4829794
Description
Mind Map by Heather Snaith, updated more than 1 year ago
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Created by Heather Snaith
over 8 years ago
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|
Neurology - Week 7 -
Brain tumour &
Stroke
- STROKE: Sudden loss of
neurological function
due to interruption of
blood supply
- Ischaemia -
blockage of a
blood vessel (85%)
- THROMBOSIS:
Stroke due to clot
which has arised
from within the
arteries of the brain
Atherosclerosis = in
the blood vessil
itself
- May be caused by
blood disorders
that promote
clotting like Sickle
cell disease ,
Thrombophilia
- May be caused by
blood disorders
that promote
clotting like Sickle
cell disease ,
Thrombophilia
- EMBOLISM: Clot that
travels from the heart,
blocking brain
circulation
- May be caused by
damaged heart
vavles, artificial
valves, disorders
of rhythm
- May be caused by
damaged heart
vavles, artificial
valves, disorders
of rhythm
- TIA: Transient
Ischaemic Attack -
temporary and
reverseable loss of
function within 24
hours
- Sometimes
known
as
'mini'
stroke
- Speedy attention to
prevent major stroke
- Can do doppler
ultrasound to assess
the state of arteries in
the neck may need
Endarterectomy to
open up blocked blood
vessil.
- Sometimes
known
as
'mini'
stroke
- Fatal up to
30% for first
month
- THROMBOSIS:
Stroke due to clot
which has arised
from within the
arteries of the brain
Atherosclerosis = in
the blood vessil
itself
- Haemorrhage -
rupture of
blood vessel
(15%)
- Less common
- Normally blood - brain
barrier separates blood
from brain. Once blood in
contact with brain tissue
quite toxic
- Ischaemic
stroke tend
to survive
better
- fatal in up to 50%
of victims in the
first month
- Less common
- SYMPTOMS - weakness arm or
leg, sensory
impairment, visual
on one side…
- RISK
FACTORS
- Hypertension: Should be
treated as precipitates
hardening of the arteries
making them easy to
block or rupture
- Diabetes and
hypertension go
hand in hand - one
cause of
hypertension is renal
/ kidney cause
- Diabetes and
hypertension go
hand in hand - one
cause of
hypertension is renal
/ kidney cause
- Age
- Smoking - can also
lead to can lead to
atherosclerosis
(artery hardening)
- High
cholesterol -
fuzzing of
arteries
- Family history /
genetic
pre-disposition
- Heart problems, e.g.
Atrial fibrillation :
disturbance in heart
rhythm leading to
clot
- Hypertension: Should be
treated as precipitates
hardening of the arteries
making them easy to
block or rupture
- RISK
FACTORS
- 2:1000 new cases
ever year
- 3rd major cause of
death after cancer
and heart disease
- Major cause of
disability
- DIAGNOSIS
- Brain CT or Brain MRI used to
image brain. MRI more
detailed but CT more readily
available.
- Can have coloured scans for
the blood vessels if diagnosis
is not straight forward.
- Manifestation
depends on area of
brain affected
- Described as Anterior
circulation or posterior
circulation infarction
depending on whcih
affected
- May be called:
severe, mild,
moderate are 3
classifications etc…
- ANTERIOR circulation
infarction features (affect
opp side of body)
- Hemiplegia:
weakness of
upper and
lower limbs
- Hemianesthesia:
lack of sensation
- Hemianopia:
Loss vision
one side field
- Dysphasia: Inability
to express self or
understand others
- Inattention: Unable
to pay attention to
one side of body /
environment
- More able to
treat this kind of
infarct - e.g. if in
the neck
- Posterior surgery
more risky and
less rewarding
- Posterior surgery
more risky and
less rewarding
- Hemiplegia:
weakness of
upper and
lower limbs
- POSTERIOR
circulation
infarction
- Vertigo / unsteadiness
- Loss of vision
/ double
vision
- Upper and
lower limb
weakness
- Dysarthric
speech
- Receptive
dyspasia
- Vertigo / unsteadiness
- Brain CT or Brain MRI used to
image brain. MRI more
detailed but CT more readily
available.
