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Neurology Key Info > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

what does the sensory spinocerebellar pathway do?

A

sends information about unconscious proprioception to the cerebellum for posture and movement of upper and lower limbs

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2
Q

what does the vestibulospinal tract do?

A

exerts posture via extensors for legs and flexors for arms

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3
Q

which spinal tract increases tone?

A

reticulospinal tract via the pontine reflex response

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4
Q

which spinal tract decreases tone?

A

reticulospinal tract via the medullary tract

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5
Q

knee reflex nerves

A

L3/4 femoral

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6
Q

biceps reflex nerves

A

C5/6 musculocutaneous

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7
Q

triceps reflex nerves

A

C7/8 radial

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8
Q

ankle reflex nerves

A

S1/2 tibial

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9
Q

what type of cartilage is the annulus fibrosus made of?

A

fibrocartilage

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10
Q

three directions of prolapse for the nucleus pulposis

A
  1. paramedian (posterolateral)
  2. extraforaminal (far lateral)
  3. central/ medial herniation
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11
Q

paramedian prolapse

A

compresses tranversing nerve

herniation at L4/5 causes damage to L5 as nerve root exits below level

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12
Q

extraforminal (far lateral) proalpse

A

compresses exiting nerve

herniation at L4/5 causes L4 damage

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13
Q

central/ medial prolapse

A

lumbar stenosis or if large enough can cause cauda equina

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14
Q

what is a radiculopathy?

A

dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the muscle groups supplied by that nerve
LMN

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15
Q

what is a myelopathy?

A

UMN signs more predominant in lower limbs before progressing to upper limbs

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16
Q

presentation of neurogenic claudication

A

leg weakness
tingling
numbness
normal pulses

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17
Q

cause of anterior cord syndrome

A

cord infarction by anterior spinal artery

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18
Q

presentation of spinal shock

A

flaccid areflexic paralysis

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19
Q

three components of the cerebellum

A
  1. vestibulocerebellum
  2. spinocerebellum
  3. cerebrocerebellum
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20
Q

role of the vestibulocerebellum

A

balance and coordination of vestibulo-ocular reflexes

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21
Q

role of the spinocerebellum

A

maintains muscle tone and participates in posture and gait

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22
Q

role of the cerebrocerebellum

A

voluntary motor movement

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23
Q

presentation of thalamic infarction

A

hemiparesis
spontaneous pain
hemichorea
severe impairment of consciousness

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24
Q

appearance of glioblastoma multiforme

A

butterfly

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25
Q

appearance of oligodendroglioma

A

toothpaste

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26
Q

where do meningiomas originate from?

A

arachnoidal cap cells within arachnoid membrane

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27
Q

what are associations with meningiomas

A

NF2

childhood radiation

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28
Q

what are haemangioblastomas?

A

benign cystic vascular tumours in posterior fossa leading to cerebellar dysfunction and raised ICP

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29
Q

which are haemangioblastomas associated with?

A

VHL

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30
Q

diagnosis of AVM

A

catheter angiography

CTA

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31
Q

management of AVM

A

excision

radiosurgery

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32
Q

what is a cavernous malformation?

A

benign vascular lesion in sinusiodal spaces

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33
Q

types of aneurysms

A

berry/saccular
fusiform (hypertension associated)
mycotic

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34
Q

diagnosis of SAH

A

CT > LP > CTA or angiogram

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35
Q

grading scale for SAH

A

Fisher’s grading scale

36
Q

grades in Fisher’s scale

A

grade 1= no blood seen on CT
grade 2= diffuse or vertical layers <1mm
grade 3= diffuse clot and/or vertical layer >1mm

37
Q

what ischaemic penumbra?

A

early ischaemic stroke there is an area not functioning but has reversible damage atm

38
Q

pupillary light reflex pathwya

A

CNII > optic tract > ipsilateral pretectal nucleus of midbrain > bilateral EWN > CNIII > ciliary ganglion > parasympathetic via short ciliary nerve > ciliary muscle and sphincter pupillae

39
Q

what is neuromyelitis optica (Devic’s disease)?

A

bilateral severe optic neuritis and transverse myelitis in 3 or more vertebral columns (muscle weakness, increased tone and spasm)

40
Q

antibody in Devic’s disease?

A

IgG Ab against astrocystic aquaporin 4

41
Q

what causes ptosis in Horner’s?

A

muller muscle dysfunction

42
Q

define anisocoria

A

unequal pupil size

43
Q

what is Adie’s pupil?

A

loss of postganglionic parasympathetic innervation of the iris sphincter and ciliary muscle

44
Q

presentation of Adie’s pupil

A

large pupil with blurring of near vision

absent light reflex

45
Q

what does Holmes-Adie syndrome present with?

