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Neurosurgery Review > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

Patchell’s study findings

A

patients with MESCC, wide decompression and reconstruction if appropriate can keep patients ambulating and extend life expectancy when paraplegia < 48 hrs, life expectancy > 3 months, and no multiple non-continguous stenotic regions

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2
Q

Suprascapular nerve does…

A

Supraspinatous - shoulder abduction

Infraspinatous - external rotation

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3
Q

Brachial plexopathy, EMG findings will show sensory nerve action potential will be…

A

SNAP will be abnormal because injuries distal to DRG

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4
Q

What is the most common major motor nerve affected by diabetic amyotrophy

A

Femoral nerve

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5
Q

What is Lambert-Eaton syndrome

A
  • caused by antibodies to presynaptic calcium channels, associated with paraneoplastic disorders (SCLC)
  • presents with weakness early in the morning and improves with time
  • weakness overcome with exercise
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6
Q

What is a high riding vertebral artery

A

VA passes close to the C2 pedicle, making C2 pedicle screws dangerous
Most cases do not need a contrast scan

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7
Q

What is the decerebrate response, and what spinal cord tract mediates this response

A

Extension posturing, a lesion between the superior and inferior colliculi releases the inhibition on vestibular nucleus

Vestibulospinal tract begins in the Dieter’s nucleus (vestibular nucleus) and descends to rexed lamina 7, 8, and 9. Mediates extensor tone and usually under tonic inhibition by higher brain centers.

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8
Q

What is the most common mycotic infection in the CNS

A

Candidiasis

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9
Q

What is the most common bug for diskitis/osteomyelitis related to IVDU

A

S aureus

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10
Q

What are the contents of the carpal tunnel?

A

Carpal tunnel is made of bones of the wrist and transverse carpal ligament

It contains median nerve, tendons of the FDS (flexor digitorum superficialis), FDP, and FPL (flexor pollicis longus).

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11
Q

What is the fencer’s posture?

A

Classic for posterior frontal (motor strip) seizure onset

Head turned to the right, right arm extends, left arm flexes and abducts

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12
Q

Follow-up plan for < 1.5 cm acoustic neuroma with intact hearing

A

Serial scans every 6 months

If > 2cm, treatment is recommended

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13
Q

What is the most common isolate from brain abscesses in adults?

A

Strep. milleri

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14
Q

How long will it take IV vitamin K to normalize INR in a patient on warfarin?

A

24-72 hrs

Because vit K dependent coagulation factors have long half lives

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15
Q

What is the major complication of impenem?

A

generalized seizures in 3%

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16
Q

Neurenteric cysts: characteristics, pathophysiology

A

Also embryologic inclusion cyst
Remnants of persistent endodermal cell rests that remained attached to ectoderm
Can rupture and cause meningitis
Ventral location

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17
Q

SRS dose for acoustic neuromas

A

12-13 Gy, good tumor control with decreased complications to CN 7 and 8

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18
Q

What is the ideal entry for syringosubarachnoid shunt?

A

Dorsal root entry zone DREZ

May be the thinnest part of the cord

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19
Q

How to differentiate pre and post ganglionic brachial plexus injuries

A

Preganglionic injuries - from nerve root avulsion; no neurolysis or repair will fix this injury

  • often demonstrate winged scapula (long thoracic loss)
  • pseudomeningocele
  • Horner’s syndrome (lower trunk injuries)
  • intact SNAP

Postganglionic injuries have disrupted SNAP

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20
Q

Idiopathic brachial plexitis, “Parsonage-Turner Syndrome”

A

Severe shoulder pain without weakness, followed by weakness in one or more muscle groups

89% recovery at 3 years

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21
Q

EMG H reflex

A

S1 nerve; spinal cord reflex arc

if H reflex absent, but F wave is intact, then injury is at the DRG

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22
Q

EMG F wave

A

a way to determine the integrity of the motor roots

supramaximal stimulation of peripheral motor nerves
wave propagates proximally through nerve root into spinal canal, and fires other nerve roots as well

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23
Q

When is ossification of the axis complete

A

by 11 years of age

4 different ossification centers

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24
Q

What pathway mediates mydriasis

A

Hypothalamus –> intermediolateral cell column –> superior cervical ganglion –> long ciliary nerves (dilates pupil)

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25
Q

What is Paget’s disease

A

“Picture frame vertebral bodies”

Can also have hearing loss, and higher risk of bony tumors

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26
Q

According to landmark controlled trial on MTE, what % of patients complete seizure free at 1 year?

