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Neurosurg 2 Flashcards

1
Q

Most common pathogen of brain abscess

A

Streptococcus

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2
Q

Brain abscess pathogen in neonates

A

Proteus

Citrobacter

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3
Q

Brain abscess pathogen in penetrating injury

A

Staph

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4
Q

Brain abscess pathogen in ImmComp

A

Fungi

Protozoa

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5
Q

The most common route for brain abscess

A

Hematogenous, from lung

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6
Q

Epidural abscess associated with:

A

Osteomyelitis

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7
Q

RFs for cerebral abscess

A

Lung abn:
Infection
AV fistula
Osler-Weber-Rendu

Congenital heart disease:
R- to L-shunt

Bacterial endocarditis

Penetrating trauma

ImmSup

Dental abscess, poor dentition

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8
Q

Inv for brain abscess

A

CT (first in ED)
MRI (test of choice)
CBC, ESR,
B/C

LP CONTRAINDICATED IF LARGE MASS.
CSF: high ICP, high WBC, high protein, normal glucose, negative culture

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9
Q

Tx if brain abscess

A

Aspiration +/- excision:
Gram stain, AFB, Cand, fungal culture

AB:
Vanco + Cefriaxone+ metro/chloramphenicol/rifampin (6-8 wk)

Adjust AB with C&S

Anti-convulsants 1-2 yr

F/U CT

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10
Q

Lucid interval seen in:

A

Epidural hematoma

1st: post-traumatic reduced LOC
2nd: lucid interval of several hours
3rd: deterioration continuing hours to days

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11
Q

Etiology of epidural hematoma

A

Skull fx (often middle meningeal artery bleed)

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12
Q

CT of epidural hematoma

A 
Hyperdense
Lenticular
Sharp margins 
Limited by suture lines
Not limited by dural attachments
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13
Q

Tx of epidural hematoma

A

Admission

Close observation + serial CT if:
Small volume clot
\+ minimal midline shift (<5mm)
\+ GCS (>8)
\+ no focal deficit

Otherwise, Craniotomy and F/U CT

If EDH in temporoparietal region, or EDH > 10 mm in first 2 h, take F/U CT at 5-6 h post inpact

Mannitol if rised ICP

Good prognosis if prompt Mx

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14
Q

Age of subdural hematoma

A

> 50

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15
Q

Associations of subdural hematoma

A 
Acute: 
Age> 50
Trauma (acceleration-develeration injury)
Anticoag
Alcohol
Cerebral atrophy
Infant head trauma
Chronic:
Age > 50 (older)
EtOH
CSF shunt
Anticoagulated/coagulopathy
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16
Q

CT of subdural hematoma

A

Acute:
Hyperdense
Crescentic
Crossing suture lines

Chronic:
Hypodense
Crescentic
Crossing suture lines

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17
Q

Tx of subdural hematoma

A

Acute: craniotomy if > 1cm thick or mid-line shift>5mm (optimal if surgery <4h)

Chronic: burr hole to drain (if symptomatic or thickness> 1cm), craniotomy if recurs more than twice.
Seizure prophylaxis only if post-traumatic seizure.
Reverse coagulopathy

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18
Q

Prognosis of subdural hematoma

A

Acute: poor

Chronic: good

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19
Q

CT of SAH

A

Hyperdense blood in cisterns/fissures

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20
Q

Tx of SAH

A 
ICU/NICU
O2/ventilation
NPO
Bed rest, elevated head 30°
Minimal external stimulation
Neurological vital signs q 1h
IV NS+ KCl
ECG
Foley
BP: 120-150
Nimodipine: vasospasm Px, neuroprotection
Levetiracetam (seizure prophylaxis)
Mild sedation

Endovascular surgery to repair if rebleed

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21
Q

Prognosis of SAH

A

50% mortality

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22
Q

Etiology of ICH

A 
HTN
Vascular abn
Tumor
Infection
Coagulopathy
Age>55
Male
Cocaine
EtOH
Amphetamine
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23
Q

CT of ICH

A

Hyperdense intraparanchymal collection

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24
Q

Tx if ICH

A

Decrease BP

Control ICP

Craniotomy

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25
Q

CT, MRI T1, MRI T2 for intracranial bleeds within 72 h

A

CT: hyperdense

MRI T1: Grey

MRI T2: Black

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26
Q

CT, MRI T1, MRI T2 for intracranial bleeds <3 wk (subacute)

