Neurosurgery Flashcards
physical post-concussive symptoms
*headache
*nausea/vomiting
*dizziness
*fatigue
*blurred vision
*sleep disturbance
*loss of appetite
*sensitivity to light/noise
*balance problems
cognitive post-concussive symptoms
*impaired attention, concentration, memory, speed of processing, judgement, executive function
behavioral post-concussive symptoms
*depression
*anxiety
*agitation
*irritability
*impulsivity
*aggression
is prescription medication recommended for post-concussive symptoms
NOT recommended
return to play after concussion
no hits to the head for 7 days after last symptoms (otherwise, stepwise)
stupor vs coma
*stupor = responsive to vigorous stimulation
*coma = unarousable to physical stimuli
stimulation: sternal rub, supraorbital pressure, trapezius squeeze (all above the nipple line; important for localization vs withdrawal to pain)
localizing to pain (on GCS)
*patient must actively try to push away pain
*must cross the nipple line in order for it to be considered localizing
which cranial nerves are important in acute care neurosurgery?
*CN2 & CN3 (pupils)
*CN6
*CN7
pupillary changes: bilaterally fixed and dilated
*death
*hypovolemic shock
*drugs (atropine, ecstasy)
pupillary changes: unilaterally fixed and dilated
*head injury
*stroke
pupillary changes: bilateral pinpoint constriction
*opiate overdose
pupillary changes: bilateral constriction
brainstem stroke
pupillary changes: irregular pupil
*trauma
*previous eye surgery
brainstem reflexes
*protective reflexes: cough, gag, corneals
*oculocephalic (doll’s eyes)
*oculovestibular (cold caloric)
cushing’s triad
*increase systolic blood pressure with widened pulse pressure (hypothalamus triggers increased heart contractility)
*bradycardia (baroreceptors register increased SBP)
*apneusis/neurogenic breathing (loss of vagal and pneumotaxic center stimulation)
*indicates increased intracranial pressure
Monroe-Kellie Doctrine
*the volume of the cranial vault is fixed
*the cranial vault contains: brain, blood, and CSF
treatment of increased ICP
*elevate head of bed
*hyperventilation
*hypertonic therapy (mannitol or hypertonic saline)
*CSF drainage
*decrease brain metabolism
*surgical decompression
contusions
*parenchymal damage from the bony ridges at the base of the skull
*associated with edema
how does hypertonic saline help reduce ICP
*use osmotic gradient to pull fluid out of brain and into the vascular space, decreasing brain volume (mannitol + hypertonic saline)
methods for decreasing cerebral metabolic rate
-sedation
-paralytics
-barbiturate coma
-control seizures, fever, restlessness, pain
-normothermia
diffuse axonal injury
*deceleration injury (usually MVA)
*shear-strain forces on the axons during rotation/deceleration of the head
*poor prognosis
aneurysm management
*prevent rerupture (surgical clipping, endovascular coiling/remodeling, observation)
*manage complications (hydrocephalus, vasospasm)
AVM (arteriovenous malformations)
*tangles of blood vessels
*less dangerous than aneurysms
*arteries go directly into veins (no capillary beds)
“red flags” for back pain
*bowel or bladder changes (urinary retention, NOT incontinence)
*saddle anesthesia/erectile dysfunction
*rectal exam
dermatomes
*trace pain/numbness with 1 finger
C5 = shoulder
C6 = lateral forearm
C7 = middle finger
C8 = medial forearm
T1 = medial upper arm
L3 = medial upper leg
L4 = below knee to medial malleolus
L5 = big toe and lateral leg below knee
myotomes
C5 = deltoid
C6 = biceps, wrist extension
C7 = triceps
C8 = interosseous muscles
L3 = iliopsoas
L4 = quadriceps, patellar reflex
L5 = dorsiflexion
S1 = plantar flexion, achilles reflex
disk dessication
*loss of water in the disks
*loss of disk height
disk bulge
*loss of water leads to bulging against the annulus
*car tire analogy (when car tire loses air, it gets flatter and wider)
*rarely surgical
neurogenic claudication
*chronic lumbar stenosis
*buttock/posterior thigh pain when walking
*position to open the canal (leaning on the shopping cart) differentiates from vascular claudication
cervical stenosis
*myelopathy
*hyperreflexia
*proprioceptive loss
*wide based gait
* + Hoffmans/Babinski
