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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
CT, MRI T1, MRI T2 for intracranial bleeds within 72 h
CT: hyperdense MRI T1: Grey MRI T2: Black
26
CT, MRI T1, MRI T2 for intracranial bleeds <3 wk (subacute)
CT: isodense T1: white T2: white
27
CT, MRI T1, MRI T2 for intracranial bleeds > 3 wk (chronic)
CT: hypo T1: Black T2: Black
28
How to remember MRI changes in bleeding
MRI T1: George Washington Bridge MRI T2: Orio: Black, White, Black
29
Which intracranial bleeding is the great imitator of dementia)
Chronic SDH
30
Most common cause of SAH
Trauma Others: spontaneous (aneurism, AVM), coagulopathy, idiopathic,...
31
Peak age of SAH
55-60
32
RFs for SAH
``` HTN Pregnancy, partirition if pre-existing AVM Eclampsia OCP Cigarette Cocaine Alcohol ```
33
Inv for SAH
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
34
Complications of SAH
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
35
Prevention of SAH
Early clipping or coiling of eneurism
36
Most common type of intracranial aneurysms
Berry Mostly in carotid system
37
Most common location for saccular aneurysms
AComm
38
Fusiform aneurisms etiology and location
Atherosclerosis Vertebrobasilar system
39
Mist common cause of infectious aneurysms
Strep and staph
40
RFs for aneurysms
ADPKD Fibromascular dysplasia AVM Ehlers-Danlos Marfan FHx Bacterial endocarditis Osler-Weber-Randi Atherosclerosis HTN Trauma Smoking
41
Sentinel hemorrhage
SAH Sx for < 24 h May have blood on CT or LP Requires urgent clipping/coiling of aneurism to prevent Catastrophic bleed
42
The most common clinical presentation of aneurism
Rupture
43
Inv for aneurysm
CTA MRA Angiography
44
Tx of aneurism
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
45
Drugs causing ICH
Amphetamines Cocaine Alcohol Anticoagulants
46
RFs for ICH
``` >55 Male HTN Black/asian > caucasian Previous CVA Heavy alcohol use, cocaine, amphetamines Liver disease Anticoag ```
47
Inv for ICH
Severity score Non-contrast CT CTA
48
Tx of ICH
``` 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 ```
49
Contraindications to surgical Tx of ICH
Small bleed, minimal symptoms, GCS>10 Poor prognosis, low GCS, lost BS function Very old Severe coagulopathy Difficult location
50
AVM facts
M, 33yr Sx: Small ones: hemorrhage Large ones: seizures Focal neurological signs (steal phenomenon) Localized headache Bruit
51
Inv for AVM
MRI MRA Angio
52
Tx of AVM
Choice: surgical excision If <3cm or very deep: Stereotactic radiosurgery +/- Endovascular embolization Conservative, palliative embolization
53
Sx of cavernous malformation
Seizure Progressive neurological deficit Hemorrhage H/A
54
Dx of cavernous hemangioma
MRI T2: non enhancing Best method for Dx: gradient echo sequencing
55
Tx of cavernous hemangioma
Surgical excision if: | Symptomatic, surgically accessible
56
Dural fistula Sx
Asymptomatic Pulsatile tinnitus Bruit Headache If carotid cavernous involvement: Proptosis Chemosis Bruit
57
Inv for dural fistula
Non-contrast CT to R/O hemorrhage MRI Gold std: Angio
58
Tx of dural fistula
Conservative Endovascular interventions RT Surgery
59
Sx of CSF fistula
Otorrhea Rhinorrhea Recurrent meningitis Low pressure headache (worse with sitting)
60
Inv for CSF fistula
Fluid B-transferrin test, Quantitative glucose analysis of fluid Ring sign Reservoir sign CT (defect, fx, pneumocephalus) Water contrast CT cysternography
61
Tx of CSF fistula
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 ```
62
Most common cervical disc herniation
C6-C7 | Pressure on C7
63
Cervical disc syndrome Sx
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
64
Inv for cervical disc syndrome
If red flags: C-spine x-ray, CT, MRI (choice) If peripheral nerve issue and uncertain Dx: EMG, NCS
