4 clinical manifestations arising from a lesion near/ at the angular gyrus (temporal, parietal border) - Acalculia (inability to calculate numbers/ understand maths) - Left-right confusion - Alexia without agraphia (inability to read what is written) - Finger agnosia (inability to distinguish finger form hand)

Tumours and bleeds Flashcards by aderonke adesanoye

Gerstmann syndrome

4 clinical manifestations arising from a lesion near/ at the angular gyrus (temporal, parietal border)

Acalculia (inability to calculate numbers/ understand maths)
Left-right confusion
Alexia without agraphia (inability to read what is written)
Finger agnosia (inability to distinguish finger form hand)

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Arteriovenous malformations

- Pathology

Malformation arises from a direct connection between the arteries and veins, without a capillary network

Creates high-pressure communications.
Predisposes to aneurysms

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Name a genetic condition associated with cerebral AVMs

Hereditary haemorrhagic telangiectasia (HHT)/

Osler-Weber-Rendu syndrome

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Hereditary haemorrhagic telangiectasia (HHT) is inherited in what fashion?

Autosomal dominant

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What is the most common location for AVMs?

Supratentorial

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Describe the presentation of AVMs

As an intracranial haemorrhage
- Most commonly, intracerebrally
Headache
Focal neurological deficit
- Most commonly due to mass effect from haemorrhage
Seizure

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Which investigation is carried out in AVMs to rule out a haemorrhage?

Head CT

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What investigation is carried out to assess the location, feeding arteries, associated aneurysms, and venous drainage of AVMs?

Brain digital subtracted angiogram

CT or MR angiograms can also detect the malformations and aneurysms

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Management of small, superficial AVMs

Surgical resection

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Management of large AVMs

Multi-method approach

Embolisation
Surgical resection

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Management of inaccessible AVMs

Conservative if surgery is not appropriate
- Management of symptoms like seizures

Inaccessible AVMs
- Stereotactic radiosurgery

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Subdural haematoma

- pathology

Bleed located between the dura matter and subarachnoid layer.
- Most commonly caused by the breaking of bridging veins from the subarachnoid space that permeate the dura mater and empty into the dural venous sinuses.

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Most common cause of subdural haematoma

Head trauma

- Most commonly in the elderly

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Risk factors for subdural haematoma

Older age

Coagulopathies

Anticoagulation

Arteriovenous malformations

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Chronic subdural haematoma

- Pathology

An encapsulated subdural haematoma that occurs a few days after the bleed occurs.

Can cause a subdural hygroma.

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What is a subdural hygroma

A collection of CSF subdurally that can occurs as a result of a chronic subdural haematoma.

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Frontal lobe manifestations of intracranial bleeds

Confusion

Reduced cognitive/ executive function

Hemiparesis

Aphasia

Personality changes

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Parietal lobe manifestations of intracranial bleeds

Aphasia

Sensory impairment

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Posterior fossa manifestations of an intracranial bleed

CN palsy

Ataxia

Dysphagia

Vomiting

Unequal pupils

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Signs of a chronic subdural haematoma

Headache

Cognitive impairment

Apathy

Depression

Seizures

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First line imaging for a subdural haematoma

CT head

- Will reveal a crescent shaped bleed

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Important blood tests for intracranial bleeds

FBC- rules out low platelets

Group and Save

U+Es

Clotting profile

aPTT
PT
Bleeding time

LFTs

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Management of drowsiness/ bulbar symptoms in intracranial bleeds

Airway support

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What is an important management with medication that must be carried out in intracranial bleeds?

Reversal or cessation of anticoagulants

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How to reverse warfarin - Rapidly (1-2 hours) - Quickly (non-emergency surgery) - Slowly

Rapidly - Prothrombin complex concentrate Octaplex/Beriplex Quickly - Vitamin K 10mg IV Slowly - Oral Vitamin K therapy

The effects of dabigatran is reversed using...

Idarucixumab

The effects of heparin/ LMWH is reversed using...

