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Cognition, movement and senses > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

What is the effect of anterior facing herniation?

A

Suppression of the anterior cerebral artery

Leg weakness

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2
Q

What is the effect of herniation into the infraorbital fissure?

A

CN III damage
4 of 6 extraocular muscles
Parasymp nerve

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3
Q

Treatment of raised ICP from CSF:

A

Drainage

Chronic decrease in production using carbonic anhydrase

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4
Q

Treatment of raised ICP from blood:

A

Bed at 30 degrees to increase venous return
Decrease PCO2
Decrease inflow, increase outflow
Evacuate clot

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5
Q

Treatment of raised ICP from brain:

A

Decrease CMRO2 (oxygen consumption)
Steroids acutely reduce vasogenic swelling from tumour
Remove tumour
Hypertonic solution (e.g. saline 3%)

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6
Q

How do you test for brainstem death?

A

Pupil response
Corneal reflexes
Oculovestibular reflexes
Apnea test

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7
Q

Indications for brainstem death:

A

Hypothermia
Circulatory disturbances
Electrolyte and endocrine disturbances
Lack of reflexes

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8
Q

Decorticate posture:

A

Arm adduction
Elbow flexion
Hand flexion
Plantar flexion

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9
Q

Decerebrate posture:

A 
Arm adduction
Elbow extension
Forearm supination
Hand flexion
Plantar flexion
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10
Q

How do space-occupying lesions present?

A

Focal deficits
Seizures
Raised ICP

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11
Q

Signs of raised ICP in a neonate?

A 
Head circumference
Fontanelle
Dilated scalp veins
Loss of upgaze
Irritability, vomiting, reduced conscious level
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12
Q

MRI modalities:

A

T1 for contrast (tumours)

T2 for anatomy

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13
Q

Communicating causes of hydrocephalus:

A

Post-haemorrhage

Post-infection

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14
Q

Non-communicating (obstructive) causes of hydrocephalus:

A 
Aqueduct stenosis
Obstructed outlets of the 4th ventricle
Foramina of Monro
Tumour
Blood, infection
Membranes and cystic lesions
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15
Q

Difference between communicating and non-communicating hydrocephalus:

A 
Communicating = outflow obstruction outside of the ventricles (flow between the ventricles)
Non-communicating = outflow obstruction in the ventricles
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16
Q

Triad of features in normal pressure hydrocephalus:

A

Dementia or bradyphrenia (slowness of thought)
Urinary incontinence
Gait difficulties (similar to Parkinson’s)

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17
Q

Imaging of normal pressure hydrocephalus:

A

Hydrocephalus with enlarged 4th ventricle

Absence in sulcal atrophy

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18
Q

Treatment for normal pressure hydrocephalus:

A

Ventriculoperitoneal shunting

10% experience serious complications such as seizure, infection and intracerebral haemorrhage

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19
Q

Most common solid tumour in children/2nd most common cancer in children to leukaemia?

A

Posterior fossa brain tumour

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20
Q

Effect of pineal tumour?

A

Can cause hydrocephalus by compressing the aqueduct

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21
Q

History of aneurysm?

A

Crescendo over seconds to a really bad headache

22
Q

Risk factor for aneurysms:

A

Connective tissue disorders

23
Q

Poor prognostic factor in aneurysm:

A

Vasospasm

Give nimodipine

24
Q

Extradural tumour:

A

Metastases from prostate cancer

25
Q

Intradural tumours:

A

Meningioma

Neurofibroma

26
Q

Intramedullary tumours:

A

Astrocytoma
Ependymoma
Haemangioblastoma
Cavernoma

27
Q

Presentation of hydrocephalus in older children/adults:

A

Headaches
N+V
Visual blurring +/- loss of upgaze
Drowsiness, reduced conscious level

28
Q

Imaging in hydrocephalus:

A

US in neonates

Need higher resolution before intervention like CT or MRI to observe flow

29
Q

Temporary treatment of hydrocephalus:

A

Extra-ventricular drain
Ventriculosubgaleal shunts (drains to under scalp)
Resevoir

30
Q

Definitive treatment of hydrocephalus:

A

Shunt
ETV
Fenestrations
Stents

31
Q

Head injury severity by GCS:

A 
Mild = 13-15
Moderate = 9-12
Severe = 3-8
32
Q

What causes subdural haematomas?

A

Rupture of bridging veins or burst lobes in severe head injury

33
Q

What causes extradural haematomas?

A

Fracture lacerating dural artery
MMA
Venous sinus injury
May have lucid interval

34
Q

What are multiple small contusions (petechial haemorrhages) a sign of?

A

Diffuse axonal injury

35
Q

Management of DAI pre-surgery?

A

Insertion of ICP probe to monitor

36
Q

Management of brain tumours:

A

Initially steroids to reduce swelling
AEDs if needed
MRI of whole neuraxis and CT CAP
Surgery

37
Q

Management of glioblastoma?

A

High grade glioma
Resection and chemoradiation
Prognosis is 1.5 years

38
Q

Management of single metastasis?

A

Resection

39
Q

Low grade gliomas will…

A

Transform to high grade within 15 years

Maximal resections carried out to prevent this

40
Q

Management of malignant tumours e.g. medullary blastoma in neonate?

A

Resection with curative intent and adjuvant therapy

Avoid RT/proton beam in first 3 years of life

41
Q

Astrocytoma treatment?

A

Maximal safe resection

42
Q

What is a cavernoma?

A

Cluster of abnormal blood vessels typically in CNS
Thin walls, prone to leaking
Can cause seizures, strokes, haemorrhages and headaches

43
Q

Where do hypertensive bleeds tend to occur?

A

Basal ganglia

Cerebellum and brainstem but to a lesser extent

44
Q

Management of aneurysm?

A

HDU/ITU
Analgesia, laxatives, fluids
Nimodipine
CT angiogram to discuss coiling/clipping

45
Q

Spinal tumours:

A

Extradural > intramural > intramedullary

46
Q

Grade A spinal trauma:

A

Complete. No motor or sensory in sacral segments S4-5

47
Q

Grade B spinal trauma:

A

Incomplete. Motor below neurological level but no sensory. Includes sacral segments S4-5

48
Q

Grade C spinal trauma:

A

Incomplete. Motor below neurological level and more than half muscles below neurological level have grade 3 or less

49
Q

Grade D spinal trauma:

A

Incomplete. Motor below neurological level and more than half muscles below neurological level have grade 3 or more

50
Q

Grade E spinal trauma:

A

Normal. Motor and sensory intact

Cognition, movement and senses (20 decks)

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