Neurosurgery

Question 1

what are some drainage methods?

Answer 1

VP shunt

Burr hole

Question 2

What do you use a craniotomy for?

Answer 2

excision/debulking of tumor

Question 3

what do you use a cranioplasty/craniectomy for?

Answer 3

1. elevation of depressed skull fx.

2. craniectomy + cranioplasty = replacement of bone flap

Question 4

Type of bleeding of subdural hemorrhage?

Answer 4

venous, slow

Question 5

Type of bleeding of epidural hemorrhage?

Answer 5

arterial, rapid

Question 6

what is the MCC for intraparenchymal hemorrhage?

Answer 6

HTN

Question 7

what is the MCC for subarachnoid hemorrhage?

Answer 7

Berry anuerysm (80-90%) 
trauma

Question 8

What are the layers covering the brain starting from the outside?

Answer 8

Scalp –> periosteum –> skull bone –> dura mater –> subdural space –> arachnoid –> subarachnoid space –> brain

Question 9

what percentage of stroke is intracranial hemorrhage?

Answer 9

8-13%

Question 10

what kind of hemorrhage is more likely to result in death (intracranial v. ischemic stroke)?

Answer 10

intracranial hemorrhage

Question 11

Top three causes of ICH?

Answer 11

HTN, eclapsia,, drug abuse
ruptured aneurysm
AVM

Question 12

MC location of ICH

Answer 12

basal ganglia, internal capsule

Question 13

basal ganglia stroke sxs

Answer 13

contralateral hemiparesis

Question 14

sxs of ICH

Answer 14

Alterartion of level of consciousness 
n/v
HA
seizures 
focal neuro deficits 
nuchal rigidity
subhyaloid retinal hemorrhages 
anisocoria

Question 15

when do you consider surgery for ICH?

Answer 15

• hemorrhage >3cm
• if there is vascular lesion
• young pt c lobar hemorrhage.

Question 16

what are the surgical approaches for an ICH?

Answer 16

• craniotomy & clot evacuation under direct visual guidance.
• sterotactic aspiration with thrombolytic agents.
• endoscopic evacuation.

Question 17

What is a subarachnoid hemorrhage?

Answer 17

extravasation of blood into the subarachoid space btwn pian and arachnoid membranes.

Question 18

subarachnoid hemorrhage presentation

Answer 18

worst headache of life 
"thunderclap headache" 
-HA followed by imapaired consciousnes. 
-NO fever
LIFE THREATENING!

Question 19

MC of SAH?

Answer 19

trauma

Question 20

what is MC of nontraumatic SAH?

Answer 20

AVM

Question 21

what are CT findings of SAH?

Answer 21

focal high density in sulci & fissures or linear hyperdensity in the cerebral sulci.

Question 22

MC spot for cerebral aneurysm?

Answer 22

anterior circulation (anterior/posterior communicating a., MCA)

Question 23

what is a sentinel bleed?

Answer 23

sometimes the first sign of a hemorrhage. Milder sxs, pt might not have gone to the hospital.

Question 24

how many ppl with SAH get sentinel bleeds?

Answer 24

50%

sentinel bleeds can re-bleed w/in 2-6 wks.

Question 25

Diagnosis of SAH

Answer 25

CT LP: RBC @3hrs, xanthochromia @12hours. if +CT and LP, get angiography

Question 26

Hunt Hess for SAH: grade 0

Answer 26

asxs, unruptured aneurysm

Question 27

Hunt Hess for SAH: grade 1

Answer 27

awake, asxs, mild HA, mild nuchal rigidity

Question 28

Hunt Hess for SAH: grade 2

Answer 28

awake; moderate to severe HA, CN palsy, nuchal rigidity

Question 29

Hunt Hess for SAH: grade 3

Answer 29

lethargic; mild focal neruo deficits (eg. pronator drift)

Question 30

Hunt Hess for SAH: grade 4

Answer 30

stuporous; significat neurologic deficit (eg hemiplegia)

Question 31

Hunt Hess for SAH: grade 5

Answer 31

comatose; posturing

Question 32

what grade of Hunt Hess needs intubation & hemodynamic monitoring + stabilization?

Answer 32

grade 4 and 5

Question 33

SAH tx if ^ICP

Answer 33

``` intubation and hyperventilation Osmotic agents (eg, mannitol) Loop diuretics (eg, furosemide) IV steroids (controversial but recommended by some) Antihypertensive agents (IV beta blockers) when mean arterial pressure >130 mm Hg Avoidance of nitrates (which elevate ICP) when feasible ```

Question 34

SAH medical managment

Answer 34

- rebleeds - vasospasm - hydrocephalus - hyponatremia - seizures - pulmonary complications - cardiac complications

Question 35

SAH surgical tx to prevent rebleed

Answer 35

- clipping of ruptured aneurysm | - Endovascular tx (coiling)

Question 36

SAH surgery f/u

Answer 36

1-3 wks of ICU care after aneurysm occlusion for medical complications that accompany neuro injury need rehab after hospital 1/3 pts return to pre-SAH function

Question 37

what is an EDH?

Answer 37

hematoma btwn inner skull and the dura. Meningeal a/temporal a. bleed. acts as "space occupying" lesion

Question 38

EDH CT

Answer 38

lenticular shaped or convex accumulation

Question 39

what has been correlated to EDH mortality

Answer 39

-level of concsiousness prior to surgery: higher = better, coma = 20% mortality

Question 40

who does EDH affect more?

Answer 40

Males! | 2-60yo (rare in age groups outside of this)