Intracranial Bleeding & Brain Tumors PDF

Intra Cranial Bleeding (ICB) & Brain Tumours Neurosurgery Session II Skull is a closed Vault Brain Herniation Causes of high intercranial pressure  Brain insult ( Tumor, ischemia hematoma infection etc ) Cushing Triad Cushing Triad ...

Intra Cranial Bleeding (ICB) & Brain Tumours Neurosurgery Session II Skull is a closed Vault Brain Herniation Causes of high intercranial pressure  Brain insult ( Tumor, ischemia hematoma infection etc ) Cushing Triad Cushing Triad Types of monitoring ICP monitor  cerebral perfusion pressure Diastolic x 2 + systolic / 3 = MAP Intracerebral hematoma Intracerebral hemorrhage (bleeding into the brain tissue) is the second most common cause of stroke (15-30% of strokes) and the most deadly. Hypertension: chronic high blood pressure causes changes to the arteries of the brain which can make them much more likely to rupture. Age: more common after age of 50 Gender: more common in men. Race: affects African Americans and Asians more than whites; likely related to higher prevalence of Hypertension in those races. Previous history of stroke: increases risk 23 times. Alcohol: cocaine, amphetamines increases risk. Liver disease: increases risk due to issues with blood clotting. Use of blood thinners. Primary brain causes: tumors, vascular anomalies, infection and venous sinus thrombosis Investigation and treatment ICB A non-contrast computer tomography (CT) scan of brain is the diagnostic study of choice. CT or magnetic resonance (MR) angiogram is recommended (once the patient is stabilized) Non-Surgical Treatments Candidates for non-surgical treatment are patients with: Minimal symptoms; Minimal chance of a favorable outcome (large hemorrhage, poor neurologic condition, advanced age, bleeding disorder); and A hemorrhage location (basal ganglia or thalamic hemorrhage, where surgery is no better than medical management). Non-surgical treatments include: Clotting factor administration, if patient was on blood thinners; Blood pressure control to reduce risk of more bleeding; and Measuring and controlling ICP (pressure on brain tissue due to clot). Surgery Candidates for surgical treatment are patients: Less than 50 years of age (tolerate surgery better than an elderly patient); With a hemorrhage location in a favorable location for surgical evacuation, including in the lobar, cerebellar, external capsule and non-dominant hemisphere; and For whom surgery may lower issues with re-bleeding, edema and necrosis, but rarely causes neurologic improvement. Surgical treatments include: A craniotomy involves removing a piece of the skull bone and exposing the brain to remove the clot. It is useful when the clot is close to the surface of the brain or if the clot is associated with an underlying brain lesion. Stereotactic clot aspiration CT of ICB Cerebral ischemia Cerebral ischemia can be global or focal. Global cerebral ischemia is a result of systemic processes, often shock. The most common cause of global brain ischemia is systemic hypotension. Transient cerebral hypoperfusion can occur when autonomic and neurohormonal mechanisms that control blood pressure and heart rate are disrupted, as in vasovagal syncope and postural tachycardia syndromes CT ischemia Decompression craniotomy Decompression craniotomy steps Types of brain bleedings Types of intercranial hemorrhage Subdural hematoma Subdural hematoma versus epidural hematoma Brain tumors A-primary brain tumor 1- Benign brain tumor grows slowly, has distinct boundaries, and rarely spreads. Although its cells are not malignant, benign tumors can be life threatening if located in a vital area. 2- Malignant brain tumor grows quickly, has irregular boundaries, and spreads to nearby B- Secondary brain tumors Metastatic begin as cancer elsewhere in the body and spread to the brain. They form when cancer cells are carried in the blood stream. The most common cancers that spread to the brain are lung and breast. Investigation 1- Labs 2- Imaging ( CT, MRI ) 3- Biopsy Treatment Options Surgery > Radiation > Chemotherapy Meningitis bacterial acute virus acute autoimmune fungus chronic TB meningitis the speed is to leptomeninges direct or from blood spread Diagnosis and treatment Blood cultures. A blood sample is placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide and stained (Gram's stain), then studied under a microscope to see whether bacteria are present. Imaging. Computerized tomography (CT) or magnetic resonance imaging (MRI) scans of the head may show swelling or inflammation. X-rays or CT scans of the chest or sinuses also may show infection that may be associated with meningitis. Spinal tap (lumbar puncture). For a definitive diagnosis of meningitis, you'll need a spinal tap to collect cerebrospinal fluid (CSF). In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. Treatment antibiotics given directly into a vein. fluids given directly into a vein to prevent dehydration. oxygen through a face mask if there are any breathing difficulties. steroid medication to help reduce any swelling around the brain, in some cases. Encephalitis inflammation of the active tissues of the brain caused by an infection or an autoimmune response  Spine Degeneration Degenerative disc disease Degenerative disk disease occurs when the cushioning in your spine begins to wear away. The condition is most common in older adults. After age 40, most people experience some spinal degeneration. The right treatment can lead to pain relief and increased mobility Adult scoliosis, where the spine curves. Herniated disk, also called a bulged, slipped or ruptured disk. Spinal stenosis, when the spaces around your spine narrow. Spondylolisthesis, when vertebrae move in and out of place. risk factors : Acute injuries, such as falling. Obesity. Biological sex, with women being more likely to experience symptoms. Smoking. Working a physically demanding job. Degenerative scoliosis Disc disease spinal cord stenosis ( Lumbar / Cervical ) Spondylolisthesis Investigation and treatment Investigation: Labs, X-ray, CT, MRI Treatment : Spinal decompression , Spinal Fixation Thank You