CM: Neurosurgery

Question 1

What is the Glasgow scoring for best eye opening?

Answer 1

1 - none
2 - to pain
3 - to speech
4 - spontaneous

Question 2

What is the Glasgow scoring for best verbal?

Answer 2

1 - none
2 - incomprehensible
3 - inappropriate
4 - confused
5 - oriented

Question 3

What is Glasgow scoring for best motor?

Answer 3

1 - none
2 - extensor (decerebrate)
3 - flexion (decorticate)
4 - withdraws to pain
5 - localizes pain
6 - obeys

Question 4

What are the interpretations of different Glasgow scores?

Answer 4

8 or less: severe head injury (coma)
9-12: moderate head injury
13-15: mild head injury

Question 5

What are the different types of skull fractures?

Answer 5

open vs. closed - open require operative rx, closed may require elevation if depressed greater than thickness of bone
skull base fracture: dural lacerations may lead to CSF leak skull base –> rhinorrhea, otorrhea

Question 6

What symptoms do fractures of the petrous portion of temporal bone lead to?

Answer 6

7th nerve palsy, Battle’s sign (ecchymosis over mastoid), raccoon’s eyes, hemotympanum

Question 7

What are the main signs of an epidural hematoma?

Answer 7

dilated ipsilateral pupil, contralateral hemiparesis

= classic lens shape on imaging

Question 8

What are the differences between chronic and acute subdural hematomas?

Answer 8

chronic - clot liquefies, won’t see dense blood on imaging, rx is craniotomy or burr holes
acute - see dense blood on imaging, associated w parenchymal injury –> worse outcome, rx is surgical

Question 9

What is the treatment for contusions/intracerebral hemorrhage?

Answer 9

generally nonsurgical unless mass effect

Question 10

What is the Monroe-Kellie doctrine?

Answer 10

skull is fixed box - increase in one volume means increased pressure and compensatory decrease in other components

Question 11

What are lumbar puncture findings in subarachnoid hemorrhage?

Answer 11

increased RBCs that don’t clear w successive tubes, elevated opening pressure, xanthochromia

Question 12

Where do saccular,fusiform and mycotic aneurysms tend to occur?

Answer 12

saccular - anterior circulation - related to hemodynamic factors
fusiform - posterior circulation - related to atherosclerosis
mycotic - distal branches

Question 13

What are the treatment options for aneurysms?

Answer 13

surgical clipping

endovascular coiling

Question 14

What is the etiology of vasospasm?

Answer 14

blood in subarachnoid space leads to irritation and spasm of cerebral arteries

Question 15

What is the treatment of vasospasm?

Answer 15

Ca channel blockers, HHH therapy (hypervolemia, hemodilution, HTN), mechanical balloon dilatation for focal areas
clinical window is post bleed day 3-14