TRAUMA, TUMOURS AND SEIZURES

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TRAUMA, TUMOURS AND SEIZURES

• Brain trauma - concussion, contusion,
• hematoma
• Types of tumours
• Types of seizures and their treatment

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BRAIN TRAUMA

• 1. Primary - due to impact
• - mild concussion (? swelling)
• momentary interruption to
• function (may/not lose consc.)
• - moderate and severe contusion
• unconscious, deeper coma
• (bruising, hypoxia, hematoma)
• coup / contrecoup

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BRAIN TRAUMA

• 2. Hematomas - due to intacranial
• bleeding
• a) Epidural fracture ? arterial bleeding
• (rapid)
• b) Subdural head injury ? bridging veins torn,
  acute (?ICP) or chronic (slow)
• c) Subarachnoid arterial ? CSF
• d) Intracerebral injury, elderly ? ?ICP

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BRAIN TUMOURS

• 2 of all cancer deaths
• 3 types
• a) primary - CNS tissue (neurons, glia)
• b) primary - not brain tissue(meninges,
• pituitary gland)
• c) metastatic tumours

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BRAIN TUMOURS

• Most common types
• - Astrocytes 80 all glial tumours
• (usually become malignant)
• - Meningiomas (arachnoid) about
• 20 primary tumours (usually benign)
• - Pituitary adenomas - benign
• - Metastatic about 18 of all cancer
• patients develop metastases in brain

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BRAIN TUMOURS

• Manifestations
• ?ICP , obstructed CSF flow
• headache, nausea, visual disturbances, seizures
• pain is due to compression of meninges or blood
  vessels (brain not sensitive)
• vomiting without preceding nausea is common
  symptom of ?ICP and brainstem compression

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BRAIN TUMOURS

• Treatment
• Surgery
• Radiation - but not for children lt 2 yrs
• of age (? developmental delay)
• Chemotherapy - limited due to bbb (can deliver
  into CSF, or into brain at time of surgery)

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SEIZURES

• Spontaneous, uncontrolled discharge of neurons
  from cortical or subcortical centres
• Non-epileptic seizures - result of extreme
  metabolic disturbance due to
• - sedative/hypnotic drug withdrawal
• - meningitis, CVA
• - renal failure
• - fever (children)

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EPILEPSY

• Epileptic seizures - primary disorder of
  recurrent seizures without a reversible metabolic
  cause
• Types
• a) Partial (focal) - motor or sensory, do
• not lose consciousness
• b) Generalised - lose consciousness
• - tonic / clonic
• - absence

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EPILEPSY

• Diagnosisclinical history, abnormal EEG
• Causes neurons easily depolarised, ? membrane
  excitability (? glutamate)
• Treatment - drugs which
• - ? inhibition of neurons by blocking Na
  channels
• - potentiate inhibitory n.t. GABA
• - 60 - 80 patients obtain good seizure control