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Drafts of absite from online deck > 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
tx: epidural hematoma
operate for significant neurologic degeneration or mass effect (shift > 0.5 cm)
26
caused by cerebral aneurysms (50% middle cerebral artery) and AVMs - symptoms: stiff neck (nuchal rigidity), severe headache, photophobia, neurologic defects
subarachnoid hemorrhage (nontraumatic)
27
tx: subarachnoid hemorrhage (nontraumatic)
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
28
when do you go to OR for subarachnoid hemorrhage?
go to OR only if neurologically intact
29
lobe most often affected in intracerebral hematomas
temporal lobe most often affected
30
management: intracerebral hematomas
those that are large and cause focal deficits should be drained
31
symptoms of increased ICP
stupor, headache, nausea and vomiting, stiff neck
32
signs of increased ICP
hypertension, HR lability, slow respirations
33
sign of severely elevated ICP and impending herniation
intermittent bradycardia
34
hypertension bradycardia slow respiratory rate
Cushing's triad
35
tx: spinal cord injury with deficit
give high dose steroids (decreased swelling)
36
areflexia flaccidity anesthesia autonomic paralysis below the level of the lesion
complete spinal cord transection
37
hypotension, normal or slow heart rate, and warm extremities (vasodilator) - occurs with spinal cord injuries above T5 (loss of sympathetic tone)
spinal shock
38
tx: spinal shock
fluids initially, may need phenylephrine drip (alpha agonist)
39
mcc anterior spinal artery syndrome
most commonly occurs with acutely ruptured cervical disc
40
- bilateral loss of motor, pain, and temperature sensation below the level of lesion - preservation of position-vibratory sensation and light touch
anterior spinal artery syndrome
41
rate of peeps that recover to ambulation with anterior spinal artery syndrome
about 10% recover to ambulation
42
incomplete cord transection (hemisection of cord); most commonly due to penetrating injury
brown-sequard syndrome
43
symptoms of brown-sequard syndrome
loss of ipsilateral motor and contralateral pain/temperature below level of lesion
44
rate of peeps that recover to ambulation with brown-sequard syndrome
about 90% recovery to ambulation
45
mcc central cord syndrome
most commonly occurs with hyperflexion of the cervical spine
46
bilateral loss motor, pain, and temperature sensation in upper extremities; lower extremities spared
central cord syndrome
47
pain and weakness in lower extremities due to compression of lumbar nerve roots
cauda equina syndrome
48
carries pain and temperature sensory neurons
spinothalamic tract
49
carries motor neurons
corticospinal tract | rubrospinal tract
50
are generally afferent; carry sensory fibers
dorsal nerve roots
51
are generally efferent; carry motor neuron fibers
ventral nerve roots
52
headache, seizures, progressive neurologic deficit, and persistent vomiting
brain tumors
53
where do most brain tumors present in adults?
adults: 2/3 supratentorial
54
where do most brain tumors present in children?
children: 2/3 infratentorial
55
most common primary brain tumor in adults and overall
gliomas
56
most common subtype of glioma, uniformly fatal
glioma multiforme
57
#1 metastasis to brain
lung
58
most common brain tumor in children
medulloblastoma
59
most common metastatic brain tumor in children
neuroblastoma
60
arises from the 8th cranial nerve at the cerebellopontine angle
acoustic neuroma
61
symptoms: hearing loss, unsteadiness, vertigo, nausea, and vomiting - tx: surgery usual
acoustic neuroma
62
overal most are benign; #1 spine tumor overall
neurofibroma
63
spinal tumors: more likely benign
intradural tumors
64
spinal tumors: more likely malignant
extradural tumors
65
what do you check for with paraganglioma?
check for metanephrines in urine
66
what causes intraventricular hemorrhage (subependymal hemorrhage) in premature infants?
secondary to rupture of the fragile vessels in germinal matrix
67
risk factors for intraventricular hemorrhage in premature infants
ECMO, cyanotic congenital heart disease | - patients go on to get intraventricular hemorrhage
68
symptoms: bulging fontanelle, neurologic deficits, decreased BP and decreased Hct - tx: ventricular catheter for drainage and prevention of hydrocephalus
intraventricular hemorrhage (subependymal hemorrhage)
69
- neural cord defect: herniation of spinal cord and nerve roots through defect in vertebra - most commonly occurs in the lumbar region
myelomeningocele
70
speech comprehension, temporal lobe
Wernicke's area
71
speech motor, posterior part of anterior lobe
broca's lobe
72
dx/tx: pituitary adenoma, undergoing XRT, patient now in shock
dx: pituitary apoplexy tx: steroids
73
cervical nerve roots innervating diaphragm
cervical nerve roots 3-5
74
acts as brain macrophages
microglial cells
75
CN1
olfactory - smell
76
CN2
optic - sight
77
CN3
oculomotor - motor to eye
78
CN4
trochlear - superior oblique (eye)
79
CN5
trigeminal: ophthalmic, maxillary, and mandibular branches - sensory to face - muscles of mastication
80
CN6
abducens - taste to anterior 2/3 of tongue - motor to face
81
CN7
facial - taste to anterior 2/3 of tongue - motor to face
82
CN8
vestibulocochlear | - hearing
83
CN9
glossopharyngeal - taste to posterior 1/3 of tongue - swallowing muscles
84
CN10
vagus | - many functions
85
CN 11
accessory | - trapezius, SCM
86
CN12
hypoglossal | - tongue

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