Clinical assessment of neurosurgical patient Flashcards
Give examples of different people you can take a history from
the person, bystander, family member, paramedic, the notes?
3 main things to do on an obtunded patient?
ABC
GCS
pupils
CPP=
MAP-ICP
What can uncal herniation lead to and why?
permanently dilated pupil
uncus squeezed under tentorium presses on brainstem (midbrain) and on cranial nerves
What is cushings response and the 3 parts
compensate for rising ICP
raised blood pressure, bradycardia, apnea
Observations of non communicative patient
posture, focal lack of eye movement, neglect of part of face or body, eye movements
What else would you assess in a non communicative patient?
speech
MMS - confused
What can you assess in a communicative patient of neurological function? (split into 3 parts)
cranial eg which lobe, cerebellum, cranial nerves
spinal eg radiculopathy, myelopathy, which level
spinal nerve
2 MRI techniques to view neurological function
functional MRI and tractography
List some parts of the frontal lobe and their function
precentral gyrus - voluntary control of movements
pars opecularis+triangularis - speech
higher order - restraint, initiative, order
Examining frontal lobe
inspection eg urinary catheter UMN signs pronator drift saccadic eye movements speech
2 tests for restraint eg socially acceptable language
go/no go tests
stroop test
Supplementary motor cortex signs of dysfunction
lack of motivation
apathy
depression
abulia
Abulia
Inability to act decisively
Ways to examine language
hearing fluency eg brocas aphasia repetition 3 step command baby hippopotamus orofacial movement eg ppp,ttt,mmm reading and writing
Parietal lobe functions
body image representation visuospatial awareness language - wernickes multimodality assimilation numeracy
Astereoagnosia
Inability to identify an object by touch of the hand without visual input
dysgraphaesthesia
Form of agnosia - inability to interpret sensations
Examining parietal lobe
ideomotor apraxia, ideational apraxia, dressing apraxia, loss of spatial awareness, hemineglect
Temporal lobe functions
process auditory input
language
encoding long term memory - hippocampus
emotion - amygdala
Examining occipital lobe
Visual fields
Cerebellum - DANISHP
Dysdiadochokinesia ataxia nystagmus inattention tremor slurred speech hypotonia past pointing
Radiculopathy signs
unilateral, single myotome and dermatome - LMN
Peripheral nerve signs
unilateral, motor and sensory - LMN
Myelopathy signs
bilateral, motor and sensory, UMN
Peripheral neuropathy - body parts to remember?
stocking and glove
Where does a myelopathy happen (level) and why?
mostly cervical and thoracic as not much cord at lumbar region
Long tract signs of myelopathy
clonus, upgoing plantars, proprioception
What is Hoffman sign?
flexion of ipsilateral thumb
Example of cause of myelopathy and radiculopathy
myelopathy - herniated disc
radiculopathy - mass
