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Surgery > neuro > Flashcards

neuro Flashcards

1
Q

C1

Anterior ring OR Posterior ring fracture

A

Aspen collar for stable fracture

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2
Q

burst fracture treatment

A

also known as a type II

Burst fracture ( Jefferson fracture)- 4 point fracture

anterior and posterior column

if cruciate ligament is intact you can treat with an aspen collar

if it is ruptured you get surgery or a hallo

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3
Q

type 1 C1 fx

A

Anterior ring OR Posterior ring fracture

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4
Q

type II C1 atlas fx

A

Burst fracture ( Jefferson fracture)- 4 point fracture

Need to check for ligamentous injury in order to determine treatment

If ligament is torn you need to wear the hallow or have surgery

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5
Q

Type III C1

A

lateral mass fracture

Associated Condylar fracture

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6
Q

C1 fx tx

A

Immobilization, Halo, Surgical Intervention
Stability determined by Integrity of the Transverse ligament

need MRI

really just in C1 type II that you need assess cruciate transverse ligament

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7
Q

how to differentiate odontoid fracture

A

Type I- tip of odontoid (rare)
Type II- base of odontoid
Type III- throughout the body

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8
Q

any injury above ___ can affect breathing

A

C3

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9
Q

bilateral fracture through pars, often associated sublux C2-3. Severe extension

A

Hangman’s fracture:

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10
Q

jumped facet/Perched facet-

A

jumped facet/Perched facet- severe flexion injury, unilateral vs

bilateral ,

quadriplegia due to ligamentous injury and SCI

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11
Q

Special consideration with jumped facet

A

CVA secondary to vertebral injury occlusion or dissection- evaluated on CTA,angiogram- Tx ASA/Heparin, endovascular repair

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12
Q

Tear drop fracture

A

posterior fracture with ligament injury

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13
Q

how to meausre level of spinal cord injury

A

either the last level of complete normal function or function level most caudal with 3/5 motor with temperature and pain present on exam

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14
Q

Can experience severe muscle spasm because reflexes still work but muscle tone does not

how do we manage

A

Upper motor neuron deficit
These spasms can result in fxs of bone in children
BACLOFIN (muscle relaxer)

Imaging: CT/MRI

Immobilization until surgical stability, Methylprednisone controversial

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15
Q

Complete spina; injury

A

no preservation of motor/sensory more than 3 segments below injury. If injury above C3 vent dependent

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16
Q

Incomplete quadriplegia

A

any residual motor or semsorpy for than 3 segments below the level of injury

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17
Q

Central cord syndrome-

A

greater motor deficit in UE>LE

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18
Q

Brown Sequard syndrome-

A

spinal cord hemisection with ipsilateral motor paralysis and contralateral seonsory loss of pain, temp and light touch

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19
Q

Posterior cord and Anterior cord injury-

A

rare, pain and parasthesia, in fact of anterior spinal artery respectively

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20
Q

GCS

what do we need to know

A 
need to know neuro function and GCS
GCS<8 NO BUENO
Eyes-4
Verbal response-5
Motor response -6
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21
Q

what is the picture of SDH

A

n/v/HA→ start to look like a stroke

Signs usually develop later with slow progression

usually the result of direct impact

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22
Q

if you can not recall a word suspect this head injury

A

if you can not recall a word suspect SDH on the left side

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23
Q

SDH picture on CT

A

CRESCENT and crosses suture lines

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24
Q

PE of SDH

A

weakness, facial droop, speech issues, + Prontor drift, AMS, LOC, low GSC

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25
Q

treatment of SDH

A

surgical vs observation

Considerations: Stop Anticoags

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26
Q

PE EDH

A

Can see blown pupil on the same side of the bleed → get that kid to the hospital

Resp distress due to uncal herniation vs observation if small with stable GCS and neuro exam-serial imaging

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27
Q

story of EDH

A

young
direct head trauma with a + LOC, followed by a “lucid interval”, then become obtunded with contralateral hemiparesis and ipsilateral pupil dilation

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28
Q

IPH looks like what

A

Most common in temporal,
frontal and occipital poles
Usually sudden deceleration injury causes brain to hit bony prominences, coup/contrecoup injury

