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Clinical Neuroscience > The Meninges + Subarachnoid Haemorrhage > Flashcards

The Meninges + Subarachnoid Haemorrhage Flashcards

1
Q

What are the meninges?

A

Periosteal dura mater
Meningeal dura mater
Arachnoid mater
Pia mater

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2
Q

What are the 4 important dural septa?
What do they separate?

A
  • Falx cerebri: between cerebral hemispheres
  • Falx cerebelli: between cerebellar hemispheres
  • Tentorium cerebelli: between occipital lobe + cerebellum
  • Diaphrgama sella: by sella turcica
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3
Q

What is CSF flow propelled by?

A
  • production of new fluid
  • ciliary action of ventricular ependymal
  • vascular pulsations
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4
Q

Epidemiology of subarachnoid haemorrhage

A
  • female > male
  • 50-55 year olds
  • more likely in black, Finnish + Japanese population
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5
Q

Presentation of subarachnoid haemorrhage

A
  • thunder clap headache
  • dizziness
  • orbital pain
  • double vision/visual loss (PComA can compress CN III)
  • signs of meningism: photophobia, neck stiffness
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6
Q

Risk factors for subarachnoid haemorrhage

A
  • hypertension
  • smoking
  • excessive alcohol consumption
  • family history of aneurysms
  • cocaine use
  • trauma
  • chronic kidney disease, Marfan’s syndrome, neurofibromatosis
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7
Q

Pathophysiology of subarachnoid haemorrhage

A
  • often due to rupture of aneurysm in circle of Willis
  • commonly berry aneurysms
  • often in anterior or posterior communicating artery, or bifurcation of middle cerebral artery
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8
Q

What type of aneurysm most commonly causes subarachnoid haemorrhage and common locations?

A
  • berry aneurysm
  • anterior or posterior communicating artery or bifurcation of middle cerebral artery
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9
Q

What can a subarachnoid haemorrhage cause?

A
  • microthrombi + vasoconstriction > cerebral ischaemia
  • cerebral oedema
  • apoptosis of brain cells
  • cardiac failure - due to sympathetic response
  • acute hydrocephalus due to blockage of CSF drainage by blood
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10
Q

Investigations of subarachnoid haemorrhage

A
  • CT head
  • CT angiogram to find location
  • lumbar puncture after 12 hours
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11
Q

Lumbar puncture findings in subarachnoid haemorrhage

A
  • increased opening pressure
  • frank blood or xanthochromia
  • high protein
  • high red cell count
  • normal white cells + glucose
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12
Q

What is xanthochromia?

A

Yellow colouring of CSF due to bilirubin in subarachnoid space

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13
Q

Treatment of subarachnoid haemorrhage

A
  • airway support
  • fluids
  • monitor cardiovascular parameters
  • calcium channel blockers e.g. nimodipine
  • coiling
  • clipping
  • craniectomy - decompressive surgery
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14
Q

What is clipping treatment of subarachnoid haemorrhage?

A

Placement of spring clip around neck of aneurysm causing it to lose blood supply + shrivel up

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15
Q

What is coiling treatment of subarachnoid haemorrhage?

A

Insertion of platinum wire into aneurysm sac > thrombosis of blood within aneurysm

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16
Q

Why are calcium channel blockers given in treatment of subarachnoid haemorrhage?
Example

A

Prevent cerebral vasospasm due to sympathetic activation
nimodipine

17
Q

Categories of CNS infections

A
  • encephalitis: infections of parenchyma
  • meningitis: infections of meninges
18
Q

What is the triad of meningism?

A

Headache
Neck stiffness
Photophobia

19
Q

Presentation of meningitis

A
  • triad of meningism with fever
  • joint pain
  • meningococcal non blanching rash
  • reduced GCS
  • flu like symptoms
20
Q

Presentation for babies in meningitis

A
  • listen to parents
  • inconsolable crying/high pitched
  • reduced feeds
  • floppy
  • bulging fontanelle
21
Q

What commonly causes meningitis rash?

A

Meningococcal meningitis

22
Q

Describe meningeal rash

A

Non balancing
Often on trunk, legs, mucous membranes, conjunctivae

23
Q

What is meningitis commonly due to in neonates?

A

E. coli
Group B streptococcus
Listeria monocytogenes

24
Q

What is meningitis commonly due to in children?

A

Haemophilias influenzae type B
Neisseria meningitidis

25
Q

What is meningitis commonly due to in eldery?

A

Streptococcus pneumoniae
Listeria monocytogenes

26
Q

Risk factors of meningitis

A
  • CSF defects e.g. spina bifida
  • spinal procedures e.g. surgery, lumbar puncture
  • diabetes
  • alcoholism
  • endocarditis
  • splenectomy
  • crowded housing
27
Q

Pathophysiology of meningitis

A
  • nasal commensals enter circulation > bacteraemia
  • damages vessel walls in brain + meninges
  • allowing pathogens to enter subarachnoid space
  • pathogen multiply rapidly > purulent CSF + meningeal inflammation
  • cerebral oedema + raised ICP
28
Q

Complications of meningitis

A
  • septic shock
  • disseminated intravascular coagulation
  • coma
  • seizures
  • hearing loss
  • hydrocephalus
  • focal paralysis
29
Q

What is Kernig sign?

A
  • supine patient with thigh flexed at 90°
  • extension of knee met with resistance
30
Q

What is Brudzinki’s neck sign?

A

When neck is flexed there is involuntary flexion of knees and hips

31
Q

What are two tests signs of meningitis?

A

Kernig sign
Brudzinski

32
Q

Investigations of meningitis

A
  • lumbar puncture
  • bloods (sepsis screen + PCCR)
  • head CT if raised ICP
33
Q

What signs would delay a lumbar puncture?

A

Decreasing consciousness
Brainstem signs
Recent seizure

34
Q

Lumbar puncture findings of bacterial meningitis

A
  • cloudy CSF
  • high protein
  • high white cells (especially neutrophils)
  • low glucose (bacteria metabolise it)
35
Q

Lumbar puncture findings of viral meningitis

A
  • clear or cloudy
  • protein level normal or raised
  • high white cells (especially lymphocytes)
  • normal glucose
36
Q

Treatment of meningitis

A
  • analgesia
  • antipyretics
  • fluids
  • IV ceftriaxone
  • dexamethasone
  • aciclovir if viral
37
Q

Why is dexamethasone given in treatment of meningitis?

A

To prevent hearing loss

38
Q

What does the presence of xanthochromia in CSF suggest?

A

Subarachnoid haemorrhage occurred >12 hours ago

Clinical Neuroscience (20 decks)

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