A

60%

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27
Q

Lateral recess stenosis is a common cause of radicular leg pain, what is compressing on the nerve?

A

SAP of the vertebrae below

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28
Q

Post op management of DNET

A

Observation

No XRT or chemo after GTR

WHO grade 1, medically intractable epilepsy

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29
Q

Pineal tumor with + BHCG, - AFP, - PLAP

A

Choriocarcinoma

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30
Q

Dysembryoplastic gangliocytoma of cerebellum

A

Also Lhermitte-Duclos syndrome

PTEN mutation
Cowden’s syndrome
also associated with multiple trichilemmomas, breast, and endometrial carcinoma

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31
Q

Wyburg-Mason syndrome

A

presents with facial nevi, orbital/optic pathway AVMs

presents with SAH, seizures

underlying cause unknown

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32
Q

Marchiafava-Bignami disease

A

classic “Italian man” disorder, those who consume ++ wine

demyelination, necrosis of CC

onset leads to initially nonspecific symptoms including depression, memory loss, and confusion

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33
Q

Hnad-Schuller-Christian triad

A

exopthalmos from intraorbital tumor

lytic bone lesions in the cranium

diabetes insipidus from mass

because of Langerhans cell histiocytosis

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34
Q

Difference between a Sunderland grade III and IV lesion

A

Immobile Tinel’s Sign

In grade III injury, the tinel sign over the injury slowly progresses distally with nerve regeneration

Neuroma in continuity develops in grade IV lesions - Immobile Tinel’s Sign

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35
Q

What is F wave most helpful in determining what underlying disorder?

A

Multilevel radiculopathy - suggests multilevel involvement

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36
Q

Cause of PCNSL in HIV patient?

A

EBV, B cell type

5% of HIV patients

median survival 3 months

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37
Q

Joubert syndrome

A

molar tooth malformation on MRI

cerebellar peduncle hypoplasia

small midbrain

batwing shaped 4th ventricle

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38
Q

Internal arcuate fibers

A

Decussating connections in the medulla where myelinated neurons from nucleus gracilis and cuneatus form the medial lemniscus

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39
Q

Kawase’s triangle, or posteromedial triangle

A

V3 mandibular nerve
GSPN inferiorly
superior petrosal sinus

allows by anterior petrosectomy, connecting middle and posterior cranial fossa; contains petrous corner of ICA, and lateral aspect contains the cochlea

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40
Q

SEGA: histology

A

gemistocytic type cells with large eosinophilic cytoplasm, large eccentric nucleus

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41
Q

Verocay bodies

A

sequential nuclear palisading

present in schwannomas

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42
Q

Charcot-Marie-Tooth disease

A

peripheral neuropathies, lower extremity deformities

onion bulb formation in peripheral nerve system

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43
Q

Suprachiasmatic nucleus of hypothalamus

A

Circadian rhythm

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44
Q

Duration of rocuronium

A

30-90 minutes

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45
Q

Friedrich’s ataxia

A

autosomal recessive

mutation in frataxin gene, iron transport into mitochondria

trunk and limb ataxia, nystagmus, sensory loss, spasticity with hyporeflexia

often die by 40 years of age

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46
Q

What is the maximum safe dose of radiation to the optic apparatus?

A

10 Gy

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47
Q

Percentage of patients with recurrent lumbar disk herniation after discectomy

A

4% at 10 years, 1/3 of those in the first year

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48
Q

Ligament of Struthers

A

connects a supracondylar process(5 cm proximal to medial epicondyle) to medial epicondyle

present in 3% of patients, median nerve and brachial artery passes there

compresses median nerve

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49
Q

What structures pass through the ambient cistern?

A

CN 4, basal veins of Rosenthal, SCA

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50
Q

What supplies the vein of Galen?

A

Paired internal cerebral veins
Paired basal veins of Rosenthal
Precentral cerebellar vein

(thalamostriate veins drain into the internal cerebral veins near foramen of Monro)

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51
Q

What are the deep cerebellar nuclei?

