neurosurgery

Question 1

what is an important cause of subarachnoid hemorrhage

Answer 1

aneurysm

Question 2

describe the presentation of a subarachnoid hemorrhage

Answer 2

worst headache of their life—thunderclap/sudden onset

cognitive changes, drowsy, N/V, decreased LOC/syncopal spells

Question 3

where is a common site for brain aneurysms

Answer 3

posterior communicating artery

Question 4

describe symptoms of a posterior communicating artery aneurysm

Answer 4

pain

pupil involving third nerve palsy (pupil blown down and out)

ptosis

Question 5

what is the most common etiology of subarachnoid hemorrhage

Answer 5

trauma

another common one is cerebral aneurysms –> in basal cisterns at base of brain; intracranial aneurysms occur at arterial bifurcations

Question 6

where are aneurysms most likely to be found

Answer 6

base of brain–more likely to have blood here in aneurysm rupture

Question 7

why are some people more likely to have aneurysms

Answer 7

because they have defects in the elastic lamina/arterial wall

Question 8

what is the incidence of cerebral aneurysm

Answer 8

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

Question 9

what is the risk of re-bleeding in a ruptured aneurysm

Answer 9

50% in 6 mo

–re-rupture has a high rate of mortality

Question 10

management of subarachnoid hemorrhage

Answer 10

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

Question 11

what three things do you want to prevent in someone with a brain injury

Answer 11

hypotension

hypoxia

hypercarbia

Question 12

major treatment options for cerebral aneurysm

Answer 12

microsurgical aneurysm clipping

endovascular aneurysm clipping

Question 13

what is the most common cause of airway obstruction

Answer 13

tongue

Question 14

what is cheyne stokes respiration

Answer 14

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

Question 15

what headaches cant you miss

Answer 15

subarachnoid hemorrhage–thunderclap headache

temporal arteritis–visual changes, jaw claudication

meningitis–fevers, stiff neck, headache

acute closed angle glaucoma

Question 16

causes of subarachnoid hemorrhage

Answer 16

trauma
spontaneous
VTE
vasculitis

Question 17

what is the rule out test for a subarachnoid hemorrhage

Answer 17

lumbar puncture

first do CT but if negative and you suspect subarachnoid hemorrhage have to do LP

Question 18

what are the most common primary brain tumours

Answer 18

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

Question 19

what makes you think your patient has a brain tumour

Answer 19

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

Question 20

what role does surgery play in brain tumours (i.e gliomas)

Answer 20

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

Question 21

mean survival for glioblastoma with treatment

Answer 21

within a year