A

CT: isodense

T1: white

T2: white

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27
Q

CT, MRI T1, MRI T2 for intracranial bleeds > 3 wk (chronic)

A

CT: hypo

T1: Black

T2: Black

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28
Q

How to remember MRI changes in bleeding

A

MRI T1: George Washington Bridge

MRI T2: Orio: Black, White, Black

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29
Q

Which intracranial bleeding is the great imitator of dementia)

A

Chronic SDH

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30
Q

Most common cause of SAH

A

Trauma

Others: spontaneous (aneurism, AVM), coagulopathy, idiopathic,…

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31
Q

Peak age of SAH

A

55-60

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32
Q

RFs for SAH

A 
HTN
Pregnancy, partirition  if pre-existing AVM
Eclampsia
OCP
Cigarette
Cocaine
Alcohol
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33
Q

Inv for SAH

A

Non-contrast CT

If negative CT, but high suspicion: LP

Opening pressure > 18

Bloody
Xanthochromic if centrifuged (by 12hr)
Lasts 2wk

RBC > 100,000, without significant drop in last tube

Elevated protein

MRA, CTA to find aneurysm

Gold standard for aneurysms: four vessel cerebral angiography. Repeat in 7-14 d if negative

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34
Q

Complications of SAH

A

Vasospasm:

Onset: 4-14d
New onset ischemic defect, infarct, death
Dx with transcranial doppler or clinical

Delayed cerebral ischemia:
4-10 d

Hydrocephalus:
Acute or chronic
Tx: extraventricular drain or shunt

Neurogenic pulmonary edema

Hyponatremia

DI

Cardiac arrhythmia, MI, CHF

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35
Q

Prevention of SAH

A

Early clipping or coiling of eneurism

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36
Q

Most common type of intracranial aneurysms

A

Berry

Mostly in carotid system

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37
Q

Most common location for saccular aneurysms

A

AComm

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38
Q

Fusiform aneurisms etiology and location

A

Atherosclerosis

Vertebrobasilar system

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39
Q

Mist common cause of infectious aneurysms

A

Strep and staph

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40
Q

RFs for aneurysms

A

ADPKD

Fibromascular dysplasia

AVM

Ehlers-Danlos

Marfan

FHx

Bacterial endocarditis

Osler-Weber-Randi

Atherosclerosis

HTN

Trauma

Smoking

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41
Q

Sentinel hemorrhage

A

SAH Sx for < 24 h

May have blood on CT or LP

Requires urgent clipping/coiling of aneurism to prevent Catastrophic bleed

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42
Q

The most common clinical presentation of aneurism

A

Rupture

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43
Q

Inv for aneurysm

A

CTA
MRA
Angiography

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44
Q

Tx of aneurism

A

Ruptured:
Early surgery or coiling (within 48-96h)

Unruptured:
Treat if > 10 mm
Or 7-9 mm in middle aged, young, FHx
If smaller: F/U with serial angio

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45
Q

Drugs causing ICH

A

Amphetamines
Cocaine
Alcohol
Anticoagulants

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46
Q

RFs for ICH

A 
>55
Male
HTN
Black/asian > caucasian
Previous CVA
Heavy alcohol use, cocaine, amphetamines
Liver disease
Anticoag
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47
Q

Inv for ICH

A

Severity score

Non-contrast CT

CTA

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48
Q

Tx of ICH

A 
Decrease MAP (target 140-90)
Correct coagulopathy
Control raised ICP
SEIZURE Px: levetiracetam, phenytoin
Follow lyes
Angiogram to R/O vascular lesions (unless > 45y, known HTN, putamen/thalamic/posterior fossa ICH)
Surgical if:
Symptoms of raised ICP or mass effect
Rapid deterioration
Favourable location
Young (> 50)
If tumor, AVM, aneurysm
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49
Q