A

Lateral to medial

Dentate, Emboliform, Globose, Fastigial

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52
Q

Which hypothalamus nucleus controls satiety?

A

Ventromedial nucleus

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53
Q

Pineoblastoma: hsitology

A

Poorly differentiated cancer of embryonal origin
Sheets of blue cells forming classic Flexner Wintersteiner rosettes

Rosettes formed around cellular extensions rather than blood vessel

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54
Q

Risks (OR) of having a spontaneous ICH with sBP > 160 as opposed with good BP control

A

5 times

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55
Q

Fibrous dysplasia of the skull

A

At risk of malignant degeneration into osteosarcoma, so RADIATION is CONTRAINDICATED

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56
Q

What % of patients with myelomeningocele ambulate in adolescence?

A

50% with aids

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57
Q

What is the most common causative organism in pediatric shunt infections?

A

Coagulase-negative Staph (Staph epidermidis) - 50-72%

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58
Q

What pineal region tumor has + AFP, - PLAP, - BHCG

A

Embryonal carcinoma, yolk sac carcinoma, immature teratoma

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59
Q

Most commonly elevated hormone from pituitary adenoma

A

GH

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60
Q

Patients with acromegaly have increased risk of what cancer?

A

2x risk of colon cancer

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61
Q

What age can a child be eligible for cranial radiation?

A

3 years

demonstrated decrease in IQ if done before 7 years of age

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62
Q

DBS STN targeting, where is in relation the 3rd nerve?

A

Efferent fibers of 3rd nerve are medial to STN, causing ipsilateral eye deviation

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63
Q

Organization of cerebral peduncles

A

Sacral fibers - most lateral aspect

Head and arms - most medial

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64
Q

Pathway of cochlear nerve

A

Hair cells in organ of Corti (Cochlea) –> Spiral ganglion –> cochlear nerve –> cochlear nucleus in the brainstem

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65
Q

Pathway of vestibular nerve

A

Receptors in labyrinth of saccule, utricle, semicircular canals –> Scarpa’s ganglion –> vestibular nerve –> vestibular nuclei

Some fibers from Scarpa’s ganglion –> mossy fibers –> flocculonodular lobe (mediating balance)

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66
Q

Medication for frequent urination in SCI

A

Oxybutynin - anticholinergic, M1-3 receptors on bladder wall, inhibit ACh activity

Leads to bladder relaxation for bladder spasticity and frequent urination

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67
Q

Serotonergic neurons are primarily located where?

A

Raphe nucleus of brainstem reticular formation

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68
Q

Neurofibroma: histology

A

Spindle cells in wavy pattern with large amounts of collagen and myxoid background

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69
Q

What is a hippus?

A

Normal physiologic response where pupils dilate and contract seemingly randomly

Can also be seen during recovery of CN 3

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70
Q

Mechanism of plavix

A

inhibits platelet function by inhibiting P2Y12 receptor and ADP-mediated GPIIb/IIIa complex formation

Irreversible

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71
Q

Precedex is thought to act where?

A

On locus coeruleus - mediating arousal, sleep-wave cycles

This nucleus is primarily noradrenergic

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72
Q

What percentage of patients > 65 will have spondylosis on imaging

A

95%

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73
Q

What hormone to check after resection of pituitary adenoma in a patient with acromegaly

A

GH

IGH-1 lasts much longer

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74
Q

What percentage of GBM resection is associated with improved overall survival

A

> 97%

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75
Q

Ulnar neuropathy, differences in relation to compression at Guyon’s canal or more proximal

A

Dorsal cutaneous branch of ulnar nerve takes off 5-8 cm proximal to Guyon’s canal

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76
Q

Recurrent branch of laryngeal nerve

A

Branch of vagus

Recurrent route runs alone tracheoesophageal groove

Innervates all intrinsic muscles of larynx with exception of cricothyroid muscle

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77
Q

Uncovertebral joints

A

Laterally on each cervical vertebral body

Formed by uncinate process, help provide stability to the cervical spine by limiting lateral movement

78
Q

What cortical layer projects to the thalamus?

