Neurosurgery Flashcards
Name the 4 major spinal trauma fractures/injuries according to the Denis classification
• compression fracture
• burst
• flexion-distraction or seat belt type fracture
• fracture-dislocation
Cervical flexion myotome
C1,c2
Cervical side flexion myotome
C3
Scapula elevation myotome
C4
Shoulder abduction myotome
C5
Elbow flexion myotome
C6
Wrist extension myotome
C6
Wrist flexion myotome
C7
Elbow extension myotome
C7
Thumb extension myotome
C8
Finger abduction myotome
T1
Hip flexion myotome
L1 l2
Knee extension myotome
L3
Ankle dorsiflexion myotome
L4
Big toe extension myotome
L 5
Ankle plantarflexion myotome
S1
Knee flexion myotome
S 2
Name nine risk factors for blunt cerebro-vascular injury ( BCVI ) that needs Ct angio screening
• unexplained neuro deficit
• arterial epistaxis following blunt head trauma
• GCS <8
• petrous bone fracture evidence
• dai and GCS <6
• C spine fractures especially involving foramen transversarium
• C spine fractures with subluxation or rotational components
• Le fort 2-3 facial fractures or bilateral mandibular fracture
• near hanging or strangulation
Name 4 signs of basal skull fracture
•Haemotympanum
• raccoon eyes
• CSF otorrhea or rhinorrhea
. Battles sign
Primary arterial supply of spine?
Anterior spinal arteries that originate as paired branches of vertebral arteries that join just below basilar artery
Posterior columns supplied by posterior spinal arteries
Venous drainage of spine? (3)
Batson’s plexus
• extradural vertebral venous plexus
• extravertebral venous plexus
• veins of bony structures of spine
Define neurogenic shock cause and symptoms (6)
• occur due to loss sympathetic autonomic supply
• usually lesions above T 1
. Hypotension’s not responsive to fluids.vasopressors may be required (dobutamine)
• loss muscle tone, venous pooling, hypovolaemia
• bradycardia due to unopposed parasympathetic
Define spinal shock cause and symptoms (4)
• Transient loss motor activity below level of lesion
. Return of bulbocavernosus reflex signal end
• poor prognostic sign for serious spinal cord injury
• abate 72 hours to weeks to months
Define autonomic dysreflexia cause and symptoms ( 10)
• Opposite of neurogenic shock
• usually injuries above t6
. Bouts severe paroxysmal ht, due to sympathetic overdrive
• throbbing headaches, nasal stuffy, cognitiveimpair, feeling of doom
. Profuse sweating, skin flush, anxiety
• usual triggers are bladder distension, fecal impaction
• Medical emergency
• priapism poor prognostic sign!
Where does spinal cord end?
L1/L2
Where is t12 segment of spinal cord found in relation to vertebrae?
T 9
Where is t8 segment of spinal cord found in relation to vertebrae?
T6
Clinical level of t1-t6 lesion?
Add 1. Eg T 1 injury is clinical level t2
Clinical level of t7-t 9 lesion?
Add Two. Eg t8 lesion at clinical level t10
Clinical level of T10 lesion?
L1 l2
Clinical level of t11 lesion?
L3 L 4
Clinical level of t 12 lesion?
L5
Clinical level of l1 lesion?
Sacrococcygeal
Define incomplete spinal lesion (4)
• Any residual motor or sensory function more than 3 segments below level of injury
. Preserved long tract signs
• sensation or voluntary movement in lower limbs in presence of C spine or t spine injury
. Sacral sparing (does not qualify with this alone)
Define complete spinal cord lesion
• No preservation of any motor or sensory function more than 3 segments below level of injury
• In absence of spinal shock
• catastrophic trauma
• 3% may develop some recovery in 24 hours
Name injury and symptoms of brown Sequard syndrome (4)
• Hemi-transection of spinal cord
• ipsilateral pyramidal tract loss
• ipsilateral dorsal tract loss
• contralateral spinothalamic tract loss
Name injury and symptoms of central cord syndrome (2)
• Hyper extension injury in older patients with pre-existing spondylosis
• motor weakness ul > ll
Name injury and symptoms of anterior cord syndrome (4)
• Anterior compression or ASA occlusion
• motor paralysis below level injury - corticospinal tracts
• loss spinothalamic tracts
• spare dorsal tracts
Name symptoms of posterior cord syndrome (4)
• spare corticospinal. so motor function preserved
• loss dorsal tracts
•spinothalamic tracts spared
Name symptoms of conus medullaris syndrome (4)
• Sudden and bilateral (last part spine)
. Back pain more severe than radicular pain
• numbness located to perianal area
• urinary retention and atonic anal sphincter
Name symptoms of cauda equina syndrome (4)
• Gradual and unilateral
. Radicular pain more severe than back pain
. Asymmetric areflexic paraplegia
. Urinary retention
Name the 5 grades of the aisa classification of spinal cord injury
A - no motor or sensory function preserved in sacral segments
B- sensory but not motor function preserved in at least sacral segments
C-motor function preserved below neurological level and most key muscles have motor score <3
D-motor score ≥3
E-motor and sensory normal
Define an unstable vertebral fracture (5)
• > 50% columns involved (1 or more)
• increased or decreased intervertebral space height
• interspinous distance increased
• facet joint widening
• > 25% vertebral compression visible on xray
Name the 4 minor spinal trauma fractures according to the Denis classification
• Transverse process fracture
• burst
• pars interarticularis
• spinous process
Cerebral perfusion pressure formula?
Map-icp
Marshall radiologic classification of TBI (6)?
• Diffuse injury 1: no visible pathology
• diffuse injury 2: midline shift 0-5mm
• diffuse injury 3 (swelling): midline shift 0-5 mm and basal cisterns compressed or completely effaced
• diffuse injury 4 (shift): midline shift > 5 mm
• evacuated mass lesion 5: any lesion evacuated surgically
• non-evacuated mass lesion 6: high or mixed density lesions > 25 cm3
Appearance extradural haemorrhage on ct?
Lenticular shape
Appearance subdural haemorrhage on ct?
Crescent shaped
Normal ICP adults?
0-15
What is neurotremesis?
Nerve transection
