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Comprehensive Prep > Chapter 41: Neurosurgery > Flashcards

Chapter 41: Neurosurgery Flashcards

1
Q

come together to form a single basilar artery, which branches into 2 posterior cerebral arteries

A

vertebral arteries

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2
Q

connect middle cerebral arteries to posterior cerebral arteries

A

posterior communicating arteries

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3
Q

branches off middle cerebral arteries and are connected to each other thru the 1 anterior communicating artery

A

anterior cerebral arteries

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4
Q

no axonal injury (temporary loss of function, foot falls asleep)

A

neurapraxia

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5
Q

disruption of axon with preservation of axon sheath, will improve

A

axonotmesis

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6
Q

disruption of axon and axon sheath (whole nerve is disrupted), may need surgery for recovery

A

neurotmesis

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7
Q

how fast does regeneration of nerves occur?

A

1mm/day

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8
Q

nerves: bare sections; allows salutatory conduction

A

nodes of ranvier

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9
Q

what controls the release of antidiuretic hormone (ADH)?

A

release controlled by supraoptic nucleus of hypothalamus, which descends into the posterior pituitary gland

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10
Q

released in response to high plasma osmolarity; ADH increases water absorption in collecting ducts

A

antidiuretic hormone (ADH)

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11
Q

increased urine output
decreased urine specific gravity
increased serum Na
increased serum osmolarity

A

diabetes insipidus (decreased ADH)

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12
Q

two situations which can cause diabetes insipidus

A

ETOH, head injury

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13
Q

tx: diabetes insipidus

A

DDAVP, free water

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14
Q 
decreased urine output
concentrated urine
decreased serum Na
decreased serum osmolarity 
- can occur with head injury
A

SIADH (increased ADH)

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15
Q

Tx: SIADH

A

fluid restriction, then diuresis

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16
Q

50% present with hemorrhage; are congenital

- usually in patients

A

arteriovenous malformation

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17
Q

tx: arteriovenous malformation

A

resection if symptomatic

- can coil embolize these prior to resection

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18
Q

usually occur in patients > 40; most are congenital.

- can present with bleeding, mass effect, seizures, or infarcts

A

cerebral aneurysms

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19
Q

where do cerebral aneurysms most likely occur?

A

occur at branch points in artery, most off middle cerebral artery

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20
Q

tx: cerebral aneurysm

A

often place coils before clipping and resecting aneursym

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21
Q

cause by torn bridging veins

A

subdural hematoma

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22
Q
  • has crescent shape on head CT and conforms to brain

- higher mortality than epidural hematoma

A

subdural hematoma

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23
Q

tx: subdural hematoma

A

operate for significant neurologic degeneration of mass effect (shift > 1cm)

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24
Q

caused by injury to middle meningeal artery

  • has lens shape on heat CT and pushes brain away
  • patients classically lose consciousness, have a lucid interval, and then lose consciousness again
A

epidural hematoma

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25
Q

tx: epidural hematoma

A

operate for significant neurologic degeneration or mass effect (shift > 0.5 cm)

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26
Q

caused by cerebral aneurysms (50% middle cerebral artery) and AVMs
- symptoms: stiff neck (nuchal rigidity), severe headache, photophobia, neurologic defects

A

subarachnoid hemorrhage (nontraumatic)

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27
Q

tx: subarachnoid hemorrhage (nontraumatic)

A

goal is to isolate the aneurysm from systemic circulation (clipping vascular supply), maximize cerebral perfusion to overcome vasospasm, and prevent rebleeding; use hypervolemia and CCB to overcome vasospasm

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28
Q

when do you go to OR for subarachnoid hemorrhage?

A

go to OR only if neurologically intact

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29
Q

lobe most often affected in intracerebral hematomas

A

temporal lobe most often affected

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30
Q

management: intracerebral hematomas

A

those that are large and cause focal deficits should be drained

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31
Q

symptoms of increased ICP

A

stupor, headache, nausea and vomiting, stiff neck

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32
Q

signs of increased ICP

A

hypertension, HR lability, slow respirations

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33
Q

sign of severely elevated ICP and impending herniation

A

intermittent bradycardia

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34
Q

hypertension
bradycardia
slow respiratory rate

A

Cushing’s triad

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35
Q

tx: spinal cord injury with deficit

A

give high dose steroids (decreased swelling)

36
Q

areflexia
flaccidity
anesthesia
autonomic paralysis below the level of the lesion

A

complete spinal cord transection

37
Q

hypotension, normal or slow heart rate, and warm extremities (vasodilator)
- occurs with spinal cord injuries above T5 (loss of sympathetic tone)

A

spinal shock

38
Q

tx: spinal shock

A

fluids initially, may need phenylephrine drip (alpha agonist)

