Neurosurg 2 Flashcards
Most common pathogen of brain abscess
Streptococcus
Brain abscess pathogen in neonates
Proteus
Citrobacter
Brain abscess pathogen in penetrating injury
Staph
Brain abscess pathogen in ImmComp
Fungi
Protozoa
The most common route for brain abscess
Hematogenous, from lung
Epidural abscess associated with:
Osteomyelitis
RFs for cerebral abscess
Lung abn:
Infection
AV fistula
Osler-Weber-Rendu
Congenital heart disease:
R- to L-shunt
Bacterial endocarditis
Penetrating trauma
ImmSup
Dental abscess, poor dentition
Inv for brain abscess
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
Tx if brain abscess
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
Lucid interval seen in:
Epidural hematoma
1st: post-traumatic reduced LOC
2nd: lucid interval of several hours
3rd: deterioration continuing hours to days
Etiology of epidural hematoma
Skull fx (often middle meningeal artery bleed)
CT of epidural hematoma
Hyperdense Lenticular Sharp margins Limited by suture lines Not limited by dural attachments
Tx of epidural hematoma
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
Age of subdural hematoma
> 50
Associations of subdural hematoma
Acute: Age> 50 Trauma (acceleration-develeration injury) Anticoag Alcohol Cerebral atrophy Infant head trauma
Chronic: Age > 50 (older) EtOH CSF shunt Anticoagulated/coagulopathy
CT of subdural hematoma
Acute:
Hyperdense
Crescentic
Crossing suture lines
Chronic:
Hypodense
Crescentic
Crossing suture lines
Tx of subdural hematoma
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
Prognosis of subdural hematoma
Acute: poor
Chronic: good
CT of SAH
Hyperdense blood in cisterns/fissures
Tx of SAH
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
Prognosis of SAH
50% mortality
Etiology of ICH
HTN Vascular abn Tumor Infection Coagulopathy
Age>55 Male Cocaine EtOH Amphetamine
CT of ICH
Hyperdense intraparanchymal collection
Tx if ICH
Decrease BP
Control ICP
Craniotomy
CT, MRI T1, MRI T2 for intracranial bleeds within 72 h
CT: hyperdense
MRI T1: Grey
MRI T2: Black
CT, MRI T1, MRI T2 for intracranial bleeds <3 wk (subacute)
CT: isodense
T1: white
T2: white
CT, MRI T1, MRI T2 for intracranial bleeds > 3 wk (chronic)
CT: hypo
T1: Black
T2: Black
How to remember MRI changes in bleeding
MRI T1: George Washington Bridge
MRI T2: Orio: Black, White, Black
Which intracranial bleeding is the great imitator of dementia)
Chronic SDH
Most common cause of SAH
Trauma
Others: spontaneous (aneurism, AVM), coagulopathy, idiopathic,…
Peak age of SAH
55-60
RFs for SAH
HTN Pregnancy, partirition if pre-existing AVM Eclampsia OCP Cigarette Cocaine Alcohol
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
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
Prevention of SAH
Early clipping or coiling of eneurism
Most common type of intracranial aneurysms
Berry
Mostly in carotid system
Most common location for saccular aneurysms
AComm
Fusiform aneurisms etiology and location
Atherosclerosis
Vertebrobasilar system
Mist common cause of infectious aneurysms
Strep and staph
RFs for aneurysms
ADPKD
Fibromascular dysplasia
AVM
Ehlers-Danlos
Marfan
FHx
Bacterial endocarditis
Osler-Weber-Randi
Atherosclerosis
HTN
Trauma
Smoking
Sentinel hemorrhage
SAH Sx for < 24 h
May have blood on CT or LP
Requires urgent clipping/coiling of aneurism to prevent Catastrophic bleed
The most common clinical presentation of aneurism
Rupture
Inv for aneurysm
CTA
MRA
Angiography
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
Drugs causing ICH
Amphetamines
Cocaine
Alcohol
Anticoagulants
RFs for ICH
>55 Male HTN Black/asian > caucasian Previous CVA Heavy alcohol use, cocaine, amphetamines Liver disease Anticoag
Inv for ICH
Severity score
Non-contrast CT
CTA
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
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
AVM facts
M, 33yr
Sx:
Small ones: hemorrhage
Large ones: seizures
Focal neurological signs (steal phenomenon)
Localized headache
Bruit
Inv for AVM
MRI
MRA
Angio
Tx of AVM
Choice: surgical excision
If <3cm or very deep:
Stereotactic radiosurgery
+/- Endovascular embolization
Conservative, palliative embolization
Sx of cavernous malformation
Seizure
Progressive neurological deficit
Hemorrhage
H/A
Dx of cavernous hemangioma
MRI T2: non enhancing
Best method for Dx: gradient echo sequencing
Tx of cavernous hemangioma
Surgical excision if:
Symptomatic, surgically accessible
Dural fistula Sx
Asymptomatic
Pulsatile tinnitus
Bruit
Headache
If carotid cavernous involvement:
Proptosis
Chemosis
Bruit
Inv for dural fistula
Non-contrast CT to R/O hemorrhage
MRI
Gold std: Angio
Tx of dural fistula
Conservative
