Clinical Assessment of the Neurosurgical Patient Flashcards

1
Q

What does CPP stand for?

A

Cerebral perfusion pressure

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2
Q

What is cerebral perfusion pressure (CPP)?

A

Net pressure gradient that drives oxygen delivery to cerebral tissue, measured in mmHg

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3
Q

What formula describes cerebral perfusion pressure?

A

CPP = MAP - ICP

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4
Q

What are some functions of the frontal lobe?

A
  • Voluntary control of movement
    • Precentral gyrus
  • Speech
    • Pars opercularis, pars triangularis
  • Saccadic eye movements
    • Frontal eye field
  • Bladder control
    • Paracentral lobule
  • Gait
    • Periventricular
  • Higher order
    • Restraint, initiative, and order (RIO)
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5
Q

What parts of the examination are important for frontal lobe?

A
  • Inspection
    • Decorticate posture
    • Magnetic gait
    • Urinary catheter
    • Abulia
  • Pyramidal weakness
    • UMN signs
      • Weakness, increased tone, brisk reflexes, up-going planter
      • Pronator drift
  • Saccadic eye movement
  • Primitive reflexes
  • Speech
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6
Q

What is the neurophychology of the frontal lobe?

A
  • Orbitofrontal cortex (restraint)
    • Mediates empathic, civil and socially appropriate behaviour
      • Is speech and behaviour socially appropriate
      • Go/no-go tests
      • Stroop test
  • Supplementary motor cortex/anterior cingulate (initiative)
    • Lack of motivation
    • Apathy (lack of enthusiasm or concern)
    • Abulia
    • Depression
  • Dorsolateral prefrontal cortex (order)
    • Executive function
      • The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
        • Ability to make an appointment and keep to time
        • Ability to give coherent account of history
        • Spell world backwards
        • Say as many words as possible with a particular letter
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7
Q

How does the orbitofrontal cortex control behaviour?

A
  • Orbitofrontal cortex (restraint)
    • Mediates empathic, civil and socially appropriate behaviour
      • Is speech and behaviour socially appropriate
      • Go/no-go tests
      • Stroop test
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8
Q

Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for restraint?

A

Oritofrontal cortex

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9
Q

Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for initiative?

A

Supplementary motor cortex/cingulate

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10
Q

Neurophychological aspects of the brain can be broken down into restraint, initiative and order. What part of the frontal lobe is responsible for order?

A

Dorsolateral prefonrtal cortex

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11
Q

What is the clinical presentation of problems with supplementary motor cortex/anterior cingulate, in terms of psychology?

A
  • Lack of motivation
  • Apathy (lack of enthusiasm or concern)
  • Abulia
  • Depression
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12
Q

What is apathy?

A

Lack of enthusiasm or concern

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13
Q

What can be done to test the dorsolateral prefrontal cortex?

A
  • Executive function
    • The integration of sensory information, the generation of a range of response alternatives to environmental challenges, selection of the most appropriate response, sequential ordering of data, self-evaluation of performance
      • Ability to make an appointment and keep to time
      • Ability to give coherent account of history
      • Spell world backwards
      • Say as many words as possible with a particular letter
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14
Q

What is done to examine language?

A
  • Ensure hearing is intact and patient’s first language is English
  • Handedness
  • Fluency (Broca’s)
  • Nominal aphasia
  • Repetition
  • 3 step command
  • Reading
  • Writing
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15
Q

What are functions of the parietal lobe?

A
  • Body image representation
    • Primary somatosensory area
  • Multimodality assimilation
  • Visuospatial coordination
  • Language
  • Numeracy
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16
Q

What is looked for when examining the parietal lobe?

A
  • Cortical sensory syndromes
    • Sensory inattention
    • Astereognosia
    • Dysgraphasthesia
    • Two point discriminiation
  • Dominant side (Gerstman’s syndrome)
    • Gyscalculia
    • Finger anomia
    • Left/right disorientation
    • Agraphia
  • Examining non-dominant
    • Ideomotor apraxia
    • ‘How to do’ light a match
    • Ideational apraxia
    • ‘What to do’, loss of understanding of the purpose of objects
    • Constructional apraxia
    • Dressing apraxia
    • Hemineglect
    • Loss of spatial awareness
17
Q

What are functions of the temporal lobe?

A
  • Processes auditory input (Heschl gyrus)
  • Language
  • Encoding declarative long term memory (hippocampus)
  • Emotion (amygdala)
  • Visual fields (Meyer’s loop)
18
Q

What part of the temporal lobe is responsible for processing auditory input?

A

Heschl gyrus

19
Q

What part of the temporal lobe is responsible for encoding declarative long term memory?

A

Hippocampus

20
Q

What part of the temporal lobe is responsible for emotion?

A

Amygdala

21
Q

What part of the temporal lobe is responsible for visual fields?

A

Meyer’s loop

22
Q

What are signs/symptoms for pathology in the cerebellum?

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
  • Past pointing
23
Q

What are different kinds of diseases of the spine?

A
  • Nerve root (radiculopathy)
    • Unilateral, single myotome, single dermatome, reflex, LMN
  • Peripheral nerve
    • Unilateral, motor and sensory deficit fits with PN, LMN
  • Cord (myelopathy)
    • Bilateral, motor, sensory level, UMN (long tract signs)
  • Peripheral neuropathy
24
Q

What are diseases of the nerve root called?

A

Radiculopathy

25
Q

What are diseases of the spinal cord called?

A

Myelopathy

26
Q

Describe the kinds of clinical presentations due to radiculopathy compared to peripheral nerve compared to myelopathy?

A
  • Nerve root (radiculopathy)
    • Unilateral, single myotome, single dermatome, reflex, LMN
  • Peripheral nerve
    • Unilateral, motor and sensory deficit fits with PN, LMN
  • Cord (myelopathy)
    • Bilateral, motor, sensory level, UMN (long tract signs)
27
Q

What are some long tract signs (myelopathy)?

A
  • Clonus, upgoing pantars, increased tone, Hoffman sign, brisk reflexes proprioception impairment, tandem walking
28
Q

What is clonus?

A

Muscular spasm involving repeated, often rhythmic, contractions