A

Layer 6

79
Q

What cortical layer receives input from thalamus

A

Layer 4, heavily myelinated in the occipital cortex (aka Stria of Gennari, striate cortex)

80
Q

What cortical layer contains the large pyramidal Betz cells that project to the spinal cord?

A

Layer 5

81
Q

What chromosomes are affected in familial cavernomas

A

Chromosome 3 and 7

82
Q

During brachial plexus exploration, what runs on the anterior scalene muscle

A

Phrenic nerve

83
Q

Semiology of right temporal lobe epilepsy (MTS)

A

olfactory hallucinations, followed by behavioral arrest, lip smacking, left upper extremity shaking

84
Q

Extent of resection of amydalohippampectomy, left and right

A

Left: 4-5 cm (language near angular gyrus)
Right: 6-7 cm

85
Q

Posterior-superior aspect of amygdalohippocampectomy

A

Meyer’s loop - contralateral superior quandranopsia

86
Q

Internal capsule in relation to STN

A

Anterolateral

87
Q

Wolf’s law

A

bone will form along lines of stress
variable angle screws are used in ACDF to allow the bone to settle and put stress on the graft, leading to higher rates of fusion

88
Q

stress shielded

A

when there is no stress on the graft

89
Q

WHO grade III meningiomas

A

Papillary, rhabdoid, anaplastic

90
Q

Histology of chordoma

A

groups of cells with vacuolated cytoplasm, known as physaliphorous cells

glycogen deposits can also be seen

locally aggressive, from remnants of notochord

91
Q

Origin of medulloblastoma

A

Arise from roof of 4th ventricle, specifically granular layer of cerebellum

92
Q

Fetal surgery for myelomeningocele is undertaken what time?

A

24-26 weeks GA

93
Q

Poiseuille’s law, flow is related to resistance to the power of ?

A

4

94
Q

Rate of control with AEDs in patients with epilepsy

A

AED naive patient, 1st AED control seizures in roughly 50%

2nd AED, a further 15%

3rd AED, another 4%

medically refractory epilepsy is declared after failure of 2 adequate AED trials

95
Q

What is the paramedian pontine reticular formation (PPRF)

A

abducens nucleus, lateral gaze centre

ipsilateral PPRF stimulates ipsilateral abducens nerve to abduct the eye and sends fibres to MLF to contralateral CN3 nucleus

96
Q

What does the thoracodorsal nerve innervate

A

latissimus dorsi

comes from posterior cord of brachial plexus; straddled by upper and lower subscapular nerve

97
Q

Volume of CSF; rate of production

A

approximately 150cc at any time

450-500cc produced each day

CSF turns over 3 times per day

98
Q

What is the most common type of paraganglioma?

A

Pheochromocytoma

also common is carotid body tumor

less common: glomus jugulare, glomus intravagle, glomus tympanicum

99
Q

Starting dose of carbamazepine for TN

A

100mg BID

100
Q

What is the most common cranial neuropathy after CEA?

A

Cranial nerves overall 8-10%

Hypoglossal -1%; most common of all cranial nerves; tongue deviation towards side of injury

Other: vagus or recurrent laryngeal nerve 1%

Mandibular branch of facial nerve - loss of ipsilateral lip depressor

101
Q

What is brachium pontis, brachium conjunctivis, restiform body

A

Middle cerebellar peduncle

Superior cerebellar peduncle

Inferior cerebellar peduncle

102
Q

What is the functional spinocerebellum?

A

Vermis, projects to fastigial nucleus; receives afferent from spinocerebellar tract

Efferent from fastigial nucleus goes to reticular formation and lateral vestibular nuclei AND contralateral motor cortex via VL thalamus

103
Q

Path of CN3

A

Begins at CN3 nucleus at superior colliculus
Travels between PCA and SCA
Enters SOF, within annulus of Zinn

superior and inferior division
superior division = levator palpebrae and superior rectus

inferior division = medial/inferior rectus, inferior oblique

104
Q

CN4 innervates? and which way does patient compensate

A

superior oblique muscle

tilt head to contralateral side

CN4 only nerve to deccusate outside CNS, and exit dorsally from the brainstem

105
Q

Function of nervus intermedius

A

Parasympathetic fibers to lacrimal gland (GSPN, pterygopalatine ganglion); submandibular gland (submandibular ganglion), taste afferents (chorda tympani)

106
Q

What is in the tarsal tunnel

A 
Tibial nerve
Posterior tibial artery
Posterior tibial vein
Flexor hallicus longus tendon
Flexor digitorum longus tendon
Tibialis posterior tendon
107
Q

What does the deep peroneal nerve innervate?