Endovascular interventions
RT
Surgery
Sx of CSF fistula
Otorrhea
Rhinorrhea
Recurrent meningitis
Low pressure headache (worse with sitting)
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
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
Most common cervical disc herniation
C6-C7
Pressure on C7
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
Inv for cervical disc syndrome
If red flags:
C-spine x-ray, CT, MRI (choice)
If peripheral nerve issue and uncertain Dx:
EMG, NCS
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
Sensory, motor, reflex Sx in C4-C5 disc syndrome
C5
S: shoulder
M: deltoid, biceps, supraspinarus
R:-
Sensory, motor, reflex Sx in C5-C6 disc syndrome
C6
S: thumb
M: biceps
R: biceps, brachioradialis
Sensory, motor, reflex Sx in C6-C7 disc syndrome
C7
S: middle finger
M: triceps
R: triceps
Sensory, motor, reflex Sx in C8-T1 disc syndrome
C8
S: 5th finger
M: digital flexors, intrinsics
R: Hoffmann (finger jerk)
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
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
The most worrisome complaint in cervical spondylosis
Lower extremity weakness
Epidemiology of cervical spondylosis
40-50yr
M>F
C5-C6> C6-C7
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
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
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)
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
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
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
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
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
Sensory, motor, reflex, pain pattern in lumbar disc syndrome
L5-S1
S1
P: sciatic
S: lateral leg/foot
M: ankle plantar flextion
R: achilles
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
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
Inv for cauda equina
Urgent MRI (compression on S2,S3,S4)
Post void residual (>250 cause for concern)
Tx of cauda equina
Surgical decompression within 48 h
RT for palliative oncology pt
Etiology of lumbar spinal stenosis
Congenital narrowing + degenerative changes
Sx of lumbar spinal stenosis
Back and leg pain with standing and walking
Relieved by sitting and lying down
Normal exam
Inv for lumbar spinal stenosis
MRI : confirms and localizes the level of stenosis
Tx of spinal stenosis
NSAID, analgesics
Surgical:
Laminectomy
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
Inv for neurogenic claudication
Bicycle test: individuals with neurogenic claudication last longer in comparison with vascular claudication
Etiology of syringomyelia
Chiari I malformation (70%)
Basilar invagination (10%)
Post-traumatic
Tumor
Tethered cord
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
Inv for syringomyelia
MRI: best
Myelogram with delayed CT
Tx of syringomyelia
Treat underlying
If progressive and size allows for shunt, : shunting of syrinx
Time of some recovery after complete spinal cord lesion
Within first 24 h
No distal function will recover after 24 h
Involved segment of spinal cord with respect to level of injury
4 levels or more below injury
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
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
Central cord syndrome etiology
Syringomyelia
Tumor
Spinal hyperextension injury
Central cord Sx
Bilateral motor weakness:
LMN Upper limb weakness > UMN lower limb weakness
Urinary retention
Bilateral loss of pain/temperature > vibration/proprioception
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
The most common spinal cord syndrome
Central
Neurapraxia
Axon structurally intact but fails to function
Recovery within hours to month (6-8 wk)
Axonotmesis
Axon and myelin sheath disrupted
Endoneurium and supporting structures intact
1mm/d spontaneous recovery. Max at 1-2 y
Neurotmesis
Nerve completely transected
Need surgical repair
Inv for peripheral nerve disease
EMG NCS CBC TSH Vit B12 CSF C-spine Xray CXR Bone Xray Myelogram CT Magnetic resonance neurogrsphy Angiogram
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
Tx of nerve stretch/contusion
F/U
Exploration if no recovery after 3 mo
Axonotmesis Tx
If no evidence of recovery, resect damaged segment
Prompt PT and rehab
Maintain joint ROM
Usually incomplete recovery
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
Complications if nerve damage
Neuroma
CRPS
GCS in minor head injury
13-15
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
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
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
Head injury + low blood pressure means
Injury elsewhere
Assessment method for CT/Xray
