial p - intracranial pressure

Question 3

define stroke

Answer 3

clinical syndrome of abrupt loss of focal brain function lasting over 24 hours (or causing death) that is due to either spontaneous haemorrhage into brain substance or inadequate blood supply to a part of the brain.

Question 4

what are the differences between to types of stroke

Answer 4

ischaemic (occlusion, more common), haemorrhagic (raptured cerebral blood vessels)

Question 5

what are possible causes for haemorrhaging stroke

Answer 5

primary: no structural lesions, secondary: structural lesions i.e. tumour; hypertension, malformations, aneurisms

Question 6

define TIA

Answer 6

Sudden onset, focal disturbance of brain function (occasionally global)

Question 7

What are the characteristics of TACS

Answer 7

ICA/MCA occlusion => contralateral hemiparesis and hemiopia, higher cerebral disfunction => high mortality

Question 8

What are the characteristics of PACS

Answer 8

MCA=> 2/3 of TACS and restricted motor deficit i.e. face or leg or arm only Or isolated cortical signs => high recurrence

Question 9

What are the characteristics of LACS (lacunar)

Answer 9

single perforating artery affected with symptoms related to tissue death => underdiagnosed and silent

Question 10

What are the characteristics of POCS

Answer 10

brainstem, cerebellar or occipital involvement=> with complex presentation

Question 11

what does fast stands for

Answer 11

F=>face weakness, A=>arm weakness; S=> slurred speech, Time => rapid treatment required

Question 12

What are the symptoms of stroke

Answer 12

“o Suggesting bleeding – Headache, Seizure
o Suggesting raised ICP – Heading, vomiting, drowsiness
o Suggesting aetiology – Cardiac symptoms
-ve symptoms”

Question 13

what are the risk factors for stroke

Answer 13

smoking, family history, personal history, diabetes, hypertension AF, hypercholesteraemia, heavy drinking and poor diet

Question 14

What are common differentials for stroke

Answer 14

hypoglycaemia, TIA, epilepsy, space occupying lesion, MS

Question 15

how effective is CT in diagnosis of stroke

Answer 15

good for haemorrhagic , may no show early ischaemic changes or only settle once

Question 16

how effective is MRI in stroke detection

Answer 16

changes seen much earlier on than CT but may not be available i.e. not routinely used

Question 17

what is normal intracranial pressure what does it raise to with coughing

Answer 17

0-10 and 20 mmHg …60 may prevent blood flow to the brain

Question 18

what are common causes of RICP

Answer 18

tumour, haemorrhage, meningitis, cerebral infarct, space occupying lesion

Question 19

what are the 3 areas scriptable to compression with RICP

Answer 19

“o The Cingulate Gyrus
o The Uncus
o The Cerebellar Tonsils
“

Question 20

What are the symptoms of RICP why do they change over time

Answer 20

early morning headache and nausea=> compensated

Question 21

what are the steps of herniation

Answer 21

hemispheres squeezed through tentorium => brainstem compression=> bottom cerebellum squeezed into foramen magnum=> further compression of brainstem => suppressed blood supply to the brainstem and its death

Question 22

what are the signs of RICP

Answer 22

local signs => reduced consciousness=> coma=> death

Question 23

what is a possible complication of temporal bone infection, what are the symptoms

Answer 23

“temporal cerebral abscess.

“

Question 24

what are the symptoms of meningitis

Answer 24

a severe headache, neck stiffness, aversion to bright lights, non-blanching

Question 25

what tissue is inflamed in meningitis

Answer 25

pia and arachnoid

Question 26

what is a common cause in neonates, 2-5 and 5-30

Answer 26

neonates => E.coli or L. monocytogenes; 2-5=> H. Influenza B; 5-39 N. Meningitidis and S pneumoniae

Question 27

What are the characteristics of chronic meningitis

Answer 27

granulomatis inflammation of meningeal fibres leading to entrapment of cranial nerves. Cause by M. Tuberculosis or cryptococcal meningitis

Question 28

what are common complication of meningitis

Answer 28

death, cerebral infarction, cerebral abscess, subdural empyema

Question 29

What is encephalitis

Answer 29

infection of brain tissue usually viral

Question 30

what are common viruses that cause encephalitis and where in the CNS

Answer 30

polio=> spinal cord, Harpies simplex => temporal lobe, rubella=> brain stem;

Question 31

what are the actions of cytomegalovirus and toxoplasmosis on nerves

Answer 31

takes over cell body machinery and eventually leads to cell death

Question 32

what type of organism is toxoplasmosis

Answer 32

protozoa

Question 33

what is the pathological process sin Alzheimer's and what are the macroscopical changes

Answer 33

beta-amyloid deposition leads to neuronal death and shrinkage of the cortex

Question 34

What are the common changes in Alzheimer's disease

Answer 34

memory impairment, language impairment agnosia

Question 35

what are the risk factors for Alzheimer's

Answer 35

family history, some anti-inflammatory drugs, down's

Question 36

What type of dementia is PD what is the pathology

Answer 36

Lewy body dementia => accumulation of alpha-synuclein

Question 37

what are the changes in subfalcine herniations

Answer 37

subflacine=> compression of blood flow through ACA=> disturbances of frontal, parietal and corpus callosum and cingulate gyrus pushed under the falx cerebri

Question 38

what are the changes in uncial herniations

Answer 38

CN3 damage, secondary haemorrhage into the brainstem, occlusion of PCA (common death in tumour)

Question 39

what are the changes in tonsillar herniations

Answer 39

cerebellar tonsils push into jugular foramen and compress the rasp centre of the brainstem

Question 40

what are the two types of damage seen with head injury

Answer 40

focal bruising=> coup and contrecoup and diffused axonal injury due to tearing of axons

Question 41

what is the location of subarachnoid haemorrhage

Answer 41

between arachnoid and pia

Question 42

what is the location of subdural haemorrhage

Answer 42

between dura and arachnoid

Question 43

what is the location of extradural haemorrhage

Answer 43

between dura and bone

Question 44

what are the different bleeding vessels in intracranial haemorrhage

Answer 44

extradural => middle meningeal a; subdural=> bridging veins,

Question 45

what is the appearance of extradural haemorrhage on CT and why

Answer 45

lens shape pilling of the dura

Question 46

who is more susceptible to subdural haemorrhage

Answer 46

elderly and alcoholics due to brain shrinkage

Question 47

what is Berry aneurism and why does it occur

Answer 47

aneurism at the junctions of circle of wellies; often due to congenitale defects of blood vessels or cystic kidney disease

Question 48

What are the symptoms of subarachnoid haemorrhage

Answer 48

Sudden, severe Thunderclap headache