Neurosurgery

Question 1

Brain tumors produce constant, progressive, severe headache which is sometimes worse (at night/in the morning)

Answer 1

in the morning

Question 2

What is the most common origin of TIAs?

Answer 2

1) high grade stenosis (70% or above) of internal carotids

2) ulcerated plaque and carotid bifurcation

Question 3

Treatment of TIA?

Answer 3

Elective carotid endarterectomy

Angioplasty and stent can be done if a filter is first deployed to prevent embolization of debris to brain

Question 4

What is the definitive treatment of subarachnoid hemoorhage?

Answer 4

Clipping is the surgical therapy, and endovascular coiling is the radiologic alternative

Question 5

What is Cushing’s triad?

Answer 5

High ICP, bradycardia, high BP

Question 6

What is Foster-Kennedy syndrome?

Answer 6

Inappropriate behavior, optic nerve atrophy on the side of the tumor, papilledema on the other side, and anosmia

Question 7

T/F: Hypertension and diabetes are also symptoms of acromegaly.

Answer 7

True

Question 8

Long-standing presence of headache, visual loss and endocrine problems, followed by an episode of severe headache with signs of increased compression of nearby structures (deterioration of the remaining vision, bilateral pallor of the optic nerves, and stupor/hypotension):

Answer 8

pituitary apoplexy

Question 9

Loss of upper gaze and sunset eyes (sclera seen above iris, lower lid obscuring part of iris) is due to what kind of tumor?

Answer 9

pineal gland

Question 10

Brain tumors in children are most commonly seen where?

Answer 10

posterior fossa (give cerebellar symptoms eg truncal ataxia) and children often assume the knee-chest position to relieve their headache

Question 11

Shooting pain across the face with an unshaven part of the face. NExt step?

Answer 11

Tic douloureux (trigemical neuralgia)–person not shaving to not trigger pain

MRI to rule out organic lesions. Treatment is with anticonvulsants, or radiofrequency if meds not working

Question 12

What can develop several months after a crushing injury?

Answer 12

reflex sympathetic dystrophy (causalgia): constant, burning agonizing pain that does not respond to the usual analgesics

Question 13

How do you diagnose causalgia (reflex sympathetic dystrophy)?

Answer 13

A successful sympathetic block. Note: surgical sympathectomy is curative