Neurosurgery Flashcards
What are the early and late complications of Subarachnoid Haemorrhage?
- Early
- Re-bleeding
- Seizures
- Hydrocephalus - Late
- Delayed cerebral ischaemia and vasospasm
- Cognitive impairment
- Mood changes
- Hypopituitarism
Which scoring systems are commonly used in the UK for assessing the severity of aneurysmal subarachnoid haemorrage?
- Hunt and Hess clinical grading scale for subarachnoid haemorrhage
- WFNS Grading scale for Aneurysmal Subarachnoid haemorrhage
- Fisher grade (CT scan)
Where are berry aneurysms most likely to occur?
- Anterior communicating artery
- Posterior communicating artery
- Middle cerebral artery
What are the risk factors associated with aneurysmal Subarachnoid Haemorrhage?
- Genetic
- Polycystic kidney disease
- Cocaine and amphetamine use
- Smoking
- Ehler-Danlos IV
What are the commonest causes of Subarachnoid Haemorrhage?
- 80% Berry aneurysm rupture
- 10% Rupture of AVM
- 10% Trauma
What is the most frequent cause of early rapid deterioration within the first three days of a subarachnoid haemorrhage?
Acute hydrocephalus
Particularly if large amounts of intraventricular blood, as the formina become obstructed
Regarding cauda equina syndrome, is urinary retention or urinary incontinence more common?
Urinary retention is more common in men
Urinary incontinence is more common in women
What is the investigation of choice for cauda equina syndrome?
MRI
What are the indications for tracheal intubation in patients with Subarachnoid haemorrhage?
GCS less than 8
Drop in GCS of more than 2 points
Control of ventilation to target PaCO2 4.5-5kPa
Hypoxia
Airway control
Seizure control
What effects does mannitol have?
Osmotic Diuretic
Free radical scavenger
Its osmotic effect also draws extracellular fluid into the vascular space, thereby reducing intracranial pressure
