Neurosurgery Flashcards
pt has sudden onset stroke sxs without headache with neuro sxs for >24 hours. what is it? workup? tx?
ischemic stroke. do assessment by CT scan (rule out hemorrhage) and therapy is based on rehab. start TPA within 90 minutes up to three hours after onset of sxs.
pt has sudden transitory loss of neuro function without headache. resolve without near sequela. what is it? most common origin? importance?
TIA. MC origin: high grade stneosis (>70%) of internal carotid or ulcerated plaque at carotid bifurcation. can predict stroke- timely elective carotid endartectomy may prevent that.
pt has sudden transitory loss of neuro function w/o headache. workup? tx?
TIA! noninvasive Duplex studies (high quality sonogram + doppler). surgery (carotid endarterectomy) is indicated if lesions described are found in the location that explains the neuro symptom. angioplasty and stent can be done if a filter is first deployed to prevent embolization of debris to brain.
uncontrolled hypertensive gets sudden onset severe headache and develops neuro deficits
hemorrhagic stroke! get CT scan! locate location and extent of hemorrhage. therapy is directed at control of HTN and rehab.
pt shows up with an extremely severe headache of sudden onset, worst headache of life, thunderclap, that is sudden, severe, singular. no neuro effects. dx? workup? tx?
subarachnoid bleeding from intracranial aneurysm. blood is in subarachnoid space and not pressing on the brain, there may be no neuro effects. get VT. follow with arteriogram to locate aneurysm (litle devil off the circle of willis). tx: clipping is surgical therapy, and encovascular coiling is radiological alternative.
pt has progressively increasing headache for several months, worse in the mornings. eventual blurred vision, papilledema, projectile vomiting. eventually bradycardia and hypotension. workup? tx?
brain tumor. eventual ICP sxs and then cushing reflex. MRI is the best detail and is preferred over CT. tx: while awaiting surgery, treat with high dose steroids (dexamethasone)
pt begins having inappropriate behavior, optic nerve atrophy on the side side of tumor, papilledema on other side of tumor, anosmia
foster-kennedy syndrome. tumors at the base of frontal lobe.
youngster is short for his age and has bitemporal hemianopsia
get X-ray of brain- calcified lesion above sella. craniopharyngoma.
young woman has amenorrhea and galactorrhea.
rule out pregnancy, hypothyroidism, determination of prolactin, MRI of the sella. prolactinoma. therapy: bromocriptine. transnasal transsphenoidal surgical removal is reserved for those who wish to get pregnant or those who fail to respond to bromocriptine.
pt has huge hands, feet, tongue, and jaw. HTN, DM, sweaty hands, headache, hx of wedding bands or hats that no longer fit. workup? dx? tx?
workup: somatomedin C, pituitary MRI. tx: surgical removal preferred, but radiation is an option. the somatic changes are irreversible
pt with longstanding headache, visual loss, endocrine problems, and acute severe headache -> deterioration of remaining vision, bilateral pallor of optic nerves -> stupor and hypotension.
pituitary apoplexy. bleeding into pituitary tumor with subsequent destruction of the pituitary. tx: steroid replacement urgently needed. eventually other hormone replacement. MRI or CT scan will show extent of problem.
pt has loss of upper gaze. “sunset eyes”
parinaud syndrome. tumor of pineal gland.
chid is stumbling around, tranquil ataxia, knee chest position.
brain tumor in children most commonly found in posterior fossa. knee chest position relieves headache.
within a week or two, pt with hx of infection (otitis media, mastoiditis) gets fever.
CT will have typical appearance. MRI not needed. actual resection is required
60 yo pt has extremely severe sharp shooting pain like a bolt of lightening in the face, brought about by touching a specific area and lasting 60 seconds. normal neuro exam.
trigeminal neuralgia. MRI is done to rule out organic lesions. tx: anticonvulsants is often successful. if not, radio frequency ablation is usually done.