Contraindications to surgical Tx of ICH

A

Small bleed, minimal symptoms, GCS>10

Poor prognosis, low GCS, lost BS function

Very old

Severe coagulopathy

Difficult location

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50
Q

AVM facts

A

M, 33yr

Sx:
Small ones: hemorrhage
Large ones: seizures

Focal neurological signs (steal phenomenon)
Localized headache
Bruit

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51
Q

Inv for AVM

A

MRI
MRA
Angio

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52
Q

Tx of AVM

A

Choice: surgical excision

If <3cm or very deep:
Stereotactic radiosurgery

+/- Endovascular embolization

Conservative, palliative embolization

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53
Q

Sx of cavernous malformation

A

Seizure
Progressive neurological deficit
Hemorrhage
H/A

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54
Q

Dx of cavernous hemangioma

A

MRI T2: non enhancing

Best method for Dx: gradient echo sequencing

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55
Q

Tx of cavernous hemangioma

A

Surgical excision if:

Symptomatic, surgically accessible

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56
Q

Dural fistula Sx

A

Asymptomatic
Pulsatile tinnitus
Bruit
Headache

If carotid cavernous involvement:
Proptosis
Chemosis
Bruit

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57
Q

Inv for dural fistula

A

Non-contrast CT to R/O hemorrhage

MRI

Gold std: Angio

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58
Q

Tx of dural fistula

A

Conservative

Endovascular interventions

RT

Surgery

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59
Q

Sx of CSF fistula

A

Otorrhea

Rhinorrhea

Recurrent meningitis

Low pressure headache (worse with sitting)

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60
Q

Inv for CSF fistula

A

Fluid B-transferrin test,

Quantitative glucose analysis of fluid

Ring sign

Reservoir sign

CT (defect, fx, pneumocephalus)

Water contrast CT cysternography

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61
Q

Tx of CSF fistula

A

Lower ICP:
Avoid straining
Acetazolamide
Modest fluid restriction

Persistent leak: continuous lumbar drainage

Surgery:
Leak > 2 wk after trauma. 
Spontaneous leak
Delayed onset of leak after trauma or surgery
Leak complicated by meningitis
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62
Q

Most common cervical disc herniation

A

C6-C7

Pressure on C7

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63
Q

Cervical disc syndrome Sx

A

Pain in arm following nerve root

Pain is referral , non dermatomal

Worse with neck extension

Worse with ipsilateral rotation

Worse with lateral flexion

LMN signs and symptoms

Myelopathy if central protrusion

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64
Q

Inv for cervical disc syndrome

A

If red flags:
C-spine x-ray, CT, MRI (choice)

If peripheral nerve issue and uncertain Dx:
EMG, NCS

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65
Q

Tx of cervical disc syndrome

A

No bed rest (unless severe)

Activity modification, pt education:
Reduce sitting, lifting

PT, exercise to strengthen core muscles

NSAIDs

Avoid manipulation, traction

95% improve in 4-8 wk

Surgery if:
Intractable pain despite 3 mo conservative Mx
Or
Progressive neurological deficit

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66
Q

Sensory, motor, reflex Sx in C4-C5 disc syndrome

A

C5

S: shoulder

M: deltoid, biceps, supraspinarus

R:-

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67
Q

Sensory, motor, reflex Sx in C5-C6 disc syndrome

A

C6

S: thumb

M: biceps

R: biceps, brachioradialis

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68
Q

Sensory, motor, reflex Sx in C6-C7 disc syndrome

A

C7

S: middle finger

M: triceps

R: triceps

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69
Q

Sensory, motor, reflex Sx in C8-T1 disc syndrome

A

C8

S: 5th finger

M: digital flexors, intrinsics

R: Hoffmann (finger jerk)

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70
Q

The most common cause of spinal cord impairment

A

Cervical spondylotic myelopathy:

Degenerative process of cervical spine leading to canal stenosis

Includes:
Disc degeneration/herniation
Osteophyte
Ossification/hypertrophy of ligaments
Congenital stenosis
Subluxation
Alteration of normal lordosis
Altered mobility
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71
Q

Cervical spondylosis Sx

A

Mechanical neck pain, exacerbated by excess vertebral motion (esp rotation and lateral bending)

Gait disturbance, lower extremities weakness or stiffness (early Sx)

Occipital H/A

Radiculopathy (neck, shoulder, arm pain, paresthesias, numbness)

Myelopathy (upper weakness> lower), decreased dexterity, sensory changes, UMN findings (hyperreflexia, clonus, babinski), funicular pain (burning and stinging +/- Lhermitte)

C5-C6 > C6-C7

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72
Q

The most worrisome complaint in cervical spondylosis

A

Lower extremity weakness

73
Q

Epidemiology of cervical spondylosis

A

40-50yr

M>F

C5-C6> C6-C7

74
Q

Inv for cervical spondylosis

A

Cervical spine X-ray */- flexion/extension

MRI most useful for neural compression

CT for bony anatomy

EMG/NCS if peripheral nerve investigation needed

75
Q

Tx of cervical spondylosis

A

Non-surgical:
Prolonged immobilization with cervical bracing

Bed rest

Anti-inflammatory meds

Surgical if:

Myelopathy with motor impairment
Progressive neurological impairment
Intractable pain

76
Q

Lumbar disc syndrome, involved nerve root?

