Clinical neurosurgery lecture [12/01/20] Flashcards
What is neurophobia?
Perceived complexity about neuroanatomy, neurological examination, multitude of rare disease
Three types of approaches to approaching a patient? Which is the modern approach?
- Disease orientated approach [diagnose on spot from Sx, simplistic]
- Localisation approach: take each patient Sx then draw vend diagram to get Dx
- Clinical syndrome: story of Pt, only 20 or so clinical syndromes mostly anatomically based. Modern way.
Name the 20 neuro clinical syndromes [very hard]
[look at slide]
if in doubt with neuro syndrome, what should you do?
Scan!
Which junction type does myasthenic syndrome involve?
Neuromuscular junction
Which part of the nerve does a radiculopathy affect?
Nerve root
Which part of the body does vertebral pain affect?
The discs/ligaments of the spine
Part of the body does a myelopathy affect?
The spine
Which cell in spine does MND affect?
Anterior horn cell
Where does a parasellar syndrome grow in the body?
Pituitary tumour
What can cause meningeal irritation?
Pus/blood against it
Put simply, what is a stroke?
Any neurological deficit
Part of the brain does extrapyramidal Sx indicate effected?
Basal ganglia
What is somatisation?
Psychological
Next steps if patient unable to give a history
- Collateral history
- ABC resus
Next steps if patient able to give a history?
- do pain tool
- do domain tool
- pick up on ‘patient speak phrases’
Following steps after speaking to patient who is able to give history
- hypothesis-based signs from framework headings
- core examination [incl. vital signs]
Final step in basic structure of neuro-assessment
Clinical syndrome secondary to [likely] underlying disease entity
Summarise basic neuro-assessment
[look up]
Reasons why patient may not be able to give a history
Patient confused, impaired level of consciousness, can;t speak language, tracheostomy, lower CN problems, struggling to speak, dysphasia, individuals who are deaf, special needs [sign language], ventilated people
What are the 5 vital signs?
Blood pressure, body temperature, pulse rate, respiratory rate, oxygen saturation
if something wrong with vital signs, what does this indicate?
A secondary brain problem is afoot
What is a primary brain problem?
A problem of the brain
Signs of an AAA
Pulse rate up, BP down, abdominal distention
Go through the GCS pointing system
[look at slide]
Name a way of doing a quick neuro examination
GCS!
Which examination should you do in ‘anal sphincter’ scenarios?
GCS! Happen about once monthly when you qualify.
Which drive present during anal sphincter moments? Describe it.
Sympathetic drive: rush adrenaline, logic out of window
Which part most important in the GCS?
Best motor response. Apply painful stimulus. Ensure doesn’t elicit reflex.
Best place to get a motor response?
Fingers back of jaw: won’t get bruising behind ears, can do jaw thrust easily from this position, squeeze same extent when can’t see hands
Another common place to do best motor response?
Supraorbital place
Which CN distribution does mastoid area for motor response sensation test?
Trigeminal nerve
Differentiate localising, flexing, and extending in the GCS
Localising: arm comes up to push away painful stimulus
Flexing: arm up but doesn’t push away
Extending: arm goes down and stays there
Which is better to use when presenting GCS, numbers or descriptors?
Descriptors! Less confusion.
When does GCS become a good predictor of outcome for patients?
If it is done an hour after the incident. Exceptions include if on tube and ventilation done on site [as anaesthetist has put pain medication down throat]
