NeuroSurg Flashcards
Provide 3 symptoms of a brain tumor causing high ICP
1) Headache (worse in morning)
2) Blurred Vision
3) projectile vomiting
What is the importance, work-up, and treatment for TIAs
1) predictor of stroke
2) work-up is duplex scan
3) treatment is carotid endarterectomy
How do you work-up ischemic stroke (1) and what is the best treatment (2)?
1) CT scan to confirm not hemorrhagic
2) tPA within 3 hours
What clinical sign increases the suspicion of a subarachnoid bleed from an intracranial aneurysm?
Thunderclap headache
What is the most common type brain cancer in an adult
Glioma
What is the most malignant intracranial tumor in an adult
Glioblastoma multiform
What medical treatment is provided to reduce ICP in brain tumors?
high-dose dexamethasone
Name two clinical side effects of prolactinomas and provide the medical treatment
1) amenorrhea and galactorrhea in young women
2) Bromocriptine
Name 4 sequelae of acromegaly
1) large hands, feet, tongue, jaw
2) hypertension
3) DM
4) headache
What is the physical finding for a pineal gland tumor
Sunset eyes (loss of upper gaze)
What is the most common type of brain tumor in children and describe its clinical presentation
1) Medulloblastoma
2) cerebellar symptoms including truncal ataxia
What is the clinical sign ependymoma
knee-chest position (to open flow of CSF)
What is the treatment for tic douloureux
trigeminal neuralgia is treated with anticonvulsants (carbamazapine)
What does a GCS score of 4+6+5 indicate
1) eyes: spontaneous opening
2) Motor: Obeys commands
3) Verbal: Oriented
What does a GCS score of 3+5+4 indicate
1) eyes: to speech
2) motor: localizes pain
3) Verbal: confused conversation
What does a GCS score of 2+4+3 indicate
1) eyes: to pain
2) motor: withdraws from pain
3) verbal: inappropriate words
What does a GCS score of 1+3+2 indicate
1) eyes: none
2) motor: decorticate posture (abnormal flexion)
3) verbal: incomprehensible sounds
What does a GCS score of 1+2+1 indicate
1) eyes: none
2) motor: decerebrate posture (extension)
3) verbal: none
What does a CGS score of 1+1+1 indicate
1) eyes: none
2) motor: no response
3) verbal: none
What is the most important principle in dealing with a severe closed head inury
Avoidance of secondary injury
When should you intubate a patient with a severe closed head injury
GCS of 8 or less
How should patients with severe head injury and localizing signs be treated in an adequately fluid resuscitated patient
Hypoventilate (reduce intracranial blood volume) and mannitol (decrease blood volume and edema in brain)
How does an epidural hematoma appear on CT and what artery is most commonly involved
Biconvex appearance, middle meningeal artery
What causes subdural hematoma
Tearing of bridging veins (more common in elderly)
A blown pupil is associated with a mass effect on which side (ipsilateral or contralateral)
Ipsilateral
When should carotid endarterectomy be considered?
> 70% occlusion and symptomatic
If following Duplex, the grade of stenosis is in question in the carotid artery, what confirmatory modality can be used
MR angiogram, CT angiogram
What are the most common site for disc hernias and what are some common symtpoms (3)
L4-5 and L5-S1
SSx: back pain radiating down legs, aggravation by coughing/sneezing/straining, relieved by lying flat
Describe cauda equina syndrome (3)
1) mechanical compression of cauda equina
2) loss of bladder and bowel function
3) paresthesia in legs and saddle region
What is appropriate treatment for prolapsed nucleus pulposus with mild to moderate symptoms
bed rest, heat/ice, NSAIDs
