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Neurosurgery Resource > Trauma and CSF > Flashcards

Trauma and CSF Flashcards

1
Q

What is the Glasgow coma scale used to assess?

A

Level of consciousness in response to defined stimuli

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2
Q

What three domains are tested in GCS?

A

Eye opening
Verbal response
Motor response

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3
Q

What occurs in decorticate posturing?

A

Severe brain damage causes the patient to present with abnormal arm flexion, leg extension and feet turned inward

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4
Q

What occurs in decerebrate posturing?

A

Patient presents with head arched back and both arms and legs extended

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5
Q

Where is CSF produced?

A

Choroid plexus in ventricles

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6
Q

CSF flows from the lateral ventricles to third ventricle via what structure?

A

Foramen of Monro

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7
Q

CSF flows through what structure to reach the fourth ventricle from the third ventricle?

A

Aqueduct of Sylvius

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8
Q

CSF circulates from the fourth ventricle to what?

A

Subarachnoid space

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9
Q

What structures absorb CSF into venous blood?

A

Arachnoid granulations

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10
Q

What are the three main intracranial components?

A

Brain tissue
CSF
Blood

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11
Q

Give some causes of raised intracranial pressure

A

Space occupying lesions
Cerebral oedema
CSF obstruction
Idiopathic intracranial hypertension

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12
Q

Give some clinical features of raised intracranial pressure

A 
Headache 
N + V
Papilloedema
Drowsiness
Cushing's triad
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13
Q

What occurs in an uncal herniation?

A

The medial temporal lobe herniates through the tentorium

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14
Q

What is the first symptom of uncal herniation?

A

Pupillary dilatation

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15
Q

What occurs in subfalcine herniation?

A

The cingulate gyrus herniates below the falx cerebri

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16
Q

What is the main symptom of subfalcine herniation?

A

Weakness of lower extremities

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17
Q

What occurs in tonsilar herniation?

A

Displacement of cerebellar tonsils into foramen magnum

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18
Q

Give some clinical features of tonsilar herniation

A

Neck stiffness
Abnormal neck posture
Respiratory anomaly

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19
Q

Central herniation of the brain stem can cause what symptom?

A

Diplopia due to CN VI palsy

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20
Q

What are the three layers of meninges?

A

Dura mater
Arachnoid mater
Pia mater

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21
Q

What is located between the periosteal and meningeal layer of dura?

A

Dural venous sinuses

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22
Q

What is the space underneath the arachnoid mater called and what does it contain?

A

Subarachnoid space - contains CSF

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23
Q

Where does blood accumulate in an extradural haematoma?

A

Between dura and bone

24
Q

Where is the commonest source of bleeding in an EDH?

A

Middle meningeal artery

25
EDH patients have classically experienced what?
Closed head trauma
26
Give some symptoms of extradural haematoma
Brief loss of consciousness Headache Vomiting Contralateral hemiparesis
27
What is the imaging modality of choice in head trauma patients?
CT scan
28
How are EDHs managed?
Immediate neurosurgical evacuation
29
Where does blood accumulate in subdural haematoma?
Between dura and arachnoid layers
30
What is the main cause of acute SDH?
Head trauma
31
What occurs in acute SDH?
The bridging veins are ruptured due to head trauma
32
What is the main cause of chronic SDH?
Brain atrophy
33
What occurs in chronic SDH?
Bridging veins become stretched and can rupture resulting in blood accumulating in the subdural space
34
How do patients with acute SDH present?
Severely decreased state of consciousness
35
How do patients with chronic SDH present?
``` Headache Confusion Urinary incontinence Seizures Weakness ```
36
How are SDHs imaged?
CT
37
What occurs in normal pressure hydrocephalus?
CSF builds up due to impaired resorption at arachnoid granulations or CSF overproduction
38
What is the triad of clinical features in NPH?
Apraxia of gait (shuffling) Dementia Urinary incontinence
39
How is NPH treated?
Ventriculo-peritoneal shunt
40
What occurs in hydrocephalus?
Excessive accumulation of CSF causing brain ventricle enlargement
41
Where is the pathology in communicating hydrocephalus?
Arachnoid granulations
42
Which part of the brain is affected in obstructive hydrocephalus?
Ventricular system
43
What is the main cause of congenital hydrocephalus?
Aqueductal stenosis
44
Give some clinical features of congenital hydrocephalus
``` Failure to thrive Dilated scalp veins Increased head circumfrence Impaired up gaze 'Setting sun' appearance ```
45
Give some clinical features of acquired hydrocephalus
``` Headaches Vomiting Diplopia Papilloedema Drowsiness ```
46
What is the best diagnostic imaging in a non-emergency situation for hydrocephalus?
MRI
47
What CSF diversion methods can be used for hydrocephalus?
Ventriculo-peritoneal | Endoscopic third ventriculostomy
48
ETV is more likely to be successful in obstructive/communicating hydrocephalus
Obstructive
49
What are Chiari malformations?
Congenital/acquired malformations affecting structural relationships between cerebellum, medulla and cervical spinal cord
50
What occurs in a Chiari I malformation?
Caudal displacement of cerebellar tonsils
51
Give some clinical features of Chiari I malformation
Headache (when coughing) Downbeat nystagmus Central cord syndromes Ataxic gait
52
What occurs in a Chiari II malformation?
Caudal displacement of cerebellum and medulla below the foramen magnum
53
Chiari II malformations are associated with what condition?
Spina bifida
54
Give some signs and symptoms of Chiari II malformations
Dysphagia Apnoea Stridor Weakness
55
How are Chiari malformations treated surgically?
Suboccipital craniectomy | Upper cervical laminectomy
56
Give some clinical features of idiopathic intracranial hypertension
Throbbing headache relieved on standing Papilloedema N + V
57
How is idiopathic intracranial hypertension managed?
Weight loss | Acetazolamide

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