Neurosurgery

Question 1

First test to run in pt with transient ischemic attack

Answer 1

Duplex scanning

- if stenosis > 70% proceed to carotid endarterectomy

Question 2

Characteristics of TIA

Answer 2

Episodes are sudden onset
Last few minutes
No associated headache
No neurologic sequelae

Question 3

First test to run in pt with suspected stroke

Answer 3

CT scan - to R/O bleeding and large infarct

Question 4

When can you use tPA in stroke patient

Answer 4

Within 90 min of onset of symptoms, after CT scan has been done to r/o hemorrhage

Question 5

Neurologic catastrophes of sudden onset with severe headache

Answer 5

Vascular hemorrhagic

Question 6

Common presentation of subarachnoid hemorrhage

Answer 6

Patient has history of sudden onset severe headache with normal neuro exam; over next few days she returns to ER with another sudden, severe and singular diffuse headache

Question 7

Management for subarachnoid hemorrhage

Answer 7

CT scan followed by angiogram

Surgery to clip aneurysm or endovascular coiling

Question 8

Lady presents with persistent headaches that have been gradually increasing for 4 months and are worse in the mornings. For the past few weeks she has had projectile vomiting and on exam she has bilateral papilledema - dx?

Answer 8

Brain tumor

Question 9

What is the Cushing reflex?

Answer 9

Bradycardia and HTN in setting of increased ICP maintains cerebral perfusion

Question 10

How can you decrease ICP caused by a brain tumor?

Answer 10

High dose steroids I.e. decadron

Question 11

Foster Kennedy syndrome

Answer 11

Syndrome caused by frontal lobe tumor with changes in behavior, optic nerve atrophy (on side of tumor), papilledema (on opposite side of tumor) and anosmia

Question 12

12 yo boy is short for his age, has bitemporal hemianopsia and has a calcified lesion above sella in xrays of the head - dx?

Answer 12

Craniopharyngioma

Question 13

A young woman presents with amenorrhea and galactorrhea; she denies being pregnant - what tests should you order first?

Answer 13

Pregnancy test
Thyroid function - to r/o hypothyroidism
Hormone levels
MRI

Question 14

Tx. Prolactinoma

Answer 14

Bromocriptine therapy

Surgery - pts who do not respond to medical tx or those who want to get pregnant

Question 15

Young woman complains of severe headache making her stupurous, and her peripheral vision had suddenly deteriorated; her BP is extremely low and she has bilateral pallor of her optic nerves. In recent months she has been complaining of amenorrhea, morning headaches and loss of peripheral vision

Answer 15

Pituitary apoplexy - bleeding into a pituitary tumor with subsequent destruction of pituitary gland

Question 16

Tx. Of pituitary apoplexy

Answer 16

Immediate steroid replacement
Eventually other hormone replacement
- MRI or CT will assess the extent of the problem

Question 17

6 yo boy has been stumbling around the house and complaining of severe morning headaches; in your office he assumes the knee-chest position as he holds his head. Neuro exam demonstrates truncal ataxia

Answer 17

Tumor of posterior fossa

- Mc brain tumor in children

Question 18

23 yo man develops severe headaches, seizures and projectile vomiting for 2 weeks. He had a low grade fever and was recently treated for acute otitis media and mastoiditis - dx? Test?

Answer 18

Brain abscess

- order CT scan

Question 19

Tx of brain abscess

Answer 19

Surgical resection

Question 20

What is the best imaging modality to examine lesions of the spine?

Answer 20

MRI

Question 21

Characteristics of lumbar disc herniation

Answer 21

Usually onset with some weight bearing activity
Worse with sneezing or coughing
Affected leg may remain flexed
Straight leg test gives excruciating pain

Question 22

When do you consider neurosurgical intervention for lumbar disc herniation?

Answer 22

If there is progressive weakness or sphincteric deficits

Question 23

Pt comes in with leg pain that is caused by walking and relieved by rest; he has to sit down or bend over for pain to go away. He has normal pulses in his legs - dx? Test?

Answer 23

Spinal stenosis - neurogenic claudication

- order MRI and refer to pain clinic

Question 24

How can you tell apart neurogenic from vascular claudication?

Answer 24

Neurogenic is position- dependent } flexion at the waist usually relieves the pain; pulses are also typically palpable
Vascular claudication is relieved by rest but does not depend on position; pulses usually absent

Question 25

A paraplegic cannot perform his in and out self catheterization at the normal time; he suddenly develops a pounding headache, profuse perspiration, bradycardia and HTN. dx?

Answer 25

Autonomic dysreflexia

Question 26

Tx. Of autonomic dysreflexia

Answer 26

Alpha adrenergic agents - to lower BP

CCB

Question 27

Severe, sharp shooting pain in face brought about by touching a specific area; part of patients face is unshaven bc he fears to touch that area - dx?

Answer 27

Trigeminal neuralgia

Question 28

Tx. Of trigeminal neuralgia

Answer 28

R/o organic lesions with MRI

TX. With anticonvulsants; if doesn’t work, radiofrequency ablation

Question 29

Months after sustaining a crush injury a pt complains of constant, burning, agonizing pain that does not respond to usual analgesic medication; pain is aggravated by slightest stimulation of the area and the arm is cold, cyanotic and moist - dx?

Answer 29

Causalgia - reflex sympathetic dystrophy

Question 30

Tx of causalgia

Answer 30

Surgical sympathectomy