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Surgery Subspecialties > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

Nonfluent aphasias, presentations

A

Brocas - poor speech output, pt aware

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2
Q

Fluent aphasias, presentations, causes

A

Wernickes - comprehension and repetition impaired, normal melody of speech but incorrect words
Anomic - repetition and comprehension intact, poor naming, d/t ICP/Alzheimer’s/drugs
Conduction - comprehension good, but repetition poor, d/t arcuate fasciculus lesion

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3
Q

Global aphasia presentation, cause

A

nonfluent speech, impaired comprehension and repetition

- MCA stroke

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4
Q

Glasgow coma scale (GCS) measures degree of ________. It takes into account ___+____+____

A
  • head trauma

- eye movements, verbal commands, motor response

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5
Q

Explain the scoring for eye movements on GCS

A

4 - spontaneous
3 - to voice
2 - to pain
1 - not at all

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6
Q

Explain the scoring for verbal commands on GCS

A 
5 - oriented to person, place, time
4 - confused
3 - inappropriate words
2 - incomprehensible sound
1 - none
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7
Q

Explain the scoring for motor movements on GCS

A 
6 - obeys commands
5 - localizes pain
4 - nonpurposeful response to pain
3 - flexion in response to pain
2 - extension in response to pain
1 - no pain response
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8
Q

What GCS scores indicate mild, moderate, and severe head injury?

A

Mild - 13-15
Moderate - 9-12
Severe - <8

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9
Q

Indications for CT in context of head injury (3)

A
  • LOC >5 min
  • GCS <13
  • symptomatic
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10
Q

Management for moderate head injury per GCS

A

CT + q1h checks in ICU

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11
Q

Management for severe head injury per GCS

A

CT + thorough w/u

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12
Q

Decorticate posture

A

flexed UE, extended LE

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13
Q

Decerebrate posture

A

extended UE and LE

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14
Q

Intracranial hematoma/mass would produce ____ _____ posturing

A

contralateral decerebrate

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15
Q

dilated pupil (unilateral) indicates ______

A

unilateral uncal herniation

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16
Q

b/l dilated pupils _______

A

b/l uncal herniation

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17
Q

b/l constricted pupils

A

pontine hemorrhage

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18
Q

Cheyne-Stokes respiration

A

deep cerebral hemisphere injury

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19
Q

Resuscitation for head injury? If focal injury? If unilateral posturing? If >5-10 mm shift?

A

IVF, +/- dexamethasone
if focal injury - phenytoin
if unilateral posturing - mannitol
if >5-10 mm shift - surgery

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20
Q

Uncal herniation s/sx

A
  • ipsilateral pupil dilatation (PSNS lost first)
  • 3rd nerve palsy
  • contralateral weakness/posturing (pyramidal compression
    Nb. pupillary dilatation more representative of the side of herniation (as opposed to which side has the hemiparesis)
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21
Q

Tx for uncal herniation (5)

A

Intubation, hyperventilation, mannitol, furosemide, surgery

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22
Q

Foramen magnum herniation s/sx

A
  • Early - posterior h/a, neck stiffness, vomiting, gait disturbance)
  • drowsiness
  • possible cushing response (HTN, bradycardia, resp arrest)
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23
Q

Tx for foramen magnum herniation

A

emergency surgery for decompression

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24
Q

Anterior SCI s/sx

A

Movement - lost b/l

Posterior column fxn intact

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25
Q

Central SCI s/sx (4)

A
  • Weakness
  • hypoesthesia of UE
  • gait disturbance
  • incontinence
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26
Q

Tx of SCI

A

alignment, Methylprednisolone, foley

+/- CP resuscitation

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27
Q

Workup of SCI (6)

A
  • assess neck
  • document ext sensation/movement
  • neuro assessment
  • ABG
  • CMP
  • typing
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28
Q

Cervical SCI tx

A

traction ?probably a c-spine collar

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29
Q

spinal shock s/sx (2)

A
  • hypotension

- warm extremities d/t autonomic dysfxn

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30
Q

Para/quadriplegia causes? w/u (2)?

A

causes - acute disc herniation, epidural tumor

w/u - spine films, MRI* or myelography

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31
Q

When you see ataxia think _____

A

cerebellar mass

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32
Q

cerebellar mass s/sx (3)

A
  • h/a
  • N/V
  • weakness of conjugate gaze to side of lesion
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33
Q

cerebellar mass w/u?

