Increased ICP
Name an acquired and congenital cause of non-communicating hydrocephalus.
Acquired: inflammation, tumor, hemorrhage
Congenital: aqueduct obstruction due to x-linked, dandy-walker, chiari malformation (type I MC)
What is the most common location of a herniation?
Transtentorial
Where is the MOST common type of cancer that will metastasize to the brain?
Lung
What is the most common cause of febrile seizures?
HHV-6 Roseola
What is the most common areas affected by global ischemic CVA?
Watershed areas
Triad of normal pressure hydrocephalus.
What is the treatment of normal pressure hydrocephalus?
Wet, wacky, wobbly - Urinary incontinence, reversible dementia, gait disturbance
Ventricular shunt
What type of herniation is the MOST lethal? Why?
Compressing the medulla - vital signs impaired
What is the most common malignant tumor in children? Adults?
Medulloblastoma
Glioblastoma multiforme
Describe what a partial seizure is. Do you have impaired consciousness with this?
Subtle auras with subtle muscle movements:
Chewing, lip smacking, smell odors
They can have it, but also not
When should you give tpa? Any CI to this?
Within 4.5 hours
Platelets <100,000
Increased intracranial pressure and mass effect causes this triad. What is it? What does it indicate?
Cushing's Triad: bradycardia, low respiratory rate, HTN
Brain stem compression
What type of central herniation is more common? What is the presenting symptoms of this type?
Descending
Duret's hemorrhages
RAPID drowsiness
Fixed and dilated pupils
Cheyene stokes
Decorticate posturing
Your patient presents with a recent onset of HA that wakes them up at night. They said that they woke up in the morning one day with a bite mark on their tongue. They are concerned something bad is happening.
When you perform the MRI, you see a tumor that is taking up an entire lobe of the brain. What is the most likely tumor causing this? How can you treat it?
Palliative care - 1 year prognosis
Triad of infantile spasms.
How would you treat it?
Hypsarrhythmia on EEG, developmental delay, myoclonic seizures
Adrenocorticotropic hormones
Patient presents with pronator drift and gaze deviation to the right concerning for stroke.
Where is it likely located?
Middle cerebral artery
I am a 23 year old female who has been having intermittent episodes of a pulsatile headache and ringing in my ears. Sometimes during these episodes, I even have weird blurry vision and the light hurts my eyes.
What might you see on physical exam during the headache? What test would you run and what would you see?
Papilledema
LP with HIGH OP of >250
Your patient comes in who is concerning for a possible herniation. They present with unilateral leg weakness, headache, and their eyes are a little funky looking.
What type of herniation do they have? What artery is that compressing?
Supratentorial - Subfalcine
Anterior cerebral artery
Your patient presents with unilateral hearing loss and ringing in their ear.
What is the most likely cause? What is the best initial test and most sensitive test?
How would you explain to them what type of tumor they have?
Acoustic neuroma or vestibular schwannoma
Audiometry --> MRI
Benign peripheral nerve sheath tumor from Schwann cells
A mother brings in her child because he has been randomly staring into space for 10 seconds at a time multiple times a day. She is concerned he has ADHD.
What test would you run? What would you see? Treatment?
EEG: 3 Hertz spike and wave pattern
Ethosuximide
Patient presents with a 30 minute episode of left homonymous hemianopsia and difficulty remembering what she did this morning. She immediately became concerned when she couldn't recognize her husband.
What type of stroke is this? What artery did it originate from?
Posterior cerebral
Basilar artery
Explain the pathophysiology behind increased intracranial pressure.
Brain attempts to compensate for increasing pressure with: Vasoconstriction and decreased CSF production.
If this does not work: Systemic vasoconstriction
Causes DECREASED oxygen and INCREASED cCO2 to brain
Increased CO2 causes vasodilation and herniation
Your patient presents and is minimally responsive. You notice their muscles are somewhat contracted and when you perform a Babinski reflex on the left side, there is up-going of the toes.
While you are performing lab and imaging tests, you notice they have an right-sided dilated pupil and minimal movement of the left side of their body. They begin having periods of apnea and rapid breathing and appear to be bringing their upper extremities in towards their chest.
What herniation do they likely have? Where is it located?
Uncal herniation on the LEFT
You have a 6 year old patient who presents with his mother, who is concerned that her son has been vomiting recently and clutching his head, with complaints of pain. She states that when he walks, he is constantly bumping into things and tripping.
What type of tumor does the patient likely have? Where would you see it on imaging? Treatment?
Medulloblastoma
Midline cerebellar
Surgery and radiation
Your patient is brought in by a bystander after they collapsed in a crowd. The bystander states that the patient cried out, "I'm having a seizure" as she fell to the floor. The bystander states the patients eyes were mostly closed and the episode lasted for 5 minutes.
What does the patient likely have? What is the best treatment?
Pseudo-seizures
CBT
How can you educate him about his risk of future episodes of similar symptoms?
Hint: Acronym....
Likely a TIA, ABCD2
Age
BP
Clinical features
Duration
DM