neurosurgery Flashcards

1
Q

diffuse axonal injury cause

A

diffuse axonal injury occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ct head within 1 hour

A

GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture.
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ct within 8 hours

A

age 65 years or older
any history of bleeding or clotting disorders
dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
more than 30 minutes’ retrograde amnesia of events immediately before the head injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SAH ix

A
Computed tomography (CT) head Acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system. CT is negative for SAH (no blood seen) in 7% of cases.
Lumbar puncture (LP) Used to confirm SAH if CT is negative. LP is performed at least 12 hours following the onset of symptoms to allow the development of xanthochromia (the result of red blood cell breakdown). Xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by the LP procedure)
Referral to neurosurgery to be made as soon as SAH is confirmed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

lucid interval in which intracranial haemorrhage

A

Extradural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Binocular vision post-facial trauma is suggestive of

A

depressed fracture of the zygoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

seen prior to coning

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fluctuating confusion/consciousness? -

A

subdural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

complication intraventricular haemorrhage

A

hydrocephalus

repeat ct head if suspicious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

signs of basal skull fracture

A

haemotympanum
, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose,
Battle’s sign bruising over mastoid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

most sensitive Ix for diffuse axonal injury

A

MRI brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

causes of 3rd nerve compression following trauma

A

extra dural bleed

transtentorial herniation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

6 tests of brain death

A

pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, and no spontaneous respiratory effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

complications of SAH

A

Re-bleeding (in around 30%)
Vasospasm (also termed delayed cerebral ischaemia), typically 7-14 days after onset
Hyponatraemia (most typically due to syndrome inappropriate anti-diuretic hormone (SIADH))
Seizures
Hydrocephalus
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management of SAH

A

Most intracranial aneurysms are now treated with a coil by interventional neuroradiologists, but a minority require a craniotomy and clipping by a neurosurgeon
Until the aneurysm is treated, the patient should be kept on strict bed rest, well-controlled blood pressure and should avoid straining in order to prevent a re-bleed of the aneurysm
Vasospasm is prevented using a 21-day course of nimodipine (a calcium channel inhibitor targeting the brain vasculature) and treated with hypervolaemia, induced-hypertension and haemodilution**
Hydrocephalus is temporarily treated with an external ventricular drain (CSF diverted into a bag at the bedside) or, if required, a long-term ventriculo-peritoneal shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hydrocephalus in infants presentation

A

increasing head circumference (splaying of the skull plates allowed by unfused sutures), bulging fontanelles, impaired upward gaze (‘sunsetting’; caused by pressure on the tectal plate), dilated scalp veins, bradycardias, seizures and coma.

17
Q

bleed in neonates

A

intraventricular haemorrhage

18
Q

cushings triad of coning from raised ICP

A

Widening of the pulse pressure
Respiratory changes cheyne stokes
Bradycardia