65
Tx of cervical disc syndrome
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
66
Sensory, motor, reflex Sx in C4-C5 disc syndrome
C5 S: shoulder M: deltoid, biceps, supraspinarus R:-
67
Sensory, motor, reflex Sx in C5-C6 disc syndrome
C6 S: thumb M: biceps R: biceps, brachioradialis
68
Sensory, motor, reflex Sx in C6-C7 disc syndrome
C7 S: middle finger M: triceps R: triceps
69
Sensory, motor, reflex Sx in C8-T1 disc syndrome
C8 S: 5th finger M: digital flexors, intrinsics R: Hoffmann (finger jerk)
70
The most common cause of spinal cord impairment
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 ```
71
Cervical spondylosis Sx
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
72
The most worrisome complaint in cervical spondylosis
Lower extremity weakness
73
Epidemiology of cervical spondylosis
40-50yr M>F C5-C6> C6-C7
74
Inv for cervical spondylosis
Cervical spine X-ray */- flexion/extension MRI most useful for neural compression CT for bony anatomy EMG/NCS if peripheral nerve investigation needed
75
Tx of cervical spondylosis
Non-surgical: Prolonged immobilization with cervical bracing Bed rest Anti-inflammatory meds Surgical if: Myelopathy with motor impairment Progressive neurological impairment Intractable pain
76
Lumbar disc syndrome, involved nerve root?
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
Sx of lumbar disc syndrome
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
Inv for lumbar disc syndrome
MRI: choice Xray to rule out other lesions CT for bony anatomy If MRI contraindicated: myelogram and post-myelogram CT
79
Tx of lumbar disc syndrome
Conservative Surgery if cauda equina, progressive neurologic deficit, intractable pain 95% spontaneous improvement within 95% Best guide for Mx: clinical status
80
Sensory, motor, reflex, pain pattern in lumbar disc syndrome L3-L4
L4 P: femoral pattern S: medial leg M: tibialis anterior (foot dorsiflexion) R: patellar
81
Sensory, motor, reflex, pain pattern in lumbar disc syndrome L4-L5
L5 P: sciatic pattern S: dorsal foot to hallux M: hallux extension R: medial hamstrings
82
Sensory, motor, reflex, pain pattern in lumbar disc syndrome L5-S1
S1 P: sciatic S: lateral leg/foot M: ankle plantar flextion R: achilles
83
Conus medullaris syndrome
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
Cauda equina syndrome
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
Inv for cauda equina
Urgent MRI (compression on S2,S3,S4) Post void residual (>250 cause for concern)
86
Tx of cauda equina
Surgical decompression within 48 h RT for palliative oncology pt
87
Etiology of lumbar spinal stenosis
Congenital narrowing + degenerative changes
88
Sx of lumbar spinal stenosis
Back and leg pain with standing and walking Relieved by sitting and lying down Normal exam
89
Inv for lumbar spinal stenosis
MRI : confirms and localizes the level of stenosis
90
Tx of spinal stenosis
NSAID, analgesics Surgical: Laminectomy
91
Neurogenic claudication
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
Inv for neurogenic claudication
Bicycle test: individuals with neurogenic claudication last longer in comparison with vascular claudication
93
Etiology of syringomyelia
Chiari I malformation (70%) Basilar invagination (10%) Post-traumatic Tumor Tethered cord
94
Sx of syringomyely
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
Inv for syringomyelia
MRI: best Myelogram with delayed CT
96
Tx of syringomyelia
Treat underlying If progressive and size allows for shunt, : shunting of syrinx
97
Time of some recovery after complete spinal cord lesion
Within first 24 h No distal function will recover after 24 h
98
Involved segment of spinal cord with respect to level of injury