A

EHL; foot extensors

108
Q

What does the superficial peroneal nerve innervate

A

Sensory to majority of top of foot

Muscles of foot eversion - peroneus longus/brevis

109
Q

Differentiating Cushing’s disease vs ectopic ACTH secretion

A

Cushing’s disease: random ACTH > 5ng/L; 50% or more reduction in cortisol after high dose DMZ; positive IPS (maybe); positive metyrapone test

110
Q

What is Nissl substance?

A

granular body of the cell containing rough endoplasmic reticulum, ribosomes

not present in axons

111
Q

Cauda equina compression leads to what type of bladder dysfunction as opposed to spinal cord compression

A 
Atonic bladder (both efferent and afferent are damaged) - no urgency
vs Hyper-reflexic bladder
112
Q

What nucleus in the brainstem mediates the jaw jerk reflex

A

Mesencephalic nucleus - proprioception of the jaw

113
Q

Glossopharyngeal nerve innervates the parotid gland via which branch?

A

lesser superficial petrosal nerve
LSPN contains preganglionic parasympathetic nerves from inferior salivatory nucleus of brain stem, synpase in otic ganglion

from the otic ganglion, the auriculotemporal nerve travels with V3

114
Q

Atlas ossification centres, when do the posterior persist, when do the anterior persist

A

up to 3 years

up to 7 years

115
Q

Which tract carries information from superior colliculus to all levels of hte cervical cord and mediates postural reflexes and movement of the upper body in response to visual and auditory stimuli?

A

Tectospinal tract

116
Q

Peroneal nerve comes from which nerve?

A

Sciatic nerve

116
Q

Peroneal nerve comes from which nerve?

A

Sciatic nerve

117
Q

What muscle group is weak with L3?

A

Quadricep

118
Q

BMP is contraindicated for what condition?

A

Soft-tissue sarcoma

Recruit mesenchymal cells to differentiate into chondroblasts and osteolbastas

119
Q

What % of patients with urinary retention in CES recover?

A

50%

in full saddle anesthesia - very few

120
Q

What diameter diagnosis spinal epidural lipomatosis

A

7mm

121
Q

What forms the Broca’s area

A

Pars triangularis and opercularis

both inferior frontal gyrus

122
Q

C7 myotome

A

tricep - elbow extension

wrist flexion

123
Q

What innervates the latissimus dorsi, and from what cord of the brachial plexus?

A

Thoracodorsal nerve

Posterior cord

124
Q

What are the 5 branches of the posterior cord?

A

Upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve, axillary nerve, radial nerve

125
Q

Post op treatment for ependymoma, and dose

A

45-48 Gy XRT

15-20 Gy for recurrence

radiosensitive

prophylactic radiation to spine if drop mets

126
Q

Rate of stabilization after syringoarachnoid shunt for syrinx at 10 years

A

50%

127
Q

Factor to consider when repairing nerve injury

A

In most cases, surgical repair utilizing end to end direct repair or grafting occurs sometime between 3 and 6 months after injury. Timing is based on several factors, but most importantly, the distance of nerve regeneration between the area of injury and the target muscle should be considered. Longer distances for regeneration should be operated earlier in an attempt to beat the “24-month rule” where irrecoverable atrophy of the muscle has occurred. Some surgeons consider 18 months the point at which irrecoverable atrophy has occurred.

128
Q

Describe a diabetic third nerve palsy?

A 
Painful, temporary
Pupil sparing (center of the nerve is involved rather than parasympathetic fibers that travel in the peripheral aspect of the never)
129
Q

What is corticobasal degeneration?

A

Involves only one limb, “alien-limb”
Parkinson-like symptoms of the limb
Increased deep tendon reflexes
Not usually have dementia

130
Q

Describe the auditory dampening reflex

A

Superior olivary nucleus

Contraction of stapedius (CN 7) and tensor tympani (CN 5)

131
Q

Anterior spinal artery syndrome

A

Paraplegia
Loss of pain/temperature
Preserved pinprick sensation (dorsal column) supplied by posterior spinal arteries)

132
Q

NF-1 optic glioma

A

Cure if complete excision of the optic nerve and eye before tumor invade the optic chiasm

133
Q

How much of dominant temporal lobe can be resected?

A

3 to 4.5 cm

134
Q

Opsoclonus-myoclonus reaction is seen in what kind of tumors?

A

Rapid, involuntary conjugate eye movements in multiple directions associated with myoclonic jerks

Neuroblastoma

Mediated by autoimmune phenomenon

135
Q

Optic strut separates what structures

A

Optic canal from superior orbital fissure

Joins lesser wing of the sphenoid to the body of the sphenoid bone

inferior and lateral wall of optic canal

Endonasal approach - inferior to optic protuberence, superiomedial to carotid protuberence, medial to lateral opticocarotid recess

136
Q

Marker for transverse sigmoid sinus

A

Asterion - where squamous and parietomastoid suture join

137
Q

What muscles do musculocutaneous nerve innervates

A

BBC

Biceps, brachialis, coracobrachialis

138
Q

What nerve innervates brachioradialis

A

C6, radial nerve

139
Q

What muscle does axiallary nerve innervate?

A

From the posterior cord

Deltoid muscle, Teres minor

139
Q

What muscle does axiallary nerve innervate?

A

From the posterior cord

Deltoid muscle, Teres minor

140
Q

Hemangiopericytoma vs meningioma

A

Staghorn vessels

both are positive for vimentin

HPCs are EMA negative while meningioma is EMA positive

141
Q

Cyst with dot sign on MRI

A

neurocysticercosis

142
Q

Paget’s bone disease

A

Hearing loss, higher risk of developing bony tumors

Serum ALP is elevated; calcium and PO4 are normal

143
Q

Uncinate fasciculus

A

Connects anterior temporal lobe to orbitofrontal cortex

Pathway of propagation for seizure

144
Q

Based on large studies, % of shunt revision within 1 year

A

30%

younger < 2 years have higher risk

145
Q

DBS target for dystonia

A

GPi

146
Q

If targeting GPi, and patient gets contralateral muscle contractions, where do you move?

A

Lateral

147
Q

Histology of pilocytic astrocytomas

A

parallel arrangement of bipolar astrocytes with Rosenthal fibers and eosinophilic granular bodies

148
Q

Results of STICH II

A

Small benefit in survival, no change in morbidity when early surgery < 48 hrs, for superficial ICH (< 1cm), 10-100cc, and no IVH; GCS 5-6 and eye opening score > 2

149
Q

Where are the motor neurons damaged in CES that cause urinary incontinence

A

Onuf’s nucleus, in the conus medullaris, projects to pudendal nerve

150
Q

SM grading and chance of good outcome

A 
grade 1 = 100%
grade 2 = 95%
grade 3 = 84%
grade 4 = 73%
grade 5 = 69%
151
Q

Risk of DVT after L3-5 D and F

A

10-40%

152
Q

Blue rubber bleb nevus syndrome, also Bean Syndrome

A

Has persistent connection btw extracranial veins and SSS = sinus pericranii

153
Q

Palinopsia

A

burnt in images when eyes are closed

154
Q

What is albuminocytologic dissociation in GBS

A

high protein and low cellularity

155
Q

What is normal ADI - atlantodental interval

A

< 3 mm

156
Q

What is the only neurotransmitter made in synaptic vesicles?

A

norepinephrine

made from dopamine, by dopamine hydroxylase

157
Q

Mucormycosis

A

commonly in bad diabetics
from anterior skull base
highly fatal

158
Q

Reversal of enoxaparin

A

Protamine can be given, 1mg per 1mg

Reverse 60% of active circulating

159
Q

What bladder problem does ASIA B have?

A

Detrusor hyperreflexia
Because intact bladder reflex arc but no inhibition from pontine micturition center
reflexive emptying of bladder and urge incontinence

160
Q

Post op radiation in GTR of LGG?

