neurosurgery Flashcards
what is an important cause of subarachnoid hemorrhage
aneurysm
describe the presentation of a subarachnoid hemorrhage
worst headache of their life—thunderclap/sudden onset
cognitive changes, drowsy, N/V, decreased LOC/syncopal spells
where is a common site for brain aneurysms
posterior communicating artery
describe symptoms of a posterior communicating artery aneurysm
pain
pupil involving third nerve palsy (pupil blown down and out)
ptosis
what is the most common etiology of subarachnoid hemorrhage
trauma
another common one is cerebral aneurysms –> in basal cisterns at base of brain; intracranial aneurysms occur at arterial bifurcations
where are aneurysms most likely to be found
base of brain–more likely to have blood here in aneurysm rupture
why are some people more likely to have aneurysms
because they have defects in the elastic lamina/arterial wall
what is the incidence of cerebral aneurysm
2-5% in population, most common in 40-60 age group
- -most of these are incidental and dont cause problems
- -most common in middle aged women
- -incidence of subarachnoid hemorrhage is 1/10000 per year
what is the risk of re-bleeding in a ruptured aneurysm
50% in 6 mo
–re-rupture has a high rate of mortality
management of subarachnoid hemorrhage
ABCs
CT with CTA
lumbar puncture if CT negative
airway and ventilation management with oxygen
BP pressure control to prevent re-bleed and aneurysm rupture (less than 140 systolic)
ICP control
what three things do you want to prevent in someone with a brain injury
hypotension
hypoxia
hypercarbia
major treatment options for cerebral aneurysm
microsurgical aneurysm clipping
endovascular aneurysm clipping
what is the most common cause of airway obstruction
tongue
what is cheyne stokes respiration
respiration pattern seen in trauma/head injury
periods of heavy, fast breathing interspersed with apneas/hypopneas
bilateral hemisphere, diencephalon, upper midbrain
other patterns of cerebral dysfunction
what headaches cant you miss
subarachnoid hemorrhage–thunderclap headache
temporal arteritis–visual changes, jaw claudication
meningitis–fevers, stiff neck, headache
acute closed angle glaucoma
causes of subarachnoid hemorrhage
trauma
spontaneous
VTE
vasculitis
what is the rule out test for a subarachnoid hemorrhage
lumbar puncture
first do CT but if negative and you suspect subarachnoid hemorrhage have to do LP
what are the most common primary brain tumours
glial tumours/gliomas
astrocytes–> astrocytomas
oligodendrocytes etc…
majority are malignant
cure rare despite all treatment modalities because they grow within the brain–> malignant cells tend to be diffuse beyond the gross/large tumour
what makes you think your patient has a brain tumour
focal neuro deficits
seizures
increased ICP/mass effect–> morning headache, N/V, visual obscurations
hydrocephalus (presents as increased ICP)
endocrine dysfunction (pituitary/hypothalamic tumour)
behavioural/neurocognitive changes
what role does surgery play in brain tumours (i.e gliomas)
pathological diagnosis to guide treatment
treat the mass–good evidence–improves neuro function
theoretical benefit to cytoreduction–i.e might make chemo or radiation to work better
mean survival for glioblastoma with treatment
within a year