A

Adie’s pupil

diminished tendon reflexes of the lower limb +/- orthostatic hypotension

46
Q

diagnosis of Adie’s pupil

A

topical pilocarpine will cause an Adie’s pupil to constrict

47
Q

what is Weber’s syndrome?

A

form of stroke affecting the ventral midbrain

48
Q

presentation of Weber’s syndrome

A

ipsilateral 3rd nerve palsy with contralateral hemiparesis

49
Q

what is Benedikt’s syndrome?

A

form of stroke affecting the dorsal midbrain

50
Q

presentation of Benedikts syndrome

A

ipsilateral 3rd nerve palsy with contralateral tremor, ataxia or chorea

51
Q

what is the cogan lid twitch?

A

brief upshoot of lid elicited by patient looking down then up

{myasthenia gravis)

52
Q

what is the ice test?

A

ptosis improves after applying ice for 2 minutes

53
Q

clinical investigations for myasthenia gravis

A

antibodies
EMG
muscle biopsy
imaging for thymoma

54
Q

what is the genetic inheritance of myotonic dystrophy?

A

AD trinucleotide repeat on chromosome 19

55
Q

presentation of myotonic dystrophy

A 
delayed muscle relaxation and wasting
christmas tree cataract (early onset)
ptosis
hypermetropia
ophthalmoplegia
56
Q

what is benign essential blepharospasm?

A

bilateral idiopathic condition with idiopathic contraction of orbicularis oculi

57
Q

management of benign essential blepharospasm

A

artificial tears

botox

58
Q

what structures are damaged to cause decorticate posturing?

A

cerebrum
internal capsule
thalamus

59
Q

which spinal tracts take over in decorticate posturing?

A

lateral CST is disrupted so rubrospinal tract causes abnormal flexion in upper limbs and reticulospinal extension of legs

60
Q

what structures are damaged to cause decerebrate posturing?

A

level below the red nucleus of the midbrain

61
Q

what spinal tracts cause decorticate posturing?

A

reticulospinal tract causes whole body extension

62
Q

what does CSF flow through to get from the lateral to the 3rd ventircle?

A

foramen of Munro (intraventricular foramen)

63
Q

what does CSF flow through to get to the 4th ventricle?

A

aqueduct of Sylvius

64
Q

what does uncal herniation cause?

A

pupillary dilatation due to involvement of oculomotor nerve and contralateral hemiparesis

65
Q

what does subfalcine hernaiton cause?

A

compression of anterior cerebral artery causing weakness in lower extremities

66
Q

what does tonsillar herniation cause?

A

medullary compression

67
Q

what does central herniation of the brainstem cause?

A

diplopia (6th nerve palsy)

brainstem dysfunction

68
Q

in the spinal which part of the dura exists?

A

only the meningeal part

69
Q

management of normal pressure hydrocephalus?

70
Q

what are chiari malformations?

A

congenital or acquired conditions of the hindbrain affecting CSF circulation through the foramen magnum

71
Q

chiari I malformation

A

caudal displacement of cerebellar tonsils, may be associated with syringomyelia

72
Q

presentation of chiari I malformation

A

HA (coughing, suboccipital pain, neck extension)
downbeat nystagmus
central cord symptoms
ataxic gait

73
Q

chiari II malformation (Arnold-Chiari)

A

displacement of cerebellum and medulla below foramen magnum with herniation of the 4th ventricle

74
Q

what is chairi II associated with?

A

spina bifida

75
Q

which nerve root is extensor hallucis longus specific for?

76
Q

what does an upgoing plantar indicate?

A

lesion not below L1/2 (cervical myelopathy)

77
Q

presentation of cervical myelopathy

A

jump at night/ sitting in char
upgoing plantars
off legs

78
Q

test in cervical myelopathy

A

Hoffman’s

79
Q

management of cervical myelopathy

A 
physio
collar
corticosteroid injections
pain relief
surgery (foot drop more urgent + progression)
80
Q

types of gait

A
  1. spastic
  2. high stepping gait
  3. hemiplegic gait
  4. festinant gait
  5. shuffling gait
81
Q

when is spastic gait present?

A

unilateral in cervical myelopathy

diplegic and scissoring in cerebral palsy

82
Q

what causes high stepping gait?

A

foot drop (L5)
disc prolapse
front of shoe scuffed

83
Q

what causes hemiplegic gait?

84
Q

what muscles are involved in hemiplegic gait?

A

flexors strong in upper limb

extensors in lower limb

85
Q

which condition has a festinant gait?

86
Q

which condition has a shuffling gait?

A

normal pressure hydrocephalus

Neurology Key Info (51 decks)

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