Cushing's Triad (RICP Finding)

Cushing's Triad Background:

• Named after the American neurosurgeon Harvey Williams Cushing (1869-1939).

Components of Cushing's Triad:

• Bradycardia
• Respiratory pattern change (irregular respirations)
• Widening pulse pressure (rising systolic + declining diastolic)

Pathophysiology:

• Produced by the Cushing reflex.
• Sign of raised intracranial pressure (RICP).
• May lead to brain herniation, which can be rapidly fatal.

Clinical Details:

• Suggests severe pressure within the cranial vault.

Causative Factors:

• Intracerebral hemorrhage
• Head trauma
• Enlarging space-occupying lesion (i.e. brain tumor)

Tags: Bradycardia - Brain herniation - Brain Tumour - Cushing's Reflex - Cushing's Triad - Head Trauma - Intracerebral haemorrhage - RICP
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Cerebral Cortex Brodmann Areas Listed

Brodmann Areas Listed:

• Areas 3, 1 & 2 - Primary Somatosensory Cortex (typically referred to as Areas 3, 1, 2 by convention)
• Area 4 - Primary Motor Cortex
• Area 5 - Somatosensory Association Cortex
• Area 6 - Premotor cortex and Supplementary Motor Cortex (Secondary Motor Cortex)(Supplementary motor area)
• Area 7 - Somatosensory Association Cortex
• Area 8 - Includes Frontal eye fields
• Area 9 - Dorsolateral prefrontal cortex
• Area 10 - Anterior prefrontal cortex (most rostral part of superior and middle frontal gyri)
• Area 11 - Orbitofrontal area (orbital and rectus gyri, plus part of the rostral part of the superior frontal gyrus)
• Area 12 - Orbitofrontal area (used to be part of BA11, refers to the area between the superior frontal gyrus and the inferior rostral sulcus)
• Area 13 and Area 14 - Insular cortex
• Area 15* - Anterior Temporal Lobe
• Area 17 - Primary visual cortex (V1)
• Area 18 - Secondary visual cortex (V2)
• Area 19 - Associative visual cortex (V3)
• Area 20 - Inferior temporal gyrus
• Area 21 - Middle temporal gyrus
• Area 22 - Superior temporal gyrus, of which the caudal part is usually considered to contain the Wernicke's area
• Area 23 - Ventral Posterior cingulate cortex
• Area 24 - Ventral Anterior cingulate cortex
• Area 25 - Subgenual cortex
• Area 26 - Ectosplenial area
• Area 27 - Piriform cortex
• Area 28 - Posterior Entorhinal Cortex
• Area 29 - Retrosplenial cingulate cortex
• Area 30 - Part of cingulate cortex
• Area 31 - Dorsal Posterior cingulate cortex
• Area 32 - Dorsal anterior cingulate cortex
• Area 33 - Part of anterior cingulate cortex
• Area 34 - Anterior Entorhinal Cortex (on the Parahippocampal gyrus)
• Area 35 - Perirhinal cortex (on the Parahippocampal gyrus)
• Area 36 - Parahippocampal cortex (on the Parahippocampal gyrus)
• Area 37 - Fusiform gyrus
• Area 38 - Temporopolar area (most rostral part of the superior and middle temporal gyri)
• Area 39 - Angular gyrus, also considered by some to be part of Wernicke's area
• Area 40 - Supramarginal gyrus considered by some to be part of Wernicke's area
• Areas 41 & 42 - Primary & Auditory Association Cortex
• Area 43 - Subcentral area (between insula and post/precentral gyrus)
• Area 44 - Pars opercularis, part of Broca's area
• Area 45 - Pars triangularis Broca's area
• Area 46 - Dorsolateral prefrontal cortex
• Area 47 - Inferior prefrontal gyrus
• Area 48 - Retrosubicular area (a small part of the medial surface of the temporal lobe)
• Area 49 - Parasubicular area in a rodent
• Area 52 - Parainsular area (at the junction of the temporal lobe & the insula)

Image: from Gray's Anatomy
Tags: Brodmann Area - Cerebral Cortex
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Vagus Nerve Stimulation (VNS) Treatment Uses

VNS Clinical Uses:

• Intractable epilepsy
• Treatment resistant depression

Other Uses For VNS Under Investigation:

• Alzheimer's disease
• Anxiety disorders
• Fibromyalgia
• Migraines
• Tinnitus

Reference:

• Groves, Duncan A., Brown, Verity J. (2005). Vagus Nerve Stimulation: A Review of its Applications and Potential Mechanisms That Mediate its Clinical Effects. Neuroscience and Biobehavioral Reviews, 29: 493-500.

Tags: Depression - Epilepsy - Vagus Nerve Stimulation
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CSF Glucose - Low Levels

General Details:

• Also known as hypoglycorrhachia.

Causes of Low CSF Glucose:
Infection:

• Lyme disease
• Pyogenic meningitis
• TB meningitis
• Fungal Meningitis

Viral Infection (occasionally):

• Herpes simplex encephalitis
• Mumps meningoencephalitis
• Zoster encephalitis

Other:

• Meningeal carcinomatosis
• Sarcoidosis
• Subarachnoid haemorrhage

Image: D-glucose structural formula
Image Source: from Wikipedia by Richard Wheeler (Zephyris) (Public Domain)
Tags: Herpes Simplex - Herpes Zoster - Lyme Disease - Meningitis - Sarcoidosis - Subarachnoid Haemorrhage
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CSF Protein Level - Marked Elevation

Causes of Markedly Raised CSF Protein:

• Acoustic neuroma
• Alcoholism
• Amyloidosis
• Diabetes mellitus
• Froin's syndrome
• Guillain-Barre syndrome
• Meningitis - Acute Bacterial
• Meningitis - Carcinomatous

Tags: Acoustic neuroma - Alcoholism - Amyloidosis - Diabetes mellitus - Froin's syndrome - Guillain-Barre syndrome - Meningitis
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Ictal Autonomic Phenomena - Listed By Systems

Cardiac:

• Arrhythmia
• Bradycardia
• Chest pain
• Palpitations
• Tachycardia

Vascular:

• Hypertension
• Hypotension

Respiratory:

• Apnoea
• Cough
• Hyperventilation
• Hypoxia

Gastrointestinal / Abdominal:

• Abdominal pain
• Belching
• Borborygmi
• Dyspepsia (ascending sensation)
• Faecal incontinence
• Hunger
• Nausea
• Salivation
• Vomiting
• Urge to defecate

Genito-urinary:

• Genital Erection
• Genital sensations
• Orgasm
• Urinary incontinence
• Urinary urgency

Cutaneous (Dermatological):

• Blanching
• Cyanosis
• Erythema
• Flushing
• Pallor
• Perspiration
• Piloerection

Ocular:

• Hippus
• Lacrimation
• Miosis
• Mydriasis

Image: from Gray's Anatomy, plate 839 (Public Domain)

Source: Epilepsy and the Autonomic Nervous System (Medscape)

Tags: Autonomic - Ictal - Seizure
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Medicalchemy Neuroscience Blog

This Medicalchemy (TM) blog will be about Neuroscience related topics.

Tags: Blog Neuroscience
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