4 levels or more below injury
99
Brown-Séquard syndrome
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
Anterior cord syndrome
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
Central cord syndrome etiology
Syringomyelia Tumor Spinal hyperextension injury
102
Central cord Sx
Bilateral motor weakness: LMN Upper limb weakness > UMN lower limb weakness Urinary retention Bilateral loss of pain/temperature > vibration/proprioception
103
Posterior cord syndrome
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
The most common spinal cord syndrome
Central
105
Neurapraxia
Axon structurally intact but fails to function Recovery within hours to month (6-8 wk)
106
Axonotmesis
Axon and myelin sheath disrupted Endoneurium and supporting structures intact 1mm/d spontaneous recovery. Max at 1-2 y
107
Neurotmesis
Nerve completely transected Need surgical repair
108
Inv for peripheral nerve disease
``` EMG NCS CBC TSH Vit B12 CSF C-spine Xray CXR Bone Xray Myelogram CT Magnetic resonance neurogrsphy Angiogram ```
109
Tx of nerve entrapment
``` Conservative: Prevent repeated stress/injury PT NSAID Local anesthetic/steroid injection ``` Surgical if: Progressive deficit Muscle weakness/atrophy Failure of medical Mx
110
Tx of nerve stretch/contusion
F/U Exploration if no recovery after 3 mo
111
Axonotmesis Tx
If no evidence of recovery, resect damaged segment Prompt PT and rehab Maintain joint ROM Usually incomplete recovery
112
Neurotmesis
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
Complications if nerve damage
Neuroma CRPS
114
GCS in minor head injury
13-15
115
Tx of minor head injury
Observation: 24-48h Wake every hour Judicious use of sedatives and painkillers Stepwise approach to return to play and school
116
Tx for severe head injury
GCS 8 or lower Clear airway, ensure breathing Secure C-spine Adequate BP Monitor for clinical deterioration Monitor/Mx increased ICP
117
Indications for admission of head trauma pt
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
Head injury + low blood pressure means
Injury elsewhere
119
Assessment method for CT/Xray
ABCDE ``` Alignment Bone Cartilage Disc Soft tissues ```
120
If negative cervical CT in trauma pt
Can remove collar
121
Gold std for skull fx
CT with bone window
122
Tx of skull fx
If simple: No surgery No AB If compound (open): Increased risk of infection: AB Surgical debridement within 24 h
123
Dx of skull base fx
Clinical Suspect in Lefort II/III
124
Canadian CT head rule
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
Spinal shock
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
Neurogenic shock
SBP < 80 due to interruption of sympathetics below the level of injury. And loss of muscle tone, causing blood pooling
127
Major causes of death in SCI
Aspiration Shock
128
Pts considered having SCI until proven otherwise
Major trauma Minor trauma with decreased LOC Neck/back pain Weakness Abdominal breathing Numbness Tingling Priapism
129
Mx of SCI
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
Compression fx of spine
Produced by flexion Posterior ligament complex intact Stable Kyphotic deformity
131
Burst fx
Stable (Posterior column intact) Pedicle widening on AP Xray If posterior column disrupted: unstable
132
Flexion distraction body
Hyperflexion and distraction of posterior elements Failure of middle and posterior column
133
Fracture-dislocation of spinal column
Anterior and cranial dislocation of superior vertebral body
134
Jefferson fx mechanism
C1 fx Vertical compression forces
135
Fx presenting with head instability (holding with hands)
Odomtoid
136
The most common odontoid fx
Type 2: odontoid neck fx
137
Hangman fx
Bilateral fx through pars interarticularis of C2 Spondylolisthesis of axis on C3 Usually neurologically intact
