What is Nelson syndrome?
Spectrum of symptoms and signs arising from an adrenocorticotropin (ACTH)–secreting pituitary macroadenoma after a therapeutic bilateral adrenalectomy.
Most common site of Berry aneurysm?
ACOM > PCOM > MCA
Most common intracranial aneurysmQ?
MC type of intracranial hemorrhageQ ?
Intracerebral hemorrhage, second most common in SAH
MC cause of Intracerebral hemorrhage?
- HypertensionQ, causing rupture of small perforating arteries or arteriolesQ
- MC site of intracerebral hemorrhage?
- Basal ganglia (PutamenQ)
MC cause of subarachnoid hemorrhage?
Trauma >Spontaneous rupture of Berry aneurysmQ
MC site of subarachnoid hemorrhage?
Berry aneurysm is anterior circulation of “circle of willis”Q
Timing of ischemia in vasospasm?
Sign of ischemia appear 4-14 days after the hemorrhage, most frequently at about 7 daysQ.
Major causes of Delayed Neurological deficit after CVA?
What is Duret Hemorrhage?
- • In case of increased ICP downward herniation of brainstem occur, which cause stretching of perforators of basilar artery and may results in bleed (Duret hemorrhage)Q.
- • Duret hemorrhage is small area of bleeding in ventral and paramedian part of upper brainstem (midbrain and pons)Q.
Vessels for EDH and SDH?
EDH - tearing of a meningeal arteryQ . It is not always arterial: disruption of a major dural venous sinus can result in an EDH.
SDH - cortical vessel or brain lacerationQ
MC site of EDH?
TemporalQ (pterion is thinnest part of skull and overlies middle meningeal artery)
Classification of SDH?
- • Acute SDH: <3 daysQ
- • Subacute SDH: 4-21 daysQ
- • Chronic SDH: >21 daysQ
Localizing signs in SAH?
- −− Third cranial nerve palsyQ: Aneurysm at junction of PCA and ICA
- −− Sixth nerve palsyQ: Aneurysm in cavernous sinus
- −− Occipital and posterior cervical pain: Inferior cerebellar artery aneurysm
- −− Pain in or behind the eyeQ: MCA aneurysm
Signs of anterior cranial fossa fracture?
- Subconjunctival hematomaQ
- CSF rhinorrheaQ
- Carotico-cavernous fistulaQ
- Periorbital hematoma or “Raccoon eyes
Signs of middle cranial fossa fracture?
- CSF otorrhea or rhinorrheaQ
- Ossicular disruptionQ
- Battle sign: Bruising behind the earQ
- 7th and 8th cranial nerve palsiesQ
Choice of side for Initial Burr Hole?
- • Ipsilateral to a blown pupil: This will be on the correct side in >85% of epidural hemorrhages and other extra- axial mass lesions.
- • If both pupils are dilated, use the side of the first dilating pupil (If known).
- • If pupils are equal, or it is not known which side dilated first, place on side of obvious external trauma.
- • If no localization clues, place hole on left side (to evaluate and decompress the dominant hemisphere).
Triple H Therapy?
- Triple H therapy of subarachnoid hemorrhage used to ameliorate cerebral perfusion, consists of:
- 1. Hypervolemia
- 2. Hypertension
- 3. Haemodilution
Uses of Mannitol
- • Increased ICT or intraocular tensionQ
- • To maintain GFR and urine flow in impending renal failureQ
- • Forced diuresis in hypnotic or other poisoningQ
- • To counteract low osmolality of plasma/ECFQ due to rapid hemodialysis or peritoneal dialysis
Contraindication of Mannitol
- Acute tubular necrosisQ
- pulmonary edemaQ
- Acute left ventricular failureQ
- Cerebral hemorrhageQ
Dose of mannitol?
20% solution, 0.25-1 gm/kg is given IV as bolusQ
Serum Osmolarity while using mannitol?
Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failureQ.
What is primary brain injury?
Primary brain injury occurs at the time of impact
What is secondary brain injury?
Secondary brain injury occurs at some time after the moment of impactQ