- Ischaemia -
blockage of a
blood vessel (85%)
- ACUTE STROKE MANAGEMENT
- 1. Confirm diagnosis of stroke
- 2. Confirm whether ischaemic or haemorhaggic
- 3. Maintain: airway, circulation, hydration, skin, bladder and bowel function
- 4. If catch them in a 4 hour window the patient may be
entitled to Thrombolysis – has to be ischaemic not
heamorrhagic- give them a drip to dissolve a clot. (About 20%)
- 4. If haemorrhage is
superficial chance you can
take the clot out, reduce
pressure in the skull '
surgical evacuation'
- e.g. young people
with deteriorating
level of
consciousness or
Cerebellar
haematoma
- e.g. young people
with deteriorating
level of
consciousness or
Cerebellar
haematoma
- 5. Prevent complications like:
Aspiration Pneumonia / Deep
vein thrombosis which can lead
to pulmonary embolism
- 6. Secondary
PREVENTATIVE
TREATMENT
- Anti-platelets
therapy like
Aspirin
- Lipid lowering / statins
lowers further
hardening of the
arteries (as result of
cholesterol).
- Full
anti-coagulation
like giving Warfarin
- have to monitor
- Diabetes /
hypertension
mangement
- Stop smoking
- Healthier life style
- Anti-platelets
therapy like
Aspirin
- 6. Secondary
PREVENTATIVE
TREATMENT
- Major risk of this
haemorrhage however.
1/8 full recovery. 1/17
bleeding.
- 4. Endarterectomy: Opening
up a narrowed artery by
surgical operation if there is
70% blockage when the pt
suffers a small stroke
- 4. If haemorrhage is
superficial chance you can
take the clot out, reduce
pressure in the skull '
surgical evacuation'
- Control of circulation: If
haemorrhagic keep low,
ischaemic keep high or
likely to make it worse
- 4. If catch them in a 4 hour window the patient may be
entitled to Thrombolysis – has to be ischaemic not
heamorrhagic- give them a drip to dissolve a clot. (About 20%)
- 3. Maintain: airway, circulation, hydration, skin, bladder and bowel function
- 2. Confirm whether ischaemic or haemorhaggic
- 1. Confirm diagnosis of stroke
- BRAIN TUMOUR: New growth
of cells which form lesion /
lump
- BENIGN Neoplasm: Does
not infiltrate normal
tissue or metastesize
- Removed with
out recurrance
- Removed with
out recurrance
- Malignant Neoplasm / cancer: Has aggressive
characteristics – multiplies
rapidly, doesn’t usually have a
capsule – unlike benign
- Metastasis to
other areas of
body
- Recurrence after
removal
- Metastasis to
other areas of
body
- CLINICAL FEATURES
- Raised ICP: If
increase by 30ml
(one tenth can of
coke) you will have
problems.
- Affects on
local tissue
- Headache:
Worse in
morning,
better as day
goes on
- Vomiting
- Bradycardia:
Slow heart
rate
- Hypertension
- Impairment on
concious level
- Papilloedema: swelling
of the cranial nerves.
You can see the selling
of optic nerve through
the eye….
- Epilepsy
- Raised ICP: If
increase by 30ml
(one tenth can of
coke) you will have
problems.
- WHO CLASSIFICATION
- 1. Tumours of
Neuro-epithelial
origin
(Gliomas)
- Astrocytoma: Most
common form of
Glioma in children
and adults - develop
from astrocytes
(neurones)
- High / low grade
(slow or rapid)
growth
- 3 Subtypes
- a. Localised - less malignant
- b. Diffuse - more malignant
- c. Anaplastic - very bad news
- a. Localised - less malignant
- Glioma = arising
from the BRAIN
TISSUE and
supporting
structures itself
- Oedema around the
glioma shows
multiplying and
dying very quickly
- Midline shifted left
- Midline shifted left
- High / low grade
(slow or rapid)
growth
- Oligodendroglioma:
from
oligodendrocytes
that make myelin
- 3% of brain
tumours
- Slow growing - doesn't
have such an effect on
surrounding structures
till gets big
- Cerebral
hemisphere
- Adults
- 3% of brain
tumours
- Medulloblastoma
- Most common
in childhood
- Coz at base of the
brain, can block flow
of CSF.
