Neurosurgery Flashcards
First line investigation for subarachnoid haemorrhage?
Non contrast CT head
Conditions associated with berry aneurys (intracranial aneurysms)
hypertension,adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta
What is a lucid interval in intracranial extradural haematoma?
briefly regain consciousness after the injury before progressing into a coma
Complications of aneurysmal SAH?
re-bleeding
hydrocephalus
vasospasm (also termed delayed cerebral ischaemia), typically 7-14 days after onset
hyponatraemia (most typically due to syndrome inappropriate anti-diuretic hormone (SIADH))
seizures
WHat are the most sensitive scans to diagnose diffuse axonal injury?
MRIs
head injury with loss of consciousness or amnesia, and who are aged over 65 years old management
CT head scan within 8 hours
Unless reason need to be scanned in an hour
Intracranial aneurysm management?
Treated with a coil by interventional neuroradiologists, but a minority require a craniotomy and clipping by a neurosurgeon
When to do a CT head within an hour?
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
Management while waiting for theatre in life threatening brain issues such as raise in ICP
IV mannitol/frusemide
How long should an LP be done after start of headache to detect a SAH?
12 hours
allow the development of xanthochromia (the result of red blood cell breakdown).
Risk factors for subdural haematoma?
old age, alcoholism and anticoagulation.
Clinical features of SAH?
headache
usually of sudden-onset (‘thunderclap’ or ‘hit with a baseball bat’)
severe (‘worst of my life’)
occipital
typically peaking in intensity within 1 to 5 minutes
there may be a history of a less-severe ‘sentinel’ headache in the weeks prior to presentation
nausea and vomiting
meningism (photophobia, neck stiffness)
coma
seizures
ECG changes including ST elevation may be seen
this may be secondary to either autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamines
What does nimodipine do?
prevent vasospasm in aneurysmal subarachnoid haemorrhages
most common cause of subdural haematomas is rupture of what?
bridging veins that cross the subdural space
Infants with hydrocephalus present with what?
increased head circumferences, a bulging fontanelle and sunsetting of the eyes