A

Posterolaterally herniation:
Nerve root exiting below the level of the disc (traversing root)

Far lateral disc herniation:
Compresses root at the level of the disc (exiting root)

77
Q

Sx of lumbar disc syndrome

A

Initially back pain, then leg> back

Limited movement esp forward flexion

Motor, sensory, reflex Sx

Exacerbation with valsalva

Relief with flexing the knee or thigh

SLR, crossed SLR (pain < 60°): L5 or S1

Femoral stretch test: L2, L3, L4

78
Q

Inv for lumbar disc syndrome

A

MRI: choice

Xray to rule out other lesions

CT for bony anatomy

If MRI contraindicated: myelogram and post-myelogram CT

79
Q

Tx of lumbar disc syndrome

A

Conservative

Surgery if cauda equina, progressive neurologic deficit, intractable pain

95% spontaneous improvement within 95%

Best guide for Mx: clinical status

80
Q

Sensory, motor, reflex, pain pattern in lumbar disc syndrome
L3-L4

A

L4

P: femoral pattern

S: medial leg

M: tibialis anterior (foot dorsiflexion)

R: patellar

81
Q

Sensory, motor, reflex, pain pattern in lumbar disc syndrome
L4-L5

A

L5

P: sciatic pattern

S: dorsal foot to hallux

M: hallux extension

R: medial hamstrings

82
Q

Sensory, motor, reflex, pain pattern in lumbar disc syndrome
L5-S1

A

S1

P: sciatic

S: lateral leg/foot

M: ankle plantar flextion

R: achilles

83
Q

Conus medullaris syndrome

A

Sudden onset

Bilateral

Pain is rare. If present, bilateral, symmetric, in perineum and thigh

Saddle, bilateral and symmetric sensory deficit.
Sensory dissociation

Symmetric motor deficit. paresis less marked. +/- fasciculation

Reflex: ankle jerk absent. Preserved knee jerk

Urinary retention, Atonic anal sphincter: (early)
Impotence

84
Q

Cauda equina syndrome

A

Usually Acute

Unilateral

Severe, radicular pain in perineum, thighs, legs, back, or bladder

Pain aggravated by valsalva and sitting
Relieved by lying down

Saddle anesthesia.
No sensory dissociation.
May be unilateral/asymmetric

Motor: asymmetric. Paresis more marked, +/- atrophy. Fasciculation rare

Knee and ankle reflexes may be absent

Sphincter dysfunction: (late) presentation: urinary retention (overflow incontinence), and/or fecal incontinence
Impotence less frequent

85
Q

Inv for cauda equina

A

Urgent MRI (compression on S2,S3,S4)

Post void residual (>250 cause for concern)

86
Q

Tx of cauda equina

A

Surgical decompression within 48 h

RT for palliative oncology pt

87
Q

Etiology of lumbar spinal stenosis

A

Congenital narrowing + degenerative changes

88
Q

Sx of lumbar spinal stenosis

A

Back and leg pain with standing and walking

Relieved by sitting and lying down

Normal exam

89
Q

Inv for lumbar spinal stenosis

A

MRI : confirms and localizes the level of stenosis

90
Q

Tx of spinal stenosis

A

NSAID, analgesics

Surgical:
Laminectomy

91
Q

Neurogenic claudication

A

Ischemia of lumbosacral nerve root secondary to vascular compromise and increased demand from exertion

Often due to lumbar stenosis

Pain/paresthesia/weakness of buttock/hip/thigh/leg

Initiated by standing or walking

Slow relief with postural change (>30 min)

May be elicited by lumbar extension

Normal exam

No PVD

92
Q

Inv for neurogenic claudication

A

Bicycle test: individuals with neurogenic claudication last longer in comparison with vascular claudication

