Neurologia: Sintomi e Segni Clinici

Study Notes

NEUROCHIRURGIA
- Syndrome of intracranial hypertension and coma
- Subarachnoid hemorrhage and vascular malformations
- Spontaneous and post-traumatic intracranial hemorrhages (epidural, subdural, intracerebral)
- Hydrocephalus
- Craniocerebral trauma
- Spinal trauma
- CNS tumors (gliomas, meningiomas, metastases, embryonal tumors, craniopharyngiomas, colloid cysts, epidermoids, dermoids, teratomas, lipomas, pituitary tumors, orbital tumors, cranial nerve tumors, peripheral nerve tumors, spinal intradural tumors)
- Disc herniation (cervical, dorsal, lumbar) and degenerative spinal pathologies
- Pain and functional neurosurgery
- Craniofacial and vertebral anomalies (craniosynostosis, Chiari syndrome, encephalocele, spina bifida)
SYNDROME OF INTRACRANIAL HYPERTENSION
- Intracranial hypertension is a syndrome caused by increased pressure inside the skull, due to space-occupying lesions (not only tumors, but also hemorrhages, abscesses, cerebral edema) which impact cerebral circulation.
- Clinically affects a large portion of neurological pathologies.
- Recognising it promptly is critical since lack of recognition can cause patient death.
- Common in patients with expansile lesions, mostly in the advanced stages; it's crucial to prevent its apparition in patients with tumors and cerebral edema by early diagnosis.
- Lesion expansion may cause hydrocephalus (buildup of cerebrospinal fluid in the skull due to overproduction, impaired absorption or obstruction of fluid circulation) or severe vascular or interstitial reactions leading to cerebral edema.
PHYSIOPATHOLOGY
- Cranial and vertebral structures are rigid and inelastic, limiting compensatory mechanisms accessible for other body cavities.
- Cranial circulation depends on a complex reticular structure (Circle of Willis) to prevent vascular occlusion impacts.
- Venous circulation has multiple interconnected pathways and ensures proper blood drainage from the brain.
- Blood pressure variation and vascular reactivity are managed by the autonomic nervous system for a consistent cerebral blood flow.
- Intracranial pressure (ICP) balance depends on the volume of three components: brain tissue, cerebrospinal fluid (CSF), and blood.
ICP
- Intracranial pressure (ICP) is the pressure within the skull.
- Normal: 5-15 mmHg
- Abnormal (syndrome of intracranial hypertension): > 20-25 mmHg
- ICP elevation can be caused by increased volume of any of the three components (blood, CSF, or brain tissue).
- Compensation mechanisms like CSF drainage to the spinal canal exist to maintain a balanced ICP.
TREATMENT PROTOCOLS
- Assessing and maintaining airway integrity.
- Administering osmotic diuretics (mannitol and furosemide).
- Intubation and mechanical ventilation.
SURGICAL TREATMENTS
- Craniectomy decompression: a very risky surgery only in extreme cases when the previous treatments are not effective.
TRAUMA CRANIO-ENCEFALICO
- Incidence: 300 per 100,000 habitants/year Mortalities: 24 per 100,000 habitants/year
- 67% related to traffic accidents
- 55-60% of serious head trauma cases have associated injuries in other organs, making it a “polytrauma”
TRAUMA CAUSES
- Direct trauma: when a solid object strikes the head.
- Indirect trauma: forces transmitted through other parts of the body (e.g., a fall).
- Open wounds: damage to the dura mater.
- Closed wounds: intact dura mater.
CLASSIFICATION
Direct: solid object strikes head
Indirect: force transmitted through body parts
Open: dura mater punctured
Closed: dura mater not punctured
Non-Concussive → no loss of consciousness nor neurological symptoms
Concussive → temporary loss of consciousness and or neurological symptoms.
COMPLICATIONS
- Extracranial complications: issues from outside the cranium (e.g., blood clots, infections)
- Intracranial complications: problems inside the skull (e.g., tumors, swelling)
TYPES OF INTRACRANIAL HEMORRAGES
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hemorrhage
- Intracerebral hematoma