Neurosurgery Flashcards
Epidural Hematoma
Path: Usually fracture tearing middle meningeal artery
Symptoms: Trauma resulting in LOC, lucid interval, then deterioration and death
Diagnosis: Noncontrast CT head with biconcave hematoma
Management: Craniotomy or even craniectomy
Complications:
Specialist and role: Neurosurgery
Subdural Hematoma
Path: Tearing of bridging veins. Usually after a fall that gradually worsens
Symptoms: Focal neuro deficit or AMS
Diagnosis: Noncontrast CT head with crescent hematoma. Acute is lighter than parenchyma, chronic is darker, subacute is same
Management: Burr holes? Craniotomy may be necessary but often not needed, reverse anticoagulation
Complications:
Specialist and role: Neurosurgery
Aneurysmal Subarachnoid Hemorrhage
Path: Aneurysmal involves circle of willis from atherosclerosis/HTN. Happens and seals off. Can happen in ehler danlos and ADPKD. Trauma involves focal trauma site
Symptoms: Thunderclap headache very quickly, meningitis like sx
Diagnosis: Noncontrast CT head if Ottawa SAH criteria suggest headache concerning for SAH. Will be blood in sulci and basal cistern. If CT head is negative and still concern, can get LP if it has been 6 hours looking for xanthochromia and bilirubin. If CT head is positive get CTA looking for aneurysm
Management: Endovascular angiogram with coil or craniectomy and clipping. Systolic BP < 140 using non nitrate IV medications. Anticoagulation reversal. Nimodipine within 48h. If seizures treat seizures but not prophlacticlaly. Maintain euglycemic, euvolemic, euthermic
Complications: Rebleeding, delayed cerebral ischemia from vasospasm up to 6 weeks, seizures, obstructive hydrocephalus
Specialist and role: Neurosurgery
Cerebral contusion
Path: Rapid deceleration results in small intraparenchymal hematomas from brain contact with skull. It’s like a concussion with a positive CT
Symptoms: LOC
Diagnosis: CT non contrast will show small intraparenchymal hematomas (punctate hematomas) anterior or posteriorly with surrounding vasogenic edema
Management: Do not require craniectomy unless expanding. Can increase in size after craniectomy
Complications:
Specialist and role: Neurosurgery
Intraparenchymal hematoma
Path: Involves lenticulostriate arteries that feed basal ganglia and internal capsule
Symptoms: Motor and Sensory deficits like ischemic stroke
Diagnosis: Noncontrast CT head. Cerebral perfusion pressure = MAP - intracranial pressure
Management: Surgery if herniation or cerebellar involvement > 3cm. Systolic < 160 with titratable antihypertensive, not nitrates. Elevate head to control bleeding. q1h neuro checks. Reverse anticoagulation. Pharmacologic DVT PPX 24h after hematoma is stable
Complications: Herniation
Specialist and role: Neurosurgery
Hydrocephalus
Path:
Symptoms: Wet, wobbly, wacky
Diagnosis: Test of choice is MRI
Management: Lumbar tap test to see if VP shunt will help, if so, VP shunt
Complications:
Specialist and role: Neurosurgery
Intraventricular hemorrhage
Path: Usually after a intraparenchymal hemorrhage or SAH
Symptoms:
Diagnosis: CT head shows blood in ventricles
Management: Extraventricular drain
Complications:
Specialist and role: Neurosurgery
Brain cancer
Path: Majority metastatic, some primary
Symptoms: Focal neurologic deficit, seizure, headaches, nausea, vomiting
Diagnosis: MRI preferred over CT, followed by biopsy
Management: Resection, radiation, and/or chemo. Seizure ppx and steroids
Complications:
Specialist and role: Neurosurgery
Pituitary tumors
Path: Usually prolactinoma, acromegaly, and craniopharyngioma
Symptoms:
Diagnosis: Pregnancy test, TSH, prolactin, CT/MRI head
Management: Dopamine for prolactinomas, sometimes resection required
Complications:
Specialist and role:
Meningioma
Path:
Symptoms: Focal deficits at site of compression
Diagnosis: Imaging shows cancer on dura mater
Management: Resection
Complications:
Specialist and role:
Gliblastoma Multiforme
Path:
Symptoms:
Diagnosis: Intraparenchymal. Ring enhancing lesion/bat’s wing
Management:
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Astrocytoma
Less dismal gliblastoma
Schwannoma
Path:
Symptoms: N, V, hearing loss, vertigo, tinnitus
Diagnosis:
Management: Resection
Complications:
Specialist and role:
Vertebral compression fracture
Path:
Symptoms:
Diagnosis:
Management: Pain control or vertebral augmentation with vertebroplasty or kyphoplasty if severe
Complications:
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Spinal tumors
Path:
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Spinal stenosis
Path: Occurs from degenerative spondylosis
Symptoms: Bilateral sensory loss, weakness, or pain
Diagnosis:
Management: Pain control, physical therapy, and laminectomy if disabling
Complications:
Specialist and role:
Herniated Disc
Path:
Symptoms: Radicular pain
Diagnosis:
Management: Discectomy/microdiscectomy
Complications:
Specialist and role:
Spondylosis/Degenerative arthritis of spine
Path:
Symptoms:
Diagnosis:
Management: Lumbar fusion
Complications:
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Degenerative disc disease
Path:
Symptoms:
Diagnosis:
Management: Disc replacement, fusion
Complications:
Specialist and role:
