General Flashcards
L5 radiculopathy
I
I
Weakness with inversion
Big toe sensory
Common Peroneal Nerve
E
E
Weakness of eversion
Nerve injury/plexus injury
Lacerations -repair in 72 hours -blunt lacerations in 2 weeks -blunt injures/stretch = EMG and NCS in 1 month then repeat in 3 months —
Carotid endarterectomy
—asymptomatic >60% and healthy <75yo = CEA (ACAS), complication rate <3%
—symptomatic >50-69%, healthy =CEA
—symptomatic >70% = CEA, complication rate <6%
Symptomatic carotid stenosis
- retinal TIA
- cortical TIA
- non-disabling stroke with CT or MRI abnormality
consider CEA after minimum 1 week for more disabling stroke
Stenting for carotid stenosis
- significant cardiac disease (symptomatic)
- advanced age >80y symptomatic
- ipsilateral radiation
- recurrent stenosis after CEA
- tandem lesions
- poor surgical anatomy
- contralateral RLN palsy
Pelvic incidence
-fixed parameter
= perpendicular to sacral line center to the femoral head — angle between
40-65 degrees
PI =SS + PT
LL = PI +/- SS
Sacral Slope
= horizontal line posterior and angle between sacral line
Range 10-30
Pelvic Tilt
-variable
= find center sacral line, draw perpendicular to femoral heads, draw vertical line = angle between vertical line and line to femoral heads
-range 30-50
Spinal AVM
1) DAVF
- thoracic and lumbar location
- low myelopathy
- MRI and A + spinal angiogram
- radicular artery at the nerve sleeve
- whet clip intradural on the arterialized vein at the sleeve
- pre ICG and post ICG
- treat surgically
Spinal AVM
2) perimedullary
- upper extremities and SAH
- MRI/A and spinal Angio to include sacral, VA, and external carotid
- posterior or anterior location
- surgery for posterior, endovascular for anterior
- spinal artery to spinal vein without nidus
Spinal AVM
3) intramedullary
- same as perimedullary
- nidus,complex
- treat endovascular
ASIA grading
A - comlplete B - motor complete sensory incomplete C - motor <3 D - motor > 3 E - normal
Cervical spine 2 column theory
Anterior column = ALL-PLL
posterior column >PLL
SLICS
Vertebral segments
4
SC -c5/6 TF
c5/6 TF - c2
C2 -dura
Intradural
Odontoid fractures
Type 1
Type 2
Type 2a - comminuted type 2
Type 3
Nonunion 21x higher for non surgical type 2
- 6mm displacement
- 10degrees angulation
Treatment of burst fracture
CC 50%
LOH 40%
Kyphosis 30 degrees
Neuro deficit
TLICS
Cervical myotomes
C5 -deltoid
C6-bicep
C7 -tricep
C8 -grip
Exiting nerve root is lower number
Types of spondylolisthesis
D2P2IT
- dysplastic (congenital)
- degenerative
- post-surgical
- pathologic
- isthmic (pars defect)
- traumatic (non-pars)
Graded 1-5
Radiosensitive tumors
SCLC lymphoma Multiple myeloma Breast Prostate
Brain infections
Hematogenous -step viridans Sinus -strep Milleri Postop -staph aureus
Treat 6-8 weeks IV antibiotics
No MRI before 3 months
Watch out for moth-eaten bone flap/resorption
Stupp Protocol for GBM
6 weeks RT at 2gy for 30 treatments = 60
+ concomitant Temodar 7days x30
+ 4 week rest then 6 28 day cycles with temodar on days 1-5
MRI w 3 months
CC fistula
1) direct —transarterial occlusion 2) indirect ICA 3) indirect ECA 4) indirect ICA/ECA
Borden classification of cranial dural AVF
1) direct drainage into sinus (observed)
2) sinus and cortical vein reflux
3) cortical reflux only
Commonly retromastoid bruit and location at transverse sigmoid junction
Cranial meningioma and hemagiopericytoma
-angiogram considerations
All cranial meningioma get a formal Angio for possible embo except olfactory groove as feeders are ant post ethmoid arteries
Neural axis MRI in brain tumors
-All posterior fossa tumors get neural axis MRIs
—medulloblastoma, ependymoma, pilocytic astrocytoma, hemangioblatoma, metastasis
—consider axis MRI in malignant pineal region tumors and other malignant ventricular lesions
Rupture rate of unruptuted aneurysms ISUIA
5 year rupture rate
Size
<7, 7-12, 12-25, >25mm
Anterior circulation
—0 2.5 15 40
Posterior circulation
—
Ruptured aneurysms (SAH) - re-rupture rate
4% rate day 1
1% days 2-14
50% at 6 months
3%/yr thereafter
Tic Douloreux
v
1) tegretol and topamax
2) perc rhizotomy RF or balloon, 3) SRS
4) MVD
ALL have similar outcomes and complication rate BUT V1 #1 is MVD
SCA most common culprit
Hemifacial spasm
1) tegretol
2) MVD
PICA
—
Brachial plexus
-c5 6 7 8 T1
5 roots, 3 trunks, 6 divisions, 3 cords, 5 TBs
-MAMRU
-EDTSI
Brachial plexus
MAMRU
EDTSI
Innervation
- musculocutaneous - elbow weakness 567
- axillary - deltoid weakness 56
- median - thumb weakness 56781
- radial - supinate weakness 56781
- ulnar - intrinsic interossei weakness 781
