dr.NI PUTU SRIWIDYANI, Sp.

PA

TOPICS
CEREBRAL EDEMA, HYDROCEPHALUS & RAISED

INTRACRANIAL PRESSURE & HERNIATION

MALFORMATION & DEVELOPMENTAL DISEASE
TRAUMA
CEREBROVASCULAR DISEASES
INFECTIONS
DEMYELINATING DISEASES
DEGENERATIVE DISEASES
TUMORS
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CEREBRAL EDEMA, HYDROCEPHALUS &

RAISED INTRACRANIAL PRESSURE &
HERNIATION

CEREBRAL EDEMA
Two principal types:
Vasogenic edema
BBB disruption & increased vascular permeability
Ex: inflammation, tumor

Cytotoxic edema

Secondary to cell injury

Ex: hypoxia

HYDROCEPHALUS
Hydrocehalus is accumulation of CSF within

ventricular system
Causes:
Increased CSF production
Impaired CSF flow
Impaired CSF absorption

Communicating & non communicating

hydrocephalus
Hydrocephalus in infancy & after this period
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INCREASED INTRACRANIAL
PRESSURE
&
HERNIATION
Elevated ICP and rigid dural folds (The falx &
tentorium) causing herniation syndrome:

Subfalcine (cingulate) herniation

Displaces the cingulate gyrus under the falx cerebri
Compress branches of anterior cerebral artery
Transtentorial (uncinate, mesial temporal) herniation

Medial aspect of temporal lobe compressed against the

free margin of tentorium
N III & posterior cerebral artery impairment

Tonsillar herniation
Cerebellar tonsils displacement through foramen magnum
Cardiorespiratory arrest
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Neural tube defects

Forebrain anomalies
Posterior fossa anomalies
Syringomyelia & Hydromyelia

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Skull fractures
Parenchymal injurius
Concussion
Contusion
Laceration

Traumatic vascular injury

Epidural hematoma
Subdural hematoma
Spinal cord trauma
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CEREBROVASCULAR
DISEASES

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Stroke
Three major categories:
Thrombosis
Embolisms
Hemorrhage

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Two processes:
Hypoxia, ischemia, infarction
Global cerebral ischemia
Ex: cardiac arrest, shock, severe hypotention
Focal cerebral ischemia
Emboli, thrombosis, or vasculitidies

Hemorrhage

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Hypertensive Cerebrovascular
Disease
Lacunar infarcts
Slit hemorrhages
Hypertensive encephalopathy
Massive hypertensive intracerebral

hemorrhage

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Intracranial Hemorrhage
Intracerebral (Intraparenchymal) hemorrhage
Subarachnoid hemorrhage & ruptured

saccular aneurysms
Vascular malformation

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INFECTIONS

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DEMYELINATING DISEASE

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Multiple Sclerosis
Autoimmune demyelinating disease
White matter disease
Clinical features:
Unilateral visual impairment
Cranial nerve signs, ataxia, nystagmus, internuclear
opthalmoplegia
Motor & sensory impairment of trunk & limbs

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DEGENERATIVE DISEASES

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Alzheimer disease
Degenerative disease affecting the cerebral
cortex
Common cause of dementia in the elderly
Insidious impairment of higher intellectual
function, with alteration in mood & behavior
Later, progressive disorientation, memory loss,
aphasia,

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Parkinsonism
Degenerative disease of basal ganglia
Damage to nigrostriatal dopaminergic system
Tremor, rigidity, bradykinesia

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TUMORS

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Gliomas
Neuronal tumors
Poorly differentiated tumors
Meningiomas
Metastatic tumors
Others
Pheripheral nerve sheath tumors

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