Neurosurgery

Question 0

Typical presentation of a brain tumor?

Answer 0

#Constant, progressive, severe headache
#Present for months
#Worse in the morning

Question 1

Differentiating occlusive versus hemorrhagic Neurovascular problems?

Answer 1

Without headache versus with headache

Question 2

Suggested neurologic illness if:

1. Sudden
2. Hours to days
3. Days to weeks
4. Months
5. Years

Answer 2

1. Vascular
2. metabolic
3. Infectious
4. Neoplastic
5. Degenerative

Question 3

TIA – most common origin? Initial test? Surgery when? Alternative therapy?

Answer 3

Carotid stenosis; noninvasive duplex studies

Surgery if lesions described are found in location consistent with neurologic symptoms; angioplasty and stent if filter first deployed to prevent embolization

Question 4

Therapy for ischemic stroke?

Answer 4

CT scan for assessment and rehabilitation

Revascularization not useful unless you did before three hour mark

Question 5

Patient presents with severe headache, and some mild rigidity – suspected diagnosis? Surgery when? Alternative therapy?

Answer 5

Subarachnoid hemorrhage

Surgery (clipping) after CT scan and arteriogram

Alternative – Endovascular coiling by IR

Question 6

Brain tumor – progressive signs?

Answer 6

#Silent
#Increased ICP – blurred vision, papilledema, projectile vomiting
#Cushing's triad – bradycardia, altered respirations and hypertension

Question 8

Foster-Kennedy syndrome?

Answer 8

Collection of symptoms caused by tumor and base of frontal lobe;
#Inappropriate behavior
#Optic nerve atrophy
#Papilledema on contralateral side
#Anosmia

Question 9

Young patient who is short for age, with bitemporal hemianopsia – suspected diagnosis? Finding on imaging?

Answer 9

Craniopharyngioma; calcified lesion above sella on x-rays

Question 10

Patient presents with amenorrhea and galactorrhea – differential?

Answer 10

#Pregnancy
#Hypothyroidism
#Prolactinoma

Question 11

Work up to determine prolactinoma? Treatment? Surgery when/how?

Answer 11

Determine prolactin level, MRI of sella

Bromocriptine

Transnasal, trains-sphenoidal surgical removal patients who fail bromocriptine or wish to get pregnant

Question 12

Pt has hat or wedding band that no longer fits – suspected diagnosis? Confirm diagnosis with? Management options?

Answer 12

Acromegaly; somatomedin C and pituitary MRI

Surgical removal or radiation

Question 13

Patient with Long history of endocrine problems develops severe headache and deterioration of vision. Eventually develops stupor and hypotension. Suspected diagnosis? Treatment?

Answer 13

#Patient with pituitary tumor (endocrine problems) develops 
#pituitary apoplexy (bleeding into pituitary tumor)
#With signs of hematoma (decreased vision) and
#Pituitary destruction (stupor and hypotension)

Steroid replacement and MRI/CT to determine extent

Question 14

Parinaud Syndrome?

Answer 14

“Sunset eyes” (loss of upper gaze) due to pineal gland tumor

Question 15

Most common brain tumor location in children? Symptoms? To relieve headache, children often assume what position?

Answer 15

Posterior fossa

Cerebellar syndromes (stumbling, ataxia)

Knee-chest position

Question 16

Consider brain abscess instead of brain tumor if? Management?

Answer 16

#Shorter timetable (a week or two)
#Fever
#Infection nearby – otitis media or mastoiditis

Resection

Question 17

Typical location for spinal cord tumor? Best diagnostic modality? Management?

Answer 17

Extradural (metastatic)

MRI; surgical decompression

Question 18

Elderly patient presents with pain brought on by walking. Patient can walk without pain when hunched over, but doing pain episodes, relief only comes once patient sits down or bends over – suspected diagnosis? Management?

Answer 18

Spinal stenosis (causing neurologic claudication)

MRI and then pain control

Question 19

Patient presents with sharpshooting pain like “of both of lightning”. Normal neurologic exam. Males may have an unshaven area in the face. Suspected diagnosis? Work up? Treatment?

Answer 19

Trigeminal neuralgia (tic Douloureux)

Unshaven area is trigger zone (Patient avoids touching it)

MRI to rule out organic lesions

Anti-convulsions. It fails, radiofrequency ablation

Question 24

Treatment for increased ICP?

Answer 24

Dexamethasone (Decadron)

Question 25

Causalgia – A.k.a.? Occurs when?

Symptoms? Aggravated by?

Physical exam finding? Surgery when?

Answer 25

Reflex sympathetic dystrophy; after a crushing injury

constant, burning, agonizing pain that is not respond to analgesics; Pain aggravated by slightest stimulation

Extremities cold, Cyanotic, moist

Surgical sympathectomy