Cranial Neurosurgery Flashcards
When high pressure headache of raised ICP is worsen ?
On coughing or bending forward
What is detected in fundoscopy in Raised ICP
Papilloedema
Loss of upgaze known as sunsetting is a feature of which syndrome ?
Parinaud’s Syndrome
What is the first line investigation to identify cause of raised ICP ?
CT
What is the gold standard for quantifying ICP and monitoring in real time ?
EVF or insertion of a pressure monitor
Clinical features of acutely raised ICP ?
1)High Pressure Headache 2)Nausea And vomiting 3)Diplopia And Blurred Vision 4)Drowsiness then coma
Where is CSF absorbed?
Arachnoid Granulations
Who are presented with idiopathic intracranial hypertension? (IIH)
Young overweight women
Clinical features of IIH
High pressure headaches and visual deterioration
Findings of IIH
1)Papilloedema 2)Occasionally Cranial nerve palsies 3) Imaging is unremarkable 3) Lumbar punture demonstrates a raised opening pressure >25mmHg
Management of IIH
1)Weight loss 2)Cessation of OCP
3)Acetazolamide to reduce CSF production
4)Serial lumbar puncture and CSF diversion as a last resort
Normal pressure hydrocephalus features
🫐Potentially reversible cause of dementia
🫐Gait Disturbance
🫐Incontinence
🫐Cognitive Decline
Where is EVF inserted ?
At Kocher’s point ( Right of midline, Anterior to the coronal suture)
Typical organisms of meningitis are
Staphylococcus aureus , Enterobacteriaceae , Pseudomonas , pneumococci
Clinical features of meningitis
1)Fever 2)Headache 3)Neck Stiffness 4)Photophobia
Clinical features of brain abscess
🍓Low Grade Fever
🍓Confusion
🍓Seizures and focal deficit
What is the initial imaging modality of choice in brain abscess ?
CT scan with contrast
Findings of CT scan with contrast for brain abscess
🫐In first few days hypo dense oedematous brain representing early cerebritis is visible
🫐 As the abscess matures classic appearances of a smooth walled , well defined , ring enhancing mass develop
A subdural empyema associated with osteomyelitis of the frontal Bone and associated scalp swelling is known as
Pott’s puffy tumour
What is the CT appearances of subdural empyema?
🍓Appearances of hypo dense or isodense sub Dural collection, with contrast enhancement at the margins and often swelling and midline shift
🍓Typically a crescentic collection with a contrast enhancing rim
What is the mainstay treatment of sub Dural empyema ?
Drainage
How TB infection of CNS represents from primary pulmonary foci?
Haematogenous spread
Primary sites of TB
Lungs, lymph node , Gut , Skin
Most common cause of SAH
Trauma
Main cause of spontaneous SAH
Result of bleeding from a ruptured aneurysm
Most common site of aneurysm
Anterior communicating artery
What type of headache is seen in SAH ?
Thunderclap headache which is both sudden and severe and is outside the patients normal experience
What results in painful third nerve palsy ?
Compression from posterior communicating artery aneurysm
The combination of SAH and vitreous haemorrhage is known as
Terson’s Syndrome
What is visible in fundoscopy of SAH ?
Intraocular haemorrhage classically subhyloid
What is the first choice of imaging in SAH ?
CT scan
Gold standard for SAH ?
DSA(Digital Subtraction Angiography)
What is administred in SAH to reduce the incidence of vasospasm and delayed ischaemic neurological deficit ?
Oral Nimodipine at a dose of 60mg every 4 hours
What is the commonest brain tumor ?
Metastasis
Features of brain tumor includes
🍪Raised ICP
🍪Seizures
🍪Neurological Deficit
When the brain tumor is located at pituitary the expected deficit is
Bitemporal Hemianopia ; Gaze palsies
When the brain tumor is located at occipital the expected deficit is
Homonymous hemianopia with central sparing
Tissue of origin for Brain metastases -
📍Lung (40%)
📍Breast
📍Melanoma
📍Renal/Genitourinary
📍Others/Unknown
Initial management of brain tumor -
High-dose steroids to alleviate any mass effect
30% of adenomas are
Prolactinomas
What is neural tube defects ?
Failure to closure of the neural tube is associated with folate deficiency, family history and some anticonvulsants
How to detect neural tube defects ?
🔹Prenatal screening using serum alpha feta protein levels and ultrasounds
🔹Diagnostic testing using amniocentesis
What is spina bifida occulta ?
A congenial absence of a spinous process, without exposure of meninges or neural tissue , but presenting a characteristics shallow hair-covered hollow at the base of spine
What’s meningocele?
A sac of meninges,covered by skin and containing CSF alone, herniates through an anterior or posterior bony defect
What’s myelomeningocele ?
A herniating sac of meninges without covering skin contains spinal cords,nerves or both. This is always associated with Chiari II malformation
Premature fusion of Sagittal suture
Scaphocephaly
Premature fusion of coronal suture
Brachycephaly
In brain stem death entails testing twice , by two clinicians , to demonstrates the absence of :
🔴Response to pain
🔴Respiratory drive (Apnea despite a PCO2>6.7kPa)
🔴Pupillary Light reflex
🔴Corneal reflex
🔴Vestibulo-ocular reflex
🔴Oculocephalic reflex
🔴Gag reflex