138
Clay shoveler fx
Avulsion of spinous process of C6 or C7
139
Tx of cervical neck fx
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
Cardiovascular activity in brain death
Remains for up to 2 weeks
141
Criteria for brain death Dx
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
Inv for coma
``` ABC Extended lytes TSH LFT BUN, Cr Toxin screen Glucose CT/MRI LP EEG ```
143
Persistent vegetative state
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
Spina bifida prevalence
15-20%
145
Most common place for spina bifida
L5 | S1
146
Inv for spina bifida
U/S MRI to R/O spinal anomalies
147
Tx for spina bifida
None
148
Mist common site for meningocele
Lumbosacral
149
Disabilities in meningocele
None
150
Inv for meningocele
Plain film CT MRI U/S Echo GU investigations
151
Tx of meningocele
Surgical excision Good prognosis
152
Myelomeningocele disabilities
Sensory Motor Urinary and fecal Hydrocephalus Most have type II chiari Most have IQ score 80-95
153
Inv for myelomeningocele
``` Xray CT MRI U/S Echo GU investigation ```
154
Tx of myelomeningocele
Surgical closure | Better outcome if in fetal period
155
Cracked pot sound on cranial percussion
Hydrocephalus
156
Sx of hydrocephalus in children
Increased HC Bulging anterior fontanelle Widened cranial sutures Irritability Lethargy Poor feeding Scalp vein dilation Sunset eyes Episodic bradycardia and apnea
157
Inv for hydrocephalus
``` Skull Xray U/S CT MRI ICP monitoring ```
158
Tx of hydrocephalus
Similar to adults
159
Dandy-Walker malformation
Atresia of Magendie and Luschka foramina Complete/incomplete agenesis of the cerebellar vermis Posterior fossa cyst, enlarged posterior fossa Dilatation of all ventricles
160
Sx of Dandy-Walker malformation
20% are asymptomatic Seizure Hydrocephalus Prominent occiput Ataxia Spasticity Poor fine motor control
161
Inv for Dandy-Walker
U/S CT MRI
162
Tx of Dandy-Walker
None if asymptomatic Hydrocephalus: surgery 50% normal IQ
163
Type 1 chiari
Cerebellar tonsils below the foramen magnum Presentation: 15 yr
164
Sx of type 1 chiari
Asymptomatic Pain Weakness Numbness Loss of temperature sensation Foramen magnum compression syndrome Cerebellar syndromic Syringomyelia Hydrocephalus
165
Inv and Tx for type 1 chiari
MRI If symptomatic: early surgery within 2 yr of Dx
166
Type II chiari
Extension through foramen magnum of: Part of cerebellum vermis Medulla 4th ventricle Presents in infancy
167
Sx of chiari type 2
Brainstem and lower CN symptoms Neurogenic dysphagia Apnea Stridor Aspiration Arm weakness Downbeat nystagmus Myelomeningocele Hydrocephalus
168
The most common cause of mortality in chiari 2
Respiratory arrest
169
Chiari 2 Tx
MRI If symptomatic: Check the shunt first Then Surgical decompression
170
Craniosynostosis of which suture results in scaphocephaly?
Long narrow scalp Sagital
171
Craniosynostosis of which suture causes brachiocephaly?
Coronal
172
Craniosynostosis causing trigonocephhaly
Metopic suture
173
Problems with Craniosynostosis
Skull deformity Raised ICP Hydrocephalus Ophthalmologic problems (increased ICP, bony abn of orbit)
174
Positional plagiocephaly
Secondary to back sleeping
175
Inv for craniosynostosis
Xray | CT
176
Tx of Craniosynostosis
Parental counseling (nature of deformity, associated symptoms) Surgery for cosmesis or if increased ICP (>2 sutures involved
177
Prevalence of pediatric brain tumor
Second most type of cancer in children 60% infratentorial
178
Most common location for brain tumors
Pilocytic astrocytoma: Posterior fossa Medulloblastoma: Cerebellum Ependymoma: 4th ventricle Hemangioblastoma: Cerebellar Craniopharyngioma: Supratentorial

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