NEUROSURGERY

Question 1

TIA

Answer 1

Internal carotid stenosis >70% at the carotid bifurcation

Duplex doppler sonogram
Carotid endarterectomy to prevent stroke

Question 2

Ischemic stroke

Answer 2

Sudden onset without headache

Neurologic defects can be permanent

> 3 hours after stroke not amenable to revascularization

CT scan diagnosis

Start t-PA within 90 minutes but for sure within 3 hours

Question 3

Hemorrhagic stroke

Answer 3

Uncontrolled HTN patient with very severe headache that comes on suddenly

CT scan dx

Question 4

Subarachnoid hemorrhage

Answer 4

Due to intracranial aneurysms

Thunderclap worst headache ever

Might not have any neurologic symptoms

CT scan for blood in subarachnoid space
Arteriogram to find aneurysm - probably branch of circle of Willis

Clip or endovasculara coiling

Question 5

Intracranial tumors

Answer 5

METASTATIC (for fave destinations for blood borne malignancies - brain, bone, liver, lung)
Come from lung, breast, melanoma

Glioblastoma multiforme is the worst

Meningioma is usually benign

Tx brain tumors with surgery, radiation, chemo

Question 6

Craniopharyngioma

Answer 6

Children who are short for their age

Bitemporal hemianopsia

Calcified lesion above sella on CT

Question 7

Prolactinoma

Answer 7

Amenorrhea and galactorrhea in young woman

Rule out pregnancy
Rule out hypothroidism
Find prolactin level
MRI sella

Tx - bromocriptine

Transnasal, trans-sphenoidal surgical removal

Question 8

Acromegaly

Answer 8

Physical exam: Huge hands, feet, tongue, jaw

Hypertension
Diabetes
Sweaty hands
Headache

Determine somatomedin C
Pituitary MRI

Remove via surgery

Question 9

Pituitary apoplexy

Answer 9

Bleeding into pituitary tumor –> destroy pituitary gland

Headache, visual loss, endocrine problems

Acute episode - severe headache

Steroid and other hormone replacement

Question 10

Pineal tumor

Answer 10

Parinaud syndrome - sunset eyes

Loss of upper gaze

Question 11

Child brain tumors

Answer 11

Posterior fossa

Medulloblastoma most common
Ependymoma 2nd most common

Truncal ataxia and unsteady gait

Question 12

Brain abscess

Answer 12

Shorter timeframe - 1-2 weeks

Fever and obvious source of infection (otitis media, mastoiditis)

CT scan has typical appearance

Need to resect

Question 13

Trigeminal neuralgia

Answer 13

Sharp shooting pain in the face by touching - lasts 1 minute

Normal neurologic exam in 60 year old patient

Carbamazepine treatment

Radio frequency ablation

Question 14

Reflex sympathetic dystrophy (causalgia)

Answer 14

Several months after a crush injury

Burning pain that’s constant and doesn’t respond to analgesics

Aggravated by small stimulation of area

Cold, cyanotic, moist

Symphatetic block is dx and surgical sympathectomy is curative