ABCDE
Alignment Bone Cartilage Disc Soft tissues
If negative cervical CT in trauma pt
Can remove collar
Gold std for skull fx
CT with bone window
Tx of skull fx
If simple:
No surgery
No AB
If compound (open):
Increased risk of infection: AB
Surgical debridement within 24 h
Dx of skull base fx
Clinical
Suspect in Lefort II/III
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
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)
Neurogenic shock
SBP < 80 due to interruption of sympathetics below the level of injury. And loss of muscle tone, causing blood pooling
Major causes of death in SCI
Aspiration
Shock
Pts considered having SCI until proven otherwise
Major trauma
Minor trauma with decreased LOC
Neck/back pain
Weakness
Abdominal breathing
Numbness
Tingling
Priapism
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
Compression fx of spine
Produced by flexion
Posterior ligament complex intact
Stable
Kyphotic deformity
Burst fx
Stable (Posterior column intact)
Pedicle widening on AP Xray
If posterior column disrupted: unstable
Flexion distraction body
Hyperflexion and distraction of posterior elements
Failure of middle and posterior column
Fracture-dislocation of spinal column
Anterior and cranial dislocation of superior vertebral body
Jefferson fx mechanism
C1 fx
Vertical compression forces
Fx presenting with head instability (holding with hands)
Odomtoid
The most common odontoid fx
Type 2: odontoid neck fx
Hangman fx
Bilateral fx through pars interarticularis of C2
Spondylolisthesis of axis on C3
Usually neurologically intact
Clay shoveler fx
Avulsion of spinous process of C6 or C7
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
Cardiovascular activity in brain death
Remains for up to 2 weeks
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
Inv for coma
ABC Extended lytes TSH LFT BUN, Cr Toxin screen Glucose CT/MRI LP EEG
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
Spina bifida prevalence
15-20%
Most common place for spina bifida
L5
S1
Inv for spina bifida
U/S
MRI
to R/O spinal anomalies
Tx for spina bifida
None
Mist common site for meningocele
Lumbosacral
Disabilities in meningocele
None
Inv for meningocele
Plain film
CT
MRI
U/S
Echo
GU investigations
Tx of meningocele
Surgical excision
Good prognosis
Myelomeningocele disabilities
Sensory
Motor
Urinary and fecal
Hydrocephalus
Most have type II chiari
Most have IQ score 80-95
Inv for myelomeningocele
Xray CT MRI U/S Echo GU investigation
Tx of myelomeningocele
Surgical closure
Better outcome if in fetal period
Cracked pot sound on cranial percussion
Hydrocephalus
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
Inv for hydrocephalus
Skull Xray U/S CT MRI ICP monitoring
Tx of hydrocephalus
Similar to adults
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
Sx of Dandy-Walker malformation
20% are asymptomatic
Seizure
Hydrocephalus
Prominent occiput
Ataxia
Spasticity
Poor fine motor control
Inv for Dandy-Walker
U/S
CT
MRI
Tx of Dandy-Walker
None if asymptomatic
Hydrocephalus: surgery
50% normal IQ
Type 1 chiari
Cerebellar tonsils below the foramen magnum
Presentation: 15 yr
Sx of type 1 chiari
Asymptomatic
Pain
Weakness
Numbness
Loss of temperature sensation
Foramen magnum compression syndrome
Cerebellar syndromic
Syringomyelia
Hydrocephalus
Inv and Tx for type 1 chiari
MRI
If symptomatic: early surgery within 2 yr of Dx
Type II chiari
Extension through foramen magnum of:
Part of cerebellum vermis
Medulla
4th ventricle
Presents in infancy
Sx of chiari type 2
Brainstem and lower CN symptoms
Neurogenic dysphagia
Apnea
Stridor
Aspiration
Arm weakness
Downbeat nystagmus
Myelomeningocele
Hydrocephalus
The most common cause of mortality in chiari 2
Respiratory arrest
Chiari 2 Tx
MRI
If symptomatic:
Check the shunt first
Then
Surgical decompression
Craniosynostosis of which suture results in scaphocephaly?
Long narrow scalp
Sagital
Craniosynostosis of which suture causes brachiocephaly?
Coronal
Craniosynostosis causing trigonocephhaly
Metopic suture
Problems with Craniosynostosis
Skull deformity
Raised ICP
Hydrocephalus
Ophthalmologic problems (increased ICP, bony abn of orbit)
Positional plagiocephaly
Secondary to back sleeping
Inv for craniosynostosis
Xray
CT
Tx of Craniosynostosis
Parental counseling (nature of deformity, associated symptoms)
Surgery for cosmesis or if increased ICP (>2 sutures involved
Prevalence of pediatric brain tumor
Second most type of cancer in children
60% infratentorial
Most common location for brain tumors
Pilocytic astrocytoma:
Posterior fossa
Medulloblastoma:
Cerebellum
Ependymoma:
4th ventricle
Hemangioblastoma:
Cerebellar
Craniopharyngioma:
Supratentorial