93
Q

Etiology of syringomyelia

A

Chiari I malformation (70%)

Basilar invagination (10%)

Post-traumatic

Tumor

Tethered cord

94
Q

Sx of syringomyely

A

Initially:
Pain, weakness, atrophy in upper extremities

Then:
Loss of pain and temperature

Sensory loss with preserved touch and proprioception in a band like distribution at the level of cervical syrinx

Dysesthetic pain in the distribution of sensory loss

LMN arm/hand weakness or wasting

Painless neuropathic arthropathies (Charcot’s joints), esp in shoulder and neck

95
Q

Inv for syringomyelia

A

MRI: best

Myelogram with delayed CT

96
Q

Tx of syringomyelia

A

Treat underlying

If progressive and size allows for shunt, : shunting of syrinx

97
Q

Time of some recovery after complete spinal cord lesion

A

Within first 24 h

No distal function will recover after 24 h

98
Q

Involved segment of spinal cord with respect to level of injury

A

4 levels or more below injury

99
Q

Brown-Séquard syndrome

A

Hemisection of cord

Ipsilateral LMN weakness AT the lesion

Ipsilateral UMN weakness BELOW the lesion

Ipsilateral loss of vibration and proprioception

Contralateral loss of pain and temperature

Preserved light touch

100
Q

Anterior cord syndrome

A

Anterior spinal artery occlusion or compression

Bilateral LMN weakness AT the lesion

Bilateral UMN weakness BELOW the lesion

Urinary retention

Preserved vibration and proprioception

Bilateral loss of pain and temperature

Preserved light touch

101
Q

Central cord syndrome etiology

A

Syringomyelia

Tumor

Spinal hyperextension injury

102
Q

Central cord Sx

A

Bilateral motor weakness:
LMN Upper limb weakness > UMN lower limb weakness

Urinary retention

Bilateral loss of pain/temperature > vibration/proprioception

103
Q

Posterior cord syndrome

A

Posterior spinal artery infarction, trauma

Motor is preserved

Bilateral loss of vibration/proprioception/light touch at and below the lesion

Preserved pain and temperature

104
Q

The most common spinal cord syndrome

A

Central

105
Q

Neurapraxia

A

Axon structurally intact but fails to function

Recovery within hours to month (6-8 wk)

106
Q

Axonotmesis

A

Axon and myelin sheath disrupted

Endoneurium and supporting structures intact

1mm/d spontaneous recovery. Max at 1-2 y

107
Q

Neurotmesis

A

Nerve completely transected

Need surgical repair

108
Q

Inv for peripheral nerve disease

A 
EMG
NCS
CBC
TSH
Vit B12
CSF
C-spine Xray
CXR
Bone Xray
Myelogram
CT
Magnetic resonance neurogrsphy
Angiogram
109
Q

Tx of nerve entrapment

A 
Conservative:
Prevent repeated stress/injury
PT
NSAID
Local anesthetic/steroid injection

Surgical if:
Progressive deficit
Muscle weakness/atrophy
Failure of medical Mx

110
Q

Tx of nerve stretch/contusion

A

F/U

Exploration if no recovery after 3 mo

111
Q

Axonotmesis Tx

A

If no evidence of recovery, resect damaged segment

Prompt PT and rehab

Maintain joint ROM

Usually incomplete recovery

112
Q

Neurotmesis

A

Surgical repair of nerve sheath/nerve graft

If clean laceration: early exploration and repair

If contaminated/associated injuries: tag with non-absobable suture, reapproach within 10 d

113
Q

Complications if nerve damage

A

Neuroma

CRPS

114
Q

GCS in minor head injury

A

13-15

115
Q

Tx of minor head injury

A

Observation: 24-48h

Wake every hour

Judicious use of sedatives and painkillers

Stepwise approach to return to play and school

116
Q

Tx for severe head injury

A

GCS 8 or lower

Clear airway, ensure breathing

Secure C-spine

Adequate BP

Monitor for clinical deterioration

Monitor/Mx increased ICP

117
Q

Indications for admission of head trauma pt

A

Skull fx

Confusion, impaired consciousness

Concussion with > 5min amnesia

Focal neurologic signs

Extreme H/A

Vomiting

Seizures

Unstable spine

Use of alcohol

Poor social support

118
Q

Head injury + low blood pressure means

A

Injury elsewhere

119
Q

Assessment method for CT/Xray

A

ABCDE

Alignment
Bone
Cartilage
Disc
Soft tissues
120
Q

If negative cervical CT in trauma pt

A

Can remove collar

121
Q

Gold std for skull fx

A

CT with bone window

122
Q

Tx of skull fx

A

If simple:
No surgery
No AB

If compound (open):
Increased risk of infection: AB
Surgical debridement within 24 h

