Neurosurgery

Question 1

What is ‘coning’

Answer 1

Brainstem compression from herniation -> TONSILAR brain herniation

Question 2

Uncal/transtentorial herniation

Answer 2

Displacement of the uncus of temporal lobe under the tentorium cerebelli

Question 3

Consequence of uncal herniation:

Answer 3

Ipsilateral fixed, dilated pupil (due to compression of the parasympathetic supply of CNIII)

Question 4

Transcalvarial herniation

Answer 4

Herniation of brain through a defect in the skull

Question 5

Cushing’s reflex

Answer 5

Hypertension, bradycardia and irregular breathing

Question 6

Extradural haematoma - where is it (between which layers)

Answer 6

Between dura and skull

Question 7

Extradural haematoma - vessel injury

Answer 7

Middle meningeal

Question 8

Subdural haematoma - where is the bleed:

Answer 8

Outermost meningeal layer

Question 9

Diffuse axonal injury occurs through which MoI

Answer 9

Mechanical shearing following deceleration

Question 10

Increased ICP tx.

Answer 10

IV mannitol

IV furosemide

Question 11

What monitoring is mandatory in GCS <8 with abnormal CT

Answer 11

ICP

Question 12

Indications for immediate CT head following injury:

Answer 12

GCS < 13 - initial assessment
GCS < 15 two hours post-injury 
Basal skull fracture 
Post-traumatic seizure 
MORE than 1 episode of vomiting

Question 13

Indications for CT head within 8 hours following injury:

Answer 13

Aged > 65 yrs
History of bleeding or clotting disorders
Dangerous mechanism of injury
More than 30 minutes of retrograde amnesia
On Warfarin

Question 14

Head injury with lucid interval:

Answer 14

Extradural haematoma

Question 15

Head injury with fluctuating cognition/confusion

Answer 15

Sub-dural haematoma

Question 16

Obstructive hydrocephalus:

Answer 16

Physical blockage to outflow - tumours, haemorrhages

Question 17

Non-obstructive hydrocephalus:

Answer 17

Imbalance in CSF absorption (choroid plexus tumour, meningitis)

Question 18

Triad of normal pressure hydrocephalus:

Answer 18

Dementia, incontinence and disturbed gait

Question 19

1st line Ix. in Hydrocephalus

Answer 19

CT

Question 20

Hydrocephalus acute tx.

Answer 20

External ventricular drain (EVD)

Question 21

Long term CSF diversion technique

Answer 21

Ventriculoperitoneal shunt (VPS)

Question 22

Lumbar puncture must not be used in which form of hydrocephalus

Answer 22

Obstructive - difference in cranial and spinal pressures induced by CSF drainage may cause brain herniation

Question 23

Confirmatory Ix. in SAH

Answer 23

CT head

Question 24

Suspected subarachnoid haemorrhage but negative CT:

Answer 24

Lumbar puncture

Question 25

When (how long after event) should LP be performed in suspected SAH

Answer 25

12 hours following the onset of symptoms

Question 26

Common complication from inter-ventricular haemorrhage

Answer 26

HYDROCEPHALUS

Question 27

CCB used to prevent vasospasm in subarachnoid haemorrhages

Answer 27

NIMODIPINE

Question 28

Following SAH - most aneurysms are treated by:

Answer 28

Coiling by interventional radiology

Question 29

Age indication for 8 hour head CT following head injury:

Answer 29

> 65 years