A
  • CT diagnostic

- MRI for more thorough eval

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34
Q

coma + stiff neck = ___ or ____ or ____

A

meningitis
SAH
encephalitis

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35
Q

Causes of a coma (12)

A 
Mnemonic: 2I'd (eye'd) HAMMSSTTEEr 
Infection
Infarction
Hematoma
Abscess
Metabolic
Meningitis
SAH
Seizure
Trauma
Tumor
Encephalopathy
Encephalitis
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36
Q

W/u for coma (5)

A
  • CT
  • LP (if no mass)
  • Vitals
  • EKG
  • CXR
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37
Q

Tx for coma (5)

A
  • ABC
  • IVF
  • foley, NGT
  • Thiamine/D50W/naloxone
  • Cspine
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38
Q

Status epilepticus tx (4)

A
  • ABC
  • thiamine/D50W
  • Phenytoin (50 mg/min to 1000 mg, i.e., for 20 min)
  • Ativan 2 mg IV
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39
Q

Meningitis w/u (4)

A
  • CT
  • LP w/gram stain
  • India ink stain
  • cultures
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40
Q

____ strokes most common

A

ischemic (80%)

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41
Q

Symptomatic tight stenosis, >65% occlusion of vessels, or complex ulcer should get ____

A

endarterectomy

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42
Q

noncomplex ulcer of bvs tx’ed w/______

A

anticoagulation

43
Q

thrombotic strokes tend to be 2/2 ____ and sx resolve in _____hr

A
  • HTN

- 48

44
Q

Vertebrobasilar strokes usually 2/2 ______ which can cause ____ and ____, or can be 2/2 ______

A

atherosclerosis
subclavian steal
basilar artery stenosis
cervical osteophytes

45
Q

Subclavian steal

A

pre/syncope 2/2 collateral blood flow from the vertebral arteries to the arm

46
Q

Locked in syndrome can be caused by

A

basilar artery stenosis

47
Q

If hypotensive stroke you would also expect to see?

A

anteriorly - shoulder/anterior thigh weakness

posteriorly - visual difficulties, memory difficulties

48
Q

RFs for hemorrhagic stroke

A

AVM, aneurysm, HTN, anticoagulation

49
Q

Indications for surgical correction of hemorrhagic stroke (4)

A
  • cerebellar stroke
  • lobar (esp temporal)
  • caudate
  • putamen (non-dominant side)
50
Q

h/a, gaze paresis towards lesion and ataxia are sx of ___ stroke

A

cerebellar

51
Q

midline shift, drowsiness are sx of ____ stroke

A

lobar

52
Q

behavioral disturbances is a sx of ___ stroke

A

caudate

53
Q

hemipelgia and gaze paresis towards the lesion are sx of ____

A

non-dominant putamen stroke

54
Q

nonsurgical strokes (4)

A
  • thalamic
  • pontine
  • tegmental
  • putamen (dominant side)
55
Q

sensory dysfxn, poorly reactive pupils are sx of ____ stroke

A

thalamic

56
Q

coma, qudriplegia, pinpoint pupils are sx of ___ stroke

A

pontine

57
Q

ipsilateral horner’s, ataxia, hemisensory loss, abnormal eye movements are sx of _____ stroke

A

tegmental

58
Q

SAH causes (4)

A
  • trauma
  • aneurysms
  • AVM
  • HTN
59
Q

Causes of aneurysms (7)

A 
Mnemonic - "Make SAH"
Marfan's
Aortic coarctation
Kidney disease (polycystic AD)
Ehlers-Danlos
SSA
Atherosclerosis
Hx (FMHx)
60
Q

S/sx of SAH

A
  • Worst h/a of my life
  • vision changes (compression of aneurysm if around PCA/superior cerebellar artery)
  • mydriasis
  • LOC
  • Meningeal irritation (neck stiffness, photophobia, N/V)
  • Sentinel bleed (d/w earlier, marked by abrupt onset of h/a, n/v, transient diplopia that resolved in min/hrs)
  • hydrocephalus (presents as drowsiness; 2/2 increased absorption of blood into CSF sinuses causing communicating hydrocephalus)
61
Q

Tx of SAH

A
  • prevent rebleeding - SBP < 150 using Hydralazine or Nitroprusside
  • head elevation (to decrease ICP)
  • hyperventilation (decreases CO2 which decreases blood flow to the brain)
  • Nimodipine (CCB) to decrease vasospasm
  • Seizure ppx (phenytoin)
  • +/- ventricular drain (if hydrocephalus)
  • +/- surgery
62
Q

Which requires early surgery and which requires non-emergent surgery of the following: Berry aneurysm, AVM

A
  • Berry - ASAP surgery for clipping/intravascular coiling

- AVM - non-emergent excision

63
Q

______ is the most common vascular dz of the SC

A

Dural AV fistula (nidus w/in the dura)

64
Q

Dx modality of vascular dz of SC _____

A

MRI

65
Q

What vascular dz do you never see in the SC?

A

aneurysms

66
Q

Tx of vascular dz of SC

A

hemilaminectomy w/coagulation of intradural draining vessel (for fistula)

67
Q

Cervical disk disease in young patients presents as _________

A

severe neck and arm pain

68
Q

Cervical disk disease in old patients presents as _____

A

chronic course w/recurrent episodes of arm and neck pain (spondylosis)

69
Q

Etiology of cervical disk disease in old patients?