39
Q

mcc anterior spinal artery syndrome

A

most commonly occurs with acutely ruptured cervical disc

40
Q
  • bilateral loss of motor, pain, and temperature sensation below the level of lesion
  • preservation of position-vibratory sensation and light touch
A

anterior spinal artery syndrome

41
Q

rate of peeps that recover to ambulation with anterior spinal artery syndrome

A

about 10% recover to ambulation

42
Q

incomplete cord transection (hemisection of cord); most commonly due to penetrating injury

A

brown-sequard syndrome

43
Q

symptoms of brown-sequard syndrome

A

loss of ipsilateral motor and contralateral pain/temperature below level of lesion

44
Q

rate of peeps that recover to ambulation with brown-sequard syndrome

A

about 90% recovery to ambulation

45
Q

mcc central cord syndrome

A

most commonly occurs with hyperflexion of the cervical spine

46
Q

bilateral loss motor, pain, and temperature sensation in upper extremities; lower extremities spared

A

central cord syndrome

47
Q

pain and weakness in lower extremities due to compression of lumbar nerve roots

A

cauda equina syndrome

48
Q

carries pain and temperature sensory neurons

A

spinothalamic tract

49
Q

carries motor neurons

A

corticospinal tract

rubrospinal tract

50
Q

are generally afferent; carry sensory fibers

A

dorsal nerve roots

51
Q

are generally efferent; carry motor neuron fibers

A

ventral nerve roots

52
Q

headache, seizures, progressive neurologic deficit, and persistent vomiting

A

brain tumors

53
Q

where do most brain tumors present in adults?

A

adults: 2/3 supratentorial

54
Q

where do most brain tumors present in children?

A

children: 2/3 infratentorial

55
Q

most common primary brain tumor in adults and overall

A

gliomas

56
Q

most common subtype of glioma, uniformly fatal

A

glioma multiforme

57
Q

1 metastasis to brain

A

lung

58
Q

most common brain tumor in children

A

medulloblastoma

59
Q

most common metastatic brain tumor in children

A

neuroblastoma

60
Q

arises from the 8th cranial nerve at the cerebellopontine angle

A

acoustic neuroma

61
Q

symptoms: hearing loss, unsteadiness, vertigo, nausea, and vomiting
- tx: surgery usual

A

acoustic neuroma

62
Q

overal most are benign; #1 spine tumor overall

A

neurofibroma

63
Q

spinal tumors: more likely benign

A

intradural tumors

64
Q

spinal tumors: more likely malignant

A

extradural tumors

65
Q

what do you check for with paraganglioma?

A

check for metanephrines in urine

66
Q

what causes intraventricular hemorrhage (subependymal hemorrhage) in premature infants?

A

secondary to rupture of the fragile vessels in germinal matrix

67
Q

risk factors for intraventricular hemorrhage in premature infants

A

ECMO, cyanotic congenital heart disease

- patients go on to get intraventricular hemorrhage

68
Q

symptoms: bulging fontanelle, neurologic deficits, decreased BP and decreased Hct
- tx: ventricular catheter for drainage and prevention of hydrocephalus

A

intraventricular hemorrhage (subependymal hemorrhage)

69
Q
  • neural cord defect: herniation of spinal cord and nerve roots through defect in vertebra
  • most commonly occurs in the lumbar region
A

myelomeningocele

70
Q

speech comprehension, temporal lobe

A

Wernicke’s area

71
Q

speech motor, posterior part of anterior lobe

A

broca’s lobe

72
Q

dx/tx: pituitary adenoma, undergoing XRT, patient now in shock

A

dx: pituitary apoplexy
tx: steroids

73
Q

cervical nerve roots innervating diaphragm

A

cervical nerve roots 3-5

74
Q

acts as brain macrophages

A

microglial cells

75
Q

CN1

A

olfactory - smell

76
Q

CN2

A

optic - sight

77
Q

CN3

A

oculomotor - motor to eye

78
Q

CN4

A

trochlear - superior oblique (eye)

79
Q

CN5

A

trigeminal: ophthalmic, maxillary, and mandibular branches
- sensory to face
- muscles of mastication

80
Q

CN6

A

abducens

  • taste to anterior 2/3 of tongue
  • motor to face
81
Q

CN7

A

facial

  • taste to anterior 2/3 of tongue
  • motor to face
82
Q

CN8

A

vestibulocochlear

- hearing

83
Q

CN9

A

glossopharyngeal

  • taste to posterior 1/3 of tongue
  • swallowing muscles
84
Q

CN10

A

vagus

- many functions

85
Q

CN 11

A

accessory

- trapezius, SCM

86
Q

CN12

A

hypoglossal

- tongue

Comprehensive Prep (45 decks)

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