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29
Q

when do we worry about swelling the most brain edema

A

4-14 days really worry about swelling with maximum around 5-10 really have to worry about seizures

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30
Q

PE with IPH

A

Exam: LOC, AMS, irritability, HA, N/V, sz activity

Concern for blossoming, increased ICP, seizures- sz prophylaxis and close GCS monitoring

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31
Q

IPH treatment

A

Observation vs surgical treatment- craniotomy, evacuation hematoma
craniotomy/craniectomy: Leave the bone off and let the brain swell for two or three weeks

Can see with encephalomalacia

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32
Q

SAH You really need to rule out

A

You really need to rule out an anyuerism with these and know what happened first

Trauma is most common cause of SAH

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33
Q

SAH workup

A

If Trauma uncertain R/o other causes with CTA/Angiogram

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34
Q

Basal skull fxs might look like this with presentation

A

-Difficult to see on imaging without thin cut CT

Pneumocepahlus, CSF otorrhea or rhinorrhea, hemotympanum, CN VII or VIII injury ( usually temporal fracture), Olfactory nerve injury (anterior fossa BSF)

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35
Q

Depressed skull fracture why do you give prophylactic anbx

A

When it collapses in you can get a dural tear and increase the risk of meningitis
Prophylactic anbx treatment for this is completely reasonable

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36
Q

CN VII or VIII injury suspect baslar fx here

A

usually temporal fracture

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37
Q

Olfactory nerve injury think about basalar skull fx here

A

anterior fossa BSF

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38
Q

what is a DAI

A

Diffuse axonal injury

A primary lesion of rotational acceleration/deceleration head injury
Rips all axons in the brain
Shearing injury
GCS is always 3

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39
Q

imaging of DAI

A

Diffuse edema

, hemorrhagic foci of corpus callosum and brain stem, changes in white matter fiber tracts

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40
Q

prognoses of DAI

A

Mild if less than 6 hours coma, moderate over 24 hour coma with amnesia, severe- coma lasting months with posturing and severe Neurologic deficit

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41
Q

Intra cranial hypertension normal and no bueno

A

Normal pressure 10-15 mmHg

> 20 NOT GOOD

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42
Q

management of intra cranial hypertension

A

This is when a GCS of 8 is super important
If the pt is not responding they get EVD automatically

Tube that drains CSF and works by gradient pressure (lowering and raising the bag)

Can also give mannitol or change respiratory status to change MAP

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43
Q

sxs of increased intracranial pressure

A

papilledema

abducens nerve palsy

decreased LOC

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44
Q

Cerebral perfusion pressure (CPP)

A

Mean Arterial pressure (MAP)- Intracranial Pressure (ICP)

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45
Q

concussion

A

Confusion, amnesia or LOC, or sxs after head trauma = concussio

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46
Q

sxs of concussion

A

vacant stare, delayed verbal or motor responses, difficulty focusing, disoriented, speech alterations, incoordination( tandem gait difficult), exaggerated emotion, memory deficit(repetitive)

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47
Q

Second Impact syndrome puts you at increase risk for

A

More likely to have increase in symptoms and sequelae

More likely to have alzheimer’s dz

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48
Q

Multiple concussion when do you stop playing

A

If 2 within 1 season- recommend imaging and if WNL 1 month no play

If 3 concussions or 2 severe( LOC) then season ending injury and consider ending all contact sports

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49
Q

Post concussive syndrome

A

HA, dizziness, visual changes, anosomia, hearing changes, balance issues, congivive changes- difficult concentrations, mild dementia, memory problems, impaired judgement, easy fatigue, depression

Post traumatic Alzheimer’s disease

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50
Q

CTE-what is it

A

Chronic Traumatic Encephalopathy

mild to severe dementia pugilistica

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51
Q

CTE presentation

A

Motor, cognitive an psychiatric impairments- mental slowing, emotional lability, violent outburst, paranoia, slowness sin though and speech, parkinson’s, dysarthria, tremor, ataxia