A
  • osteophytes, hypertrophy of facet joints

- C5-T1 affected

70
Q

S/Sx of degenerative disk disease (5)

A
  • pain
  • parasthesia
  • weakness
  • h/a
  • radiculopathy
71
Q

Radiculopathy from C6 sx

A
  • parasthesias of thumb + index finger

- weakness of biceps

72
Q

Radiculopathy from C7 sx

A
  • parasthesias of middle finger

- weakness of triceps

73
Q

Radiculopathy from C8 sx

A
  • parasthesias of ring and pinky fingers

- weakness in intrinsic hand muscles

74
Q

Tx of degenernative disk dz

A
  • Anti-inflammatories
  • Muscle relaxants
  • moderate cervical traction
75
Q

What is the utility of surgery in context of degenerative disk dz?

A
  • not helpful for chronic pain, but may reduce radiculopathy or myelopathy
  • indicated for severe pain 2/2 acute soft disk rupture
  • usually posterior laminectomy performed
76
Q

4 syndromes of lumbar disk dz

A
  • recurrent lower back pain
  • acute monoradiculopathy
  • cauda equina
  • “failed back”
77
Q

Recurrent lower back pain

A

a/w back spasms, limited motion

78
Q

acute monoradiculopathy

A

pain radiates to foot/leg, worse with sneezing or coughing

79
Q

cauda equina syndrome

A

saddle anesthesia, bowel/bladder incontinence, pain in legs

80
Q

Failed back

A

back pain following back surgeries

81
Q

Radiculopathy vs. myelopathy

A
  • radiculopathy - damage/compression of nerve roots (peripheral NS), non-emergent
  • myelopathy - damage/compression of SC, emergent
82
Q

Positive straight leg raise test indicates

A

HNP

83
Q

Tx for HNPs

A

most resolve spontaneously over 12 wks (if greater = chronic), but can use epidural corticosteroid injections, NSAIDs/narcotics, PT/OT. If it’s refractory can do surgical laminectomy/discectomy

84
Q

Lumbar stenosis differs from HNP in that _____

A

HNP - unilateral leg pain (can be b/l but usually worse on one side)
LS - b/l leg pain

85
Q

Etiology of LS

A
  • degeneration of intervertebral disks causing increased stress on facet joints, causing hypertrophy of the ligamentum flavum and then compression of the nerve roots/spinal cord
86
Q

disk degeneration to <9 mm indicates _____

A
  • always pathologic

- stenosis

87
Q

S/sx of LS (5)

A
  • worse w/walking/standing, and takes a while for the pain to abate when sitting
  • a/w numbness
  • a/w spasticity
  • NEGATIVE straight leg raise test
  • neurogenic claudication, proximal first, shopping cart sign
88
Q

DDx for LS

A
  • vascular claudication (pain decreases rapidly when movement stops)
  • Cauda Equina syndrome (saddle anesthesia, bowel/bladder dysfxn, impotence)
  • Hematoma
  • AVN
  • tumors
  • Pagets
  • Ankylosing spodylitis
89
Q

Tx for LS

A
  • Medical pain management first (heat, analgesics, antispasmodics)
  • Laminectomy for more advanced disease
90
Q

In the setting of increased ICP, steroids (i.e., ____) are ONLY used for ____ and _____

A
  • decadron (dexamethasone)
  • decreasing cerebral edema 2/2 abscess
  • decreasing cerebral edema 2/2 tumor
91
Q

When an adult has a brain tumor, think ___, ___, or ___

A
  • mets
  • GBM
  • meningioma
92
Q

When an child has a brain tumor, think ___, or ___

A
  • medulloblastoma

- pilocytic astrocytoma

93
Q

Most common brain mets (first 5)

A

lungs > breast > kidney > GI > melanoma

94
Q

Tx for brain tumors

A
  • chemo/XRT
  • decadron (dexamethasone ) for vasogenic edema
  • anti-epileptics (AEDs)
  • surgery (debulking)
95
Q

(T/F) Most brain abscesses are 1 microbe

A

False - most are polymicrobial

96
Q

Leading organisms (7)

A
  • anaerobic (bacteroides)
  • staph, strep, gram (-)’s
  • Fungal - aspergillus, candida
  • Toxo
97
Q

S/Sx of brain abscess

A 
Triad: 
- H/a
- Focal neurologic deficit
- FEVER
Increased ICP can cause CN III and VI deficits
98
Q

Dx of brain abscesses

A
  • CT scan for ring enhancing lesions
  • ESR
  • CRP
  • NO LP!
99
Q

ophthalmoplegia (EOM paralysis) + severe H/a + visual field defect = _______

A

Pituitary apoplexy (hemorrhage into pre-existing tumor d/t vasculature of pit tumor)

100
Q

Syringomyelia S/Sx (4)

A
  • b/l pain and temp loss in upper extremities
  • UE weakness
  • sensory loss in cape distribution
  • leg spasticity
101
Q

Causes of syringomyelia

A
  • trauma
  • Potts (TB of vertebrae)
  • ependymomas
  • Chiari type I
  • arachnoiditis (causes scar formation/adhesions forming syrinx and hydrocephalus)
102
Q

Dx of syringomyelia

A

MRI of c spine

103
Q

treatment of syringomyelia (4)

A
  • decompression
  • dural grafting
  • peritoneal shunting
  • ventricular shunting

Surgery Subspecialties (6 decks)

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