Neurosurgery Flashcards
First test to run in pt with transient ischemic attack
Duplex scanning
- if stenosis > 70% proceed to carotid endarterectomy
Characteristics of TIA
Episodes are sudden onset
Last few minutes
No associated headache
No neurologic sequelae
First test to run in pt with suspected stroke
CT scan - to R/O bleeding and large infarct
When can you use tPA in stroke patient
Within 90 min of onset of symptoms, after CT scan has been done to r/o hemorrhage
Neurologic catastrophes of sudden onset with severe headache
Vascular hemorrhagic
Common presentation of subarachnoid hemorrhage
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
Management for subarachnoid hemorrhage
CT scan followed by angiogram
Surgery to clip aneurysm or endovascular coiling
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?
Brain tumor
What is the Cushing reflex?
Bradycardia and HTN in setting of increased ICP maintains cerebral perfusion
How can you decrease ICP caused by a brain tumor?
High dose steroids I.e. decadron
Foster Kennedy syndrome
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
12 yo boy is short for his age, has bitemporal hemianopsia and has a calcified lesion above sella in xrays of the head - dx?
Craniopharyngioma
A young woman presents with amenorrhea and galactorrhea; she denies being pregnant - what tests should you order first?
Pregnancy test
Thyroid function - to r/o hypothyroidism
Hormone levels
MRI
Tx. Prolactinoma
Bromocriptine therapy
Surgery - pts who do not respond to medical tx or those who want to get pregnant
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
Pituitary apoplexy - bleeding into a pituitary tumor with subsequent destruction of pituitary gland
Tx. Of pituitary apoplexy
Immediate steroid replacement
Eventually other hormone replacement
- MRI or CT will assess the extent of the problem
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
Tumor of posterior fossa
- Mc brain tumor in children
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?
Brain abscess
- order CT scan
Tx of brain abscess
Surgical resection
What is the best imaging modality to examine lesions of the spine?
MRI
Characteristics of lumbar disc herniation
Usually onset with some weight bearing activity
Worse with sneezing or coughing
Affected leg may remain flexed
Straight leg test gives excruciating pain
When do you consider neurosurgical intervention for lumbar disc herniation?
If there is progressive weakness or sphincteric deficits
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?
Spinal stenosis - neurogenic claudication
- order MRI and refer to pain clinic
How can you tell apart neurogenic from vascular claudication?
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
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?
Autonomic dysreflexia
Tx. Of autonomic dysreflexia
Alpha adrenergic agents - to lower BP
CCB
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?
Trigeminal neuralgia
Tx. Of trigeminal neuralgia
R/o organic lesions with MRI
TX. With anticonvulsants; if doesn’t work, radiofrequency ablation
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?
Causalgia - reflex sympathetic dystrophy
Tx of causalgia
Surgical sympathectomy