A

No benefit (54 Gy XRT), no increase in PFS, defer until progression occurs

161
Q

post op treatment of subtotal resection of oligodendroglioma

A

PCV chemotherapy

XRT is controversial - saved for malignant transformation or recurrent growth

162
Q

5 year survival of biopsy proven primary CNS lymphoma

A

3-4 %

163
Q

Post op treatment of primary CNS lymphoma

A

XRT, methotrexate

164
Q

Cognard classification

A

I - anterograde drainage through a sinus
IIa - retrograde sinus drainage only
IIb - anterograde sinus drainage with retrograde cortical venous influx
IIa+b - retrograde sinus and retrograde cortical venous reflux
III - direct cortical venous drainage without ectasia
IV - direct cortical venous drainage with ectasia
V - direct drainage into spinal perimedullary vein

165
Q

1 unit of platelet raises by how much?

A

5-10k

166
Q

What is the most common mass lesion in patients with known AIDS

A

toxoplasmosis

167
Q

What % of retinal hemorrhages are from accidental trauma

A

5%

168
Q

Arnold-Chiari III malformations

A 
very rare
severe developmental abnormalities
neurosurgery has minor role
high cervical spina bifida - herniated hindbrain contents
ensure there is skin covering the defect
no spinal cord tethering is present
169
Q

Surgical approach to myxopapillary ependymoma

A

ID and cut the filum terminale above and below the lesion
Do not violate capsule and spill the contents
if adherent to the conus, do not perform subpial resection of the conus, as will result in permanent bowel/bladder incontinence

170
Q

What is an eosinophilic granuloma

A

Punched out lesion of the skull

Does not have sclerotic margins like skull epidermoid

171
Q

Name radioresistant tumors

A

Thyroid, melanoma, renal cell carcinoma

172
Q

How long after onset of radiculopathy does reliable acute EMG findings present?

A

3 weeks

173
Q

Central vs peripheral vertigo

A

Central: acute onset, little nausea, skew deviation and spontaneous direction changing nystagmusf\

174
Q

What mediates decorticate (flexor) posturing

A 
rubrospinal tract (red nucleus)
mediate flexor tone

flexion means that rubrospinal tract or red nucleus is intact

175
Q

Ulnar nerve compression at Guyon vs cubital tunnel

A

Dorsal ulnar cutaneous nerve - dorsum of hand, exits 6 cm before Guyon’s canal

176
Q

What is Collin’s law about pilocytic astrocytoma

A

Pediatric patients are considered cured if no recurrence after patient’sage at time of diagnosis + 9 months has passed

Controversial rule

177
Q

Origin of neuroblastoma?

A

aggressive tumors that arise from sympathetic ganglion

e.g. adrenal gland (40%)

can cause Horner’s

178
Q

Dose of SRS to tumors 21-30mm in diameter

A

18Gy used with acceptable risks

179
Q

Anesthesia dolorosa

A

Injury to V1, recurrent corneal abrasions

180
Q

Posterior interosseous nerve

A

Pure motor branch of radial nerve

Innervates abductor pollicis longus, extensor pollicis longus/brevis, extensor indices, extensor carpi ulnaris, extensor digitorum and extensor digit minimi

181
Q

What markers are associated with ependymomas

A

Loss of chromosome 22

GFAP, PTAH, and EMA positivity

182
Q

Sheehan’s syndrome

A

pituitary infarct caused by large volume blood loss during delivery
necrosis and hemorrhage
can decompensate from lack of cortisol; give hydrocortisone immediately and then consider pituitary decompression to save vision

183
Q

Who should receive washed blood products?

A

Patients with history of allergic transfusions reactions with anaphylaxis

184
Q

Who should receive leukoreduced / irradiated PRBCs

A

Multiple febrile reactions

185
Q

Succinylcholine and SCI

A

can cause dangerous hyperkalemia

186
Q

What % of patients with TN treated medically eventually need surgery

A

75%

187
Q

Muscles innervates by deep peroneal nerve and superficial peroneal nerve

A

Deep peroneal nerve = anterior tibialis

Superficial peroneal nerve = peroneus longus, peroneus brevis

188
Q

Blood T1 and T2 signals

A

Hyperacute (< 24hrs); Acute (1-3 days); Early subacute (3-7 days); Late subacute (7-14 days); Chronic (> 14 days)

T1: Iso - dark - bright - bright - dark

T2: bright - dark - dark - bright - dark

Neurosurgery Review (1 decks)

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