52
Q

Second most common reason people seek medical attention

A

Low back pain

Most common cause of disability for persons >45 yo

53
Q

Most common disc issues at

when would you do surgery

A

L4-5, L5-S1 followed by L3-4

L4/5 would see with foot drop with maybe some numbness in the big toe

With motor weakness= surgery

Microdiscectomy
Take out piece to alleviate the nerve

54
Q

Degeneration is

A

desiccation, narrowing of disc space, changes in endplates and osteophyte formation

55
Q

Herniation

A

localized displacement of disc material, can extrude leading to specific nerve compression

56
Q

Degeneration causes

A

Causes chronic pain

Epidural injections or spinal cord stimulator

57
Q

Annular tear

A

donut to the pulposa jelly

  • annulus fibrosus with nucleus pulposus
    disc
58
Q

bulging vs herniation

A

generalized displacement of disc material, can lead to lateral recess or focal stenosis

bulging not as serious as herniation

59
Q

History and PE of back pain

A

OPQRST- new vs old pain, acute exacerbation, describe pain location and quality.

Radiating pain- radiculopathy- muscle weakness, sensation changes. Bowel/bladder dysfunction. Ability to walk far ( claudication)

previous tx Medrol, PT, Chripracter, NSAIDs, Oral pain meds, conservative treatments, etc

60
Q

PE for back pain

A

Inspection- spine for deformity, Muscle tone and bulk- specific atrophy noted, Motor and sensory exam.

Hyporeflexia vs hyperreflexia, gait, +SLR
L4- knee reflex, quads weak, L5- foot drop S1- diminished achillis reflex, weak plantar flexion
Imaging: Xray, CT, MRI

61
Q

weakness in myotomes

A

suspect herniated disc

really any narrowing

62
Q

tx for herniated disc

A

oral steroids, time, PT, EPI, surgery

63
Q

degenerative disc disease -what is it

A

Slow progression of disc changes associated with facet disease, ligamentous changes
Broad based disc displacement
Can lead to lateral/foraminal recess stenosis over time or central stenosis with symptoms of radiculopathy or neurogenic claudication

64
Q

tx fo degenerative disc

A

Tx: Conservative treatments unless severe stenosis

65
Q

neurogenic claudication

A

leg pain with walking around that is not vascular

Get a doppler of the legs and check vascular supply

Not associated with edema but often leg cramping in calves
No skin/hair changes, not in stocking distribution, normal pusles

66
Q

lumbar stenosis sxs

A

Alleviated by sitting to rest or bending forward for a period of time
Increased heaviness and weakness in legs with walking

67
Q

Lumbar stenosis tx

A

oral meds, Pain management PT, EPI, Surgical intervention – laminectomy

68
Q

causes of cauda equina

A

Compression of cauda equina leading to neuro deficits.

Can be due to Herniated disc, lesions, infections, trauma/fracture.

69
Q

sxs of cauda equina

A

weakness or loss of function LE, Decreased or loss of sensation to LE, Bowel/bladder dysfunction, impotence/sexual dysfunction(late finding)

70
Q

PE cauda equina

A

Weakness to LE, diminished/loss of sensation, absent sphincter tone, saddle anesthesia

71
Q

work op and plan for cuada equina

A

MRI
Plan: Surgical decompression- emergent in most cases
Decompressive laminectomy

72
Q

Lumbar spondylosis

A

Degenerative vs

congenital condition with misalignment of vertebral bodies with anterior subluxation of one vertebral body on another

73
Q

most common lumbar spondylosis

A

Most common L5-S1 followed by L4-5

74
Q

tx for spondylotlithiss

A

PLIF/TLIF/ALIF vs conservative treatments

75
Q

which grades of spondylotlihtasis is are risk for cauda equina

A

III and IV usually surgical due to nerve root impingement and possible cauda equina syndrome

surgical tx

76
Q

treatment of I and II spondylolithiasis

A

III and IV usually surgical due to nerve root impingement and possible cauda equina syndrome

77
Q

Post op concerns for lumbar spine

A

rare complication of epidural hematoma- watch for increase pain or decline in exam, dural tears with CSF leaks, injury to nerve, hardware failure

78
Q

neck pain tx

worry post op

A

Anterior ACDF , posterior decompression

hematoma
or laryngeal nerve

79
Q

neck injuries sxs

A

related to nerve root impingement radiating pain or radiculopathy, neck pain, radiating pain to posterior head, shoulders and arms, weakness in grips, balancing issues, b/b issues if severe, dexterity issues.