Protamin sulfate

Epidural haemorrhage | - Pathology

Bleed between the skull and outer dura | - Most commonly caused by head trauma lacerating the middle meningeal artery

The "lucid phase" is associated with what type of intracranial bleed

Epidural haematoma | - Presents with a lucid phase after the incident, before a deterioration in brain function

Signs of raised ICP include

Nausea and Vomiting Blurred vision Drowsiness Seizures Headache Ipsilateral dilated pupil

Features of the Cushing's triad

Sign of raised ICP: Hypertension Bradycardia Respiratory depression

Indications of surgery for intracranial bleeds

Large haematomas changes in brain function Midline shift >5mm Fixed, dilated pupils

Management of raised ICP in intracranial bleeds

Mannitol - Osmotic diuretic Hypertonic saline

CT appearance of epidural bleeds

Convex/ lens haematoma

CT appearance of subarachnoid bleeds

Bleeds in the sulcus - Above the pia matter Blood in the ventricles

CT appearance of intracerebral bleeds

Hyperdensity (new bleed) or hypodensity intraparanchymal cerebral tissue.

Features of a large vestibular schwnomma

Ataxia/ balance problems - Due to compression of brainstem Hydrocephalus--> raised ICP - Due to compression of 4th ventricles

Conditions caused by a pituitary adenoma

Prolactinoma (excess prolactin) Cushing's disease (excess ACTH) Acromegaly (excess GH) Panhypopituitarism (non-secreting adenoma) Apoplexy (bleed into pituitary)

The most common glioma is...

Glioblastoma multiforme (astrocytoma)

What genetic conditions increase the risk of gliomas?

Neurofibromatosis 1 and 2 Li-Fraumeni syndrome

The most common primary malignant tumour of the brain in adults is...

Glioblastoma

The gold standard imaging for glioma diagnosis is...

Gadolinium contrast MRI head

Presentation of gliomas

Headache Raised ICP features Frontal= Personality/ executive function/ cognition changes CN palsy Spinal cord compression Cerebellar signs

Features of raised ICP

Headache Nausea/ vomiting Blurred vision Altered consciousness Seizures

Managemnt of raised ICP/ vasogenic oedema in gliomas

Dexamethasone

Management of seizures in glioma

Keppra / phenytoin

Meningioma most commonly arises from....

The arachnoid layer of the meninges

Most meningiomas are located...

Supratentorially

Meningiomas can cause compression of _______ or lead to excessive ________

Compression of optic nerve Excessive bone growth/ protrusion

Meningiomas are associated with which genetic condition

Neurofibromatosis type 2

Pituitary macroadenomas are defined as sizes...

>10mm

Pituitary adenomas are associated with which genetic condition?

Multiple endocrine neoplasia 1 (MEN1)

Types of pituitary adenomas causing hyperpituitarism

Cushing's disease (corticotrophic) Acromegaly (somatotrophic) Prolactinoma (lactrotrophic) Hyperthyroidism (thyrotrophic) Gonadotrophic

Pitutary adenoma can cause central diabetes insipidus via...

Hypopituitarism (macroadenoma)= low ADH production

Prolactinoma is primary treated with...

Cabergoline (dopamine antagonist)

The surgical management of Cushing's disease is...

Trans-sphenoidal adenectomy

___________ is a somatostatin analogue used to treat _________

Octreotide - treats somatrophic adenoma

The most common type of intracranial vascular anuerysm is...

Saccular aneurysm (90%)

Saccular aneurysms common occur at which part of the Circle of Willis?

Anterior communicating artery

What 3 genetic conditions are associated with intracranial aneurysms?

Autosomal dominant polycystic kidney disease Elhers Danlos syndrome Neurofibromatosis

Lifestyle factors associated with intracranial aneurysms

Alcohol, smoking Age Hypertension

Posterior communicating aneurysm can present with what nerve palsy?

Unilateral CN3

What intracranial aneurysm can present with bitemporal hemianopia?

Anterior communicating artery aneurysm

What is the gold-standard investigation for intracranial aneurysms?

Cerebral intra-arterial digital subtraction angiography

What are the surgical options of symptomatic intracranial aneurysms

Endovascular coiling Open surgical clipping

Tumours and bleeds Flashcards

(65 cards)