- Agressive
- In Posterior
Fossa
- Can be removed
- Can be removed
- Most common
in childhood
- Astrocytoma: Most
common form of
Glioma in children
and adults - develop
from astrocytes
(neurones)
- 2. Tumours of
cranial and
paraspinal
nerves
- Vestibular
schwannomas
- Arise location:
Schwann cells on VIII
cranial nerve
- Slow
growing -
benign
- Older people
- Rarely spread
- Loss of hearing
- Unilateral / bilateral
- Rarely associated with
Neurofibromatosis type 2
- Can remove, but
risk damage to
facial nerve VII
- Presses on the
cerebellar pontine angle –
dangerous to press on the
Pons – heartrate, CSF flow
etc… so needs to go.
- Presses on the
cerebellar pontine angle –
dangerous to press on the
Pons – heartrate, CSF flow
etc… so needs to go.
- Can remove, but
risk damage to
facial nerve VII
- Lack of balance
- Arise location:
Schwann cells on VIII
cranial nerve
- Spinal cord tumours
- 20% CNS
tumours
- Meningiomas
- Neurofibromas
- Cordomas
- 20% CNS
tumours
- Vestibular
schwannomas
- 3. Tumours
of the
meninges
- Meningiomas -
25% adult
brain tumours
- Older people
- Arise Location :
cerebrum,
cerebellum
- Meningeal tail' -
tumour blends
with meninges
- Meningiomas -
25% adult
brain tumours
- 4. Tumours of the
haematopoetic
system
- Lymphomas
affecting brain
or spinal cord
- 5% CNS tumours
- Arise: Diffuse
large B-cells non
Hodgkin
lymphoma
- Lymphomas
affecting brain
or spinal cord
- 5. Tumours of
the sellar
region
- Craniopharyngiomas
- Rare benign tumours
- Base of
brain,
close to
pituaitary
- Can cause
impaired
vivsion
- Can cause
impaired
vivsion
- Children
and young
adults
- Rare benign tumours
- Pituitary tumours
- Benign
- 8% of tumours
- Can be functioning
(release hormones) or
non - functioning
- Grow slowly
- Don't spread
- Can affect
Thyroid &
hormone
secretions
- Can effect
blood
pressure
- Benign
- Craniopharyngiomas
- 6. Metastatic
Tumours
- Colour
under
dye (like
Lymphomas)
- Colour
under
dye (like
Lymphomas)
- Grades of tumour
1-4: 1 benign 2 partly
benign 3 low
malignancy 4 high
malignancy
- Analysis of mitotic division
under microscope…
Histological grading =
specimin of tumour, section,
stain, and histopathologist
examine through microscope.
(Histo = tissue)
- Analysis of mitotic division
under microscope…
Histological grading =
specimin of tumour, section,
stain, and histopathologist
examine through microscope.
(Histo = tissue)
- 1. Tumours of
Neuro-epithelial
origin
(Gliomas)
- ASSESSMENT:
CT scan, MRI
- Angiogram for
surgeons – to see
where blood is
coming from in the
blood vessels &
where to stop the
bleeding in advance
etc.
- Angiogram for
surgeons – to see
where blood is
coming from in the
blood vessels &
where to stop the
bleeding in advance
etc.
- MANAGEMENT
- Palliative like
reduction of
ICP
- Surgery:
Partial or
total
excision
- Anti
epilepsy
drugs
- Steroids -
reduce
swelling
- Grade tumour
directs what
best form of
Chemo / radio
therapy
- New biologic /
targeted
therapies -
less harmful,
halt tumour
growth
- CHEMOtherpay:
Medulloblastoma
- RADIOtherapy:
Ependymoma
/
Lymphoma
- Palliative like
reduction of
ICP
- BENIGN Neoplasm: Does
not infiltrate normal
tissue or metastesize
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