Large Group 4-Neurosurgeons Flashcards
What 3 things do you use to determine a complete vs incomplete spinal injury?
- Bulbocavernosus Reflex
- Motor function
- Sensation
If BCR is negative is the injury complete or incomplete?
Can’t tell! Negative BCR means test is non-diagnostic
If BCR is positive, motor is positive and sensory is negative (or vice versa on the last 2) is the injury complete or incomplete?
Incomplete
If BCR is positive and both motor and sensory are negative is the injury complete or incomplete?
Complete
What is Central Cord Syndrome?
- Motor loss is greater in UE than LE
- Common in elderly w/spinal stenosis
- More involved w/UE function
Does the presence of peri-anal pinprick sensation, sacral sparing or rectal tone suggest complete or incomplete injury?
Incomplete
If you suspect a traumatic brain or spinal cord injury should you use steroids? If no, why not?
NO; increases risk of sepsis, death & pneumonia
What test is the gold standard for a cerebral aneurysm?
Four vessel cerebral angiogram
What is the most common cause of a SAH besides trauma?
Ruptured aneurysm
Describe the anatomy of an aneurysm.
- Degenerated or absent internal elastic membrane
- Adventitia of loosely woven, sometimes abnormal collagen
- There is no muscular tissue and essentially no internal elastic membrane
What do SAHs look like on a non-contrast CT?
Bright starburst pattern
What are some common problems after a ruptured aneurysm?
- 50% chance of re-rupturing in 6 months
- Hydrocephalus
- Vasospam
Which surgical option (clip or coil) is best for un-ruptured MCA aneurysms in young pts?
Clip
After a trauma, what is the most important secondary event affecting outcome?
Cerebral ischemia
Why is hyperventilation bad?
- Causes less perfusion → death of penumbra tissue (ischemia)
- If there is no elevated ICP then chronic prolonged hyperventilation therapy is not indicated
decrease PCO2 (<32mmHg)
Why is hypotension bad?
- Hypotension → vasodilation → increasing the flow of blood → increase in ICP
- A single episode of hypotension (SBP<90mmHg) double mortality
Where is the most common place to have an aneurysm?
Anterior communicating artery (40%)
In patients with ruptured intracranial aneurysm the outcome is significantly better with…
Endovascular coiling
What is quadriplegia?
Spinal cord injury from upper cervical to T1
What is paraplegia?
Spinal cord injuries below T1, sparing the upper extremities
If someone with a spinal cord injury has a positive perianal pinprick exam, is their prognosis good or bad?
Good!
What kind of solutions can decrease ICP?
Hypertonic solutions
What is anterior cord syndrome?
usually from flexion/extension (diving)
Loss of all motor and pain and temperature below lesion and preservation of posterior column sensation; bowel/bladder also affected
The poorest prognosis for any recovery of incomplete syndromes
What is posterior cord syndrome?
Rare
Preservation of motor and pain and temperature function with loss of posterior column function (proprioception, two-point tactile discrimination,vibration modalities)
can walk but rely on visual input
What is conus medullaris syndrome?
Isolated injury to this part of the cord produces loss of bowel and bladder control
Exam reveals loss of perirectal sensation and poor rectal muscle tone
Bilaterally symmetrical
Saddle distribution of sensory loss
No motor signs in legs (if pure), if motor loss, it is symmetrical and nor marked, ankle jerk absent –S1
Prognosis is poor for significant return of bowel and bladder
What profusion pressure do we want to maintain after spine injury?
60 mmHg
What is ischemia?
tissue PO2 anaerobic respiration and decrease pH
How much will CBF change for each 1mmHg change in PCO2?
3-4%
What should MAP be maintained at?
above 90mmHg
through the infusion of fluid