80
Q

greatest concern with cervical spine

A

concern cervical stenosis leading to cervical myelopathy

81
Q

Ankylosis Spondylitis (bamboo spine)

A

Seronegative arthropathy (ANA, RF negative)

82
Q

primary site of AS

A

Spine primary site involved starting at SI joints and moving rostrally

83
Q

sxs of AS

A

non-radiating back pain , morning back stiffness hip pain, worse with inactivity and improved with exercise

84
Q

imaging for AS

A

CT, XRAy and MRI- evaluate for stenosis, high risk with trauma

85
Q

tx for AS

A

Surgery if cauda equina syndrome, SCI following fracture/trauma, spinal stenosis (rare)

86
Q

two types of scoliosis

A

Degernatie vs idiopathic

get the COBB
<20 leave it lalone

87
Q

MC most malignant brain tumor

A

GBM- most common, most malignant

RIM INHACING lesion

88
Q

Schwannomas

A

Schwannomas (acoustic neuroma)
Vestibular-
benign lesion

89
Q

sxs of schwannomas

A

hearing loss- insidious and progressive, tinnitus, disequilibrium. Can also develop V and

VII CN palsy if large enough due to location-otalgia, facial numbness, facial weakness, taste changes.

If large enough can cause brain stem compression leading to ataxia, HA, N/V, diplopia, cerebellar signs- threatens brain stem functions- resp. distress, coma, death

90
Q

PE Schwannomas (acoustic neuroma)

A

Weber lateralizes to uninvolved side, = Rhine test, CN III deficit(hearing test prior to OR), nystagmus, facial weakness or paresthesias

91
Q

MC benign tumor

A

Meningioma (most common?)

92
Q

What is the meningioma where does it come from

A

Extra-axial lesion
Slow growing

Arise from arachnoid with attachment to the dura

peak age 45, F>M
can cause mass affect

93
Q

most pituitary tumors are

A

Most are benign adenomas arising from anterior pituitary

94
Q

labs for pit tumors

A

Go Look For The Adenoma- GH, LH, FSH, TSH, ACTH. Prolactin, cortisol

95
Q

what type of visual changes might you see with a pit tumor

A

if causing symptoms, if increasing in size rapidly, visual changes on formal visual field testing.

96
Q

Prolactinoma tx

A

Bromocriptine tx and will go away

97
Q

post op concerns with pituitary surg

A

SIADH- watch Na+, Panhypopit- check endocrine labs and consutl endocrine

98
Q

Most common mets in order:

A 
#1 Lung CA, Breast CA, renal cell CA, GI, melanoma in adults
Prostate cancer=spine mets
99
Q

multiple myeloma

A

Bone pain: especially spine* & ribs due to osteolytic, destructive lesions & osteopenic fractures, spinal cord compression (plasma cells can form a tumor), radiculopathy.

Recurrent infections: (Strep pneumo, gram negative) from leukopenia. Hyperviscosity.

Elevated Calcium (hypercalcemia): only heme malignancy associated with bone destruction.

Anemia: fatigue, pallor, weakness, weight loss, hepatosplenomegaly, soft tissue masses.

Kidnev Failure* - antibody light-chain protein deposition in the kidney. Neurologic involvement.

100
Q

hemorrhagic RF

A

HTN, Cocaine use, Cigarette smoking, high consumption ETOH, anti platlet therpy

101
Q

Ischemic CVA

A

Carotid Stenosis, Vertebral stenosis, Cerebral stenosis, hyperlipidemia

102
Q

progressive bilateral occlusion of ICAs with collateral compensatory capillaries, on angio look like ”puff of smoke”

A

Moya moya

103
Q

Amyliod disease

A

deposits of amyloid proteins, recurrent lobar hemorrhages, often elderly

104
Q

sxs to search for in CVA

A

Facial palsy, Motor weakness, ataxia( difficulty with finger to nose if cerebellar), paresthesia, aphasia/fluency/word finding, dysarthria, neglect, AMS, Coma

