dr.NI PUTU SRIWIDYANI, Sp.PA*

TOPICSCEREBRAL EDEMA, HYDROCEPHALUS & RAISED INTRACRANIAL PRESSURE & HERNIATIONMALFORMATION & DEVELOPMENTAL DISEASETRAUMACEREBROVASCULAR DISEASESINFECTIONSDEMYELINATING DISEASESDEGENERATIVE DISEASESTUMORS

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CEREBRAL EDEMA, HYDROCEPHALUS & RAISED INTRACRANIAL PRESSURE & HERNIATION*

CEREBRAL EDEMATwo principal types:Vasogenic edemaBBB disruption & increased vascular permeabilityEx: inflammation, tumorCytotoxic edemaSecondary to cell injuryEx: hypoxia

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HYDROCEPHALUSHydrocehalus is accumulation of CSF within ventricular systemCauses:Increased CSF productionImpaired CSF flowImpaired CSF absorptionCommunicating & non communicating hydrocephalusHydrocephalus in infancy & after this period

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INCREASED INTRACRANIAL PRESSURE & HERNIATIONElevated ICP and rigid dural folds (The falx & tentorium) causing herniation syndrome:Subfalcine (cingulate) herniationDisplaces the cingulate gyrus under the falx cerebriCompress branches of anterior cerebral arteryTranstentorial (uncinate, mesial temporal) herniationMedial aspect of temporal lobe compressed against the free margin of tentoriumN III & posterior cerebral artery impairmentTonsillar herniationCerebellar tonsils displacement through foramen magnumCardiorespiratory arrest*

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Neural tube defectsForebrain anomaliesPosterior fossa anomaliesSyringomyelia & Hydromyelia

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Skull fracturesParenchymal injuriusConcussionContusionLacerationTraumatic vascular injuryEpidural hematomaSubdural hematomaSpinal cord trauma*

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CEREBROVASCULAR DISEASES*

StrokeThree major categories:ThrombosisEmbolismsHemorrhage*

Two processes:Hypoxia, ischemia, infarctionGlobal cerebral ischemiaEx: cardiac arrest, shock, severe hypotention Focal cerebral ischemiaEmboli, thrombosis, or vasculitidiesHemorrhage*

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Hypertensive Cerebrovascular DiseaseLacunar infarctsSlit hemorrhagesHypertensive encephalopathyMassive hypertensive intracerebral hemorrhage*

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Intracranial HemorrhageIntracerebral (Intraparenchymal) hemorrhageSubarachnoid hemorrhage & ruptured saccular aneurysmsVascular malformation*

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INFECTIONS*

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DEMYELINATING DISEASE*

Multiple SclerosisAutoimmune demyelinating diseaseWhite matter diseaseClinical features:Unilateral visual impairmentCranial nerve signs, ataxia, nystagmus, internuclear opthalmoplegiaMotor & sensory impairment of trunk & limbs

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DEGENERATIVE DISEASES*

Alzheimer diseaseDegenerative disease affecting the cerebral cortexCommon cause of dementia in the elderlyInsidious impairment of higher intellectual function, with alteration in mood & behaviorLater, progressive disorientation, memory loss, aphasia, *

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ParkinsonismDegenerative disease of basal gangliaDamage to nigrostriatal dopaminergic systemTremor, rigidity, bradykinesia*

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TUMORS*

GliomasNeuronal tumorsPoorly differentiated tumorsMeningiomasMetastatic tumorsOthersPheripheral nerve sheath tumors

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