Neurosurg Flashcards
Brain tumours in adults are usually…
supratentorial
Brain tumours in children are usually…
infratentorial
what blood markers may be positive in germ cell brain tumours?
bHCG and alphafetoprotein
prognosis of pilocytic astrocytoma?
curable
prognosis of glioblastoma multiforme?
9-12 mo
most common location for an oligodendroglioma
frontal lobe
common first presentation for oligodendroglioma?
seizure
where is the site of an ependymoma?
floor of 4th ventricle - arises from ependymal cells
presentation of an acoustic neuroma?
hearing loss, tinnitus, dysequillibrium
which population gets neuronal tumours? (ganglioma, medulloblastoma, neuroma)
children
presentation of neuronal tumours?
obstructive hydrocephalus and cerebellar signs
why do clots occur in 20-30% of patients with brain tumours?
-thromboplastin is released when the brain is injured
ICP should be less than ___ mmHg
15
what is cushing triad
hypertension, irregular breathing, bradycardia
what are the layers of the scalp?
Skin, connective tissue, aponeurosis, loose areolar tissue, periosteum
which layer of the scalp are the blood vessels in?
loose areolar tissue
initial imaging following head injury?
non contrast CT
what type of saline can be administered to decrease ICP ?
hypertonic
which type of cranial bleed does not cross suture lines?
epidural bleed
treatment of an epidural bleed?
- craniotomy and evacuation of hematoma
- coagulate bleeding vessel
which vessels are bleeding in a subdural bleed?
bridging veins
will a subdural bleed cross suture lines ?
yes
risk factors for subdural bleed?
- elderly
- alcoholics
- anticoagulation
treatment of subdural bleed?
DEPENDS on size.
Small - conservative
Large - catheter or craniotomy
investgiations for subarachnoid hemorhage?
- non contract CT
- Lumbar puncture - xanthochromia
- CT angiogram
- cerebral formal angiography
where does the spinal cord end?
L1/L2
roots of the brachial plexus?
C5-T1
what is an UNSTABLE vertebral injury?
when 2 or more of the vertebral columns are disrupted OR 50% loss in vertebral height - implies more damage could occur
what is a “complete” neurological injury?
-when there is no motor or sensory function more than 3 segments below the injury’
what is an ‘incomplete’ neurological injury?
preservation of sacral function, toe flexion, sphinctor contraction
MRC grading for strength
0 - no active contraction
1- flicker of contraction
2- contraction producing movement if gravity is eliminated
3- weak contraction and movement against gravity
4-active movement against some resistance
5-full resistance, full strenght
which deficits occur in anterior cord syndrome?
- complete paralysis
- loss of light touch and pain
- DORSAL COLUMNS PRESERVED
what may lead to anterior cord syndrome?
burst fracture
what deficits occur in central cord syndrome?
- upper limbs affected more than lower limbs
- motor loss and sometimes sensory
what kind of injury causes central cord syndrome?
hyperextension injury
presentation of posterior cord syndrome?
loss of vibration, proprioception
presentation of brown sequard syndrome?
- ipsilateral motor loss
- contralateral sensory loss
presentaiton of cauda equina syndrome?
- bladder dysfunction
- lower limb paralysis
- sensory changes
- saddle anesthesia