105
Q

imaginign for CVA

A

Imaging: CT, MRI-best for acute stroke, CT angiogram/MR angiogram, Cerebral angiogram

106
Q

three types of vascular malformations

A

Arteriovenous anomoly
Cavernous Malformation
Cerebral Aneurysms

107
Q

what is AVM

A

Hereditary and present in 20’s or 30’s with a bleed
Engorge and grow and get big over time
Abnormal collection of blood vessels with arterial blood flow directomy into draining veins ( no capillary bed)

108
Q

imaging for AVM

A

CT- r/o acute hemorrhage,

MRI- evaluate draining veins and feeding arteries, evaluate for edema, Angiography

109
Q

tx of AVM

A

Surgery- eliminates bleeding risk and sz control. high risk, invasive

Decrease risk for bleeding again

Usually just use radiation for treatment

Endovascular embolization-

110
Q

Cavernous malformation

A

Benign vascular lesions with thick irregular vascular channels, large feeding arteries and large draining vein

benign and multiple

111
Q

if you do have sxs with cavernous malformations

A

Sz, neuro deficit related to hemorrhage of hydrocephalus, incidental finding often
Usually don’t present till after it has bled

112
Q

imagining and tx cavernous malformations

A

CT- acute hemorrhage, MRI
Will show up as black spots on a MRI
Usually just observe

Treatment: Observation, Surgery if hemorrhage

113
Q

cerebral aneurysm what is it and what does it look like

A

SAH

Cerebral aneurysm→ dead chicken
“worst headache of my life”- thunderclap HA, AMS, obtunded, 3rd nerve palsy( P-comm aneurysm), sentinel HA

down and out

114
Q

imaging for cerebral aneurysm

A

CT/MRI -SAH on imaging, CT Angio, Cerebral angiogram
CTA or MRA
LP done for RBC

115
Q

tx for cerebral aneurysm

A

Aneurysm >5mm, symptoms related I.e 3rd nerve palsy, enlargement on observation

Watch if <5 mm unless they have a 1st degree relative with rupture or if they have had a previous bleed

Surgery options- clipping, endovascular coiling/stent coil assist

116
Q

Hydrocephalus sxs and when would we see it

A

Wet wacky wobbly

looking for

We are watching for this after SAH
Forgot how to get rid of fluid

can get it secondary to mass affect

117
Q

treatment from hydrocephalus

A

Can set EVD to 20 or 10 to get off extra fluid

Once pressure is relieved pt is back to normal
Can also do a VP shunt into the abdomen
Diverts fluid into the intestines

118
Q

NPH

A

Wet wacky and wobbly again

Condition of ventriculomegaly without increased pressure

Can do a LP and will see completely normal pressures
But when you pull off fluid they wake up

119
Q

hydrocephalus from infection

A

Valley fever- Disseminated coccidioidomycosis

In the valley seen with severe hydrocephalus, spinal abscess, and osteomyelitis

Need debulking and shunts
If it has weakened the bone maybe spinal fusion
Can see the failing of shunts with obtunded

120
Q

Osteomyelitis

A

Osteomyelitis is very common in IVDU
Can also see in field workers

and field workers

can also see in Potts (TB)

121
Q

Cranisynostosis

A

bossing when cranial plates close too early

122
Q

CALL THE DOCTOR

A 
Hypertension
Changes in RR, irregularity
Bradycardia
Sever HA
Decline in neuro exam -speech, motor, etc
Decline in GCS>2 pts
Anisocoria
characterized by an unequal size of the eyes' pupils.
Elevated ICP >20 FOR 5 MINUTES
No output from EVD >2HR PERIOD
123
Q

Post op Concerns

A

Pain not well controlled- see the patient
Drains not working- check them yourself
Any decline in GCS should be notified and repeat imaging immediately

AVOID NSAIDS
Avoid anticoags as long as possible for ICH

124
Q

why avoid NSAIDS

A

Research has shown that the fusion will fail if NSAIDS are given

Leads to chronic back pain

125
Q

Chiari Malofrmaiton

A

hoffmans test- sign showing

(problems with corticospinal tract)

brain grows into formane magnum

Surgery (18 decks)

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