123
Q

Dx of skull base fx

A

Clinical

Suspect in Lefort II/III

124
Q

Canadian CT head rule

A

GCS < 15, at 2 h after trauma

Suspected open/depressed fx

Sign of basal skull fx

Vomiting > 1 episode

Age 65 and more

Amnesia after impact > 30 min

Dangerous mechanisms

125
Q

Spinal shock

A

Transient loss of all neurologic function below the level of the spinal cord injury:
Flaccid paralysis, areflexia

Variable period

Resolution indicated by return of reflexes (most commonly bulbocavernous)

126
Q

Neurogenic shock

A

SBP < 80 due to interruption of sympathetics below the level of injury. And loss of muscle tone, causing blood pooling

127
Q

Major causes of death in SCI

A

Aspiration

Shock

128
Q

Pts considered having SCI until proven otherwise

A

Major trauma

Minor trauma with decreased LOC

Neck/back pain

Weakness

Abdominal breathing

Numbness

Tingling

Priapism

129
Q

Mx of SCI

A

ABC

Immobilization

O2

Foley

Temperature regulation

SBP > 90 (dopamine, hydration, atropine)

DVT Px

CBC/Lyte monitoring

Focused Hx

Spinal palpation

Motor/sensory/reflex/autonomic function

C-spine Xraus (AP, lateral, odontoid, flexion, extension)

CT for bony injuries

MRI if neurological deficit

Methylprednisolone within 8 h

Decompression if acute non-penetrating injury

130
Q

Compression fx of spine

A

Produced by flexion

Posterior ligament complex intact

Stable

Kyphotic deformity

131
Q

Burst fx

A

Stable (Posterior column intact)

Pedicle widening on AP Xray

If posterior column disrupted: unstable

132
Q

Flexion distraction body

A

Hyperflexion and distraction of posterior elements

Failure of middle and posterior column

133
Q

Fracture-dislocation of spinal column

A

Anterior and cranial dislocation of superior vertebral body

134
Q

Jefferson fx mechanism

A

C1 fx

Vertical compression forces

135
Q

Fx presenting with head instability (holding with hands)

A

Odomtoid

136
Q

The most common odontoid fx

A

Type 2: odontoid neck fx

137
Q

Hangman fx

A

Bilateral fx through pars interarticularis of C2

Spondylolisthesis of axis on C3

Usually neurologically intact

138
Q

Clay shoveler fx

A

Avulsion of spinous process of C6 or C7

139
Q

Tx of cervical neck fx

A

Immobilization (cervical collar or halo vest) 2-3 mo

Surgical fixation if:
Comminution
Displacement
Inability to maintain alignment with external immobilization

After recovery, confirm stability with flexion-extension x-rays

140
Q

Cardiovascular activity in brain death

A

Remains for up to 2 weeks

141
Q

Criteria for brain death Dx

A

Prerequisites:

No:
CNS depressants
Neuromuscular blocking agents
Drug intoxication
Poisoning
T<32°
Electrolyte/acid-base/endocrine disturbance
Absent brainstem reflexes:
Pupillary light
Corneal
Caloric
Oculocephalic
Pharyngeal and tracheal
Cough with tracheal suctioning
Absent respiratory drive at PaCO2 >60 (20 above baseline)

2 evaluations separated by time

Performed by 2 specialists

Confirmatory testing:

Flat EEG
Absent perfusion with cerebral angiogram

142
Q

Inv for coma

A 
ABC
Extended lytes
TSH
LFT
BUN, Cr
Toxin screen
Glucose
CT/MRI
LP
EEG
143
Q

Persistent vegetative state

A

Complete unawareness

Sleep-wake cycles

Complete/partial preservation of hypothalamic and brainstem autonomic function

Awake

Irreversible loss of cerebral cortical function but intact brainstem function

2-5 yr

144
Q

Spina bifida prevalence

A

15-20%

145
Q

Most common place for spina bifida

A

L5

S1

146
Q

Inv for spina bifida

A

U/S
MRI

to R/O spinal anomalies

147
Q

Tx for spina bifida

A

None

148
Q

Mist common site for meningocele

A

Lumbosacral

149
Q

Disabilities in meningocele

A

None

150
Q

Inv for meningocele

A

Plain film

CT

MRI

U/S

Echo

GU investigations

151
Q

Tx of meningocele

A

Surgical excision

Good prognosis

152
Q

Myelomeningocele disabilities

A

Sensory
Motor
Urinary and fecal
Hydrocephalus

Most have type II chiari

Most have IQ score 80-95

153
Q

Inv for myelomeningocele

A 
Xray
CT
MRI
U/S
Echo
GU investigation
154
Q

Tx of myelomeningocele

A

Surgical closure

Better outcome if in fetal period

155
Q

Cracked pot sound on cranial percussion

A

Hydrocephalus

156
Q

Sx of hydrocephalus in children

A

Increased HC

Bulging anterior fontanelle

Widened cranial sutures

Irritability

Lethargy

Poor feeding

Scalp vein dilation

Sunset eyes

Episodic bradycardia and apnea

157
Q

Inv for hydrocephalus

A 
Skull Xray
U/S
CT
MRI
ICP monitoring
158
Q

Tx of hydrocephalus

A

Similar to adults

159
Q

Dandy-Walker malformation

A

Atresia of Magendie and Luschka foramina

Complete/incomplete agenesis of the cerebellar vermis

Posterior fossa cyst, enlarged posterior fossa

Dilatation of all ventricles

160
Q

Sx of Dandy-Walker malformation

A

20% are asymptomatic

Seizure

Hydrocephalus

Prominent occiput

Ataxia

Spasticity

Poor fine motor control

161
Q

Inv for Dandy-Walker

A

U/S
CT
MRI

162
Q

Tx of Dandy-Walker

A

None if asymptomatic

Hydrocephalus: surgery

50% normal IQ

163
Q

Type 1 chiari

A

Cerebellar tonsils below the foramen magnum

Presentation: 15 yr

164
Q

Sx of type 1 chiari

A

Asymptomatic

Pain

Weakness

Numbness

Loss of temperature sensation

Foramen magnum compression syndrome

Cerebellar syndromic

Syringomyelia

Hydrocephalus

165
Q

Inv and Tx for type 1 chiari

A

MRI

If symptomatic: early surgery within 2 yr of Dx

166
Q

Type II chiari

A

Extension through foramen magnum of:

Part of cerebellum vermis
Medulla
4th ventricle

Presents in infancy

167
Q

Sx of chiari type 2

A

Brainstem and lower CN symptoms

Neurogenic dysphagia

Apnea

Stridor

Aspiration

Arm weakness

Downbeat nystagmus

Myelomeningocele

Hydrocephalus

168
Q

The most common cause of mortality in chiari 2

A

Respiratory arrest

169
Q

Chiari 2 Tx

A

MRI

If symptomatic:
Check the shunt first
Then
Surgical decompression

170
Q

Craniosynostosis of which suture results in scaphocephaly?

A

Long narrow scalp

Sagital

171
Q

Craniosynostosis of which suture causes brachiocephaly?

A

Coronal

172
Q

Craniosynostosis causing trigonocephhaly

A

Metopic suture

173
Q

Problems with Craniosynostosis

A

Skull deformity

Raised ICP

Hydrocephalus

Ophthalmologic problems (increased ICP, bony abn of orbit)

174
Q

Positional plagiocephaly

A

Secondary to back sleeping

175
Q

Inv for craniosynostosis

A

Xray

CT

176
Q

Tx of Craniosynostosis

A

Parental counseling (nature of deformity, associated symptoms)

Surgery for cosmesis or if increased ICP (>2 sutures involved

177
Q

Prevalence of pediatric brain tumor

A

Second most type of cancer in children

60% infratentorial

178
Q

Most common location for brain tumors

A

Pilocytic astrocytoma:
Posterior fossa

Medulloblastoma:
Cerebellum

Ependymoma:
4th ventricle

Hemangioblastoma:
Cerebellar

Craniopharyngioma:
Supratentorial

Med (25 decks)

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