Neurosurgery Flashcards
What type of neurosurgical patient might present with fluctuating confusion/consciousness?
Subdural haematoma
What is the management of an aneurysm following SAH?
Interventional coiling
What would you see in the LP results of a SAH vs just a traumatic tap?
SAH-> Xanthochromia
Traumatic tap -> RBCs
What is the triad seen in raised ICP?
Cushing’s triad
Widening of the pulse pressure
Cheyne Stokes respiration
Bradycardia
(Hypertension)
What drug should be given to SAH patients with no signs of raised ICP and why?
Nimodipine - a CCB which serves to prevent vasospasm in aneurysmal SAHs
If a SAH is suspected but CT is negative, what should be done to confirm or exclude diagnosis?
LP 12 hours after the onset of symptoms
What other feature on LP would indicate an SAH aside from xanthochromia?
Raised opening pressure
What are the complications of a SAH?
Rebleed (30%) Vasospasm Hyponatraemia 2ary to SIADH Seizures Hydrocephalus
What needs to be done in any head trauma patient with GCS<=8?
Urgent neurosurgical review before CT
What is the imaging modality for investigating ?C-spine injury?
CT C-spine
What are the criteria for brainstem death?
Fixed non responsive pupils No corneal reflex Absent VO reflex No response to supraorbital pressure No cough on bronchial stimulation No observed respiratory effort on ventilator stopping
What are the indications for immediate CT head in the context of head injury?
GCS<13 initially GCS <15 @ 2hr mark Open or depressed skull fracture Signs of basal skull fracture Seizure Focal deficit >1 episode of vomiting
What are the indications for CT head within 8 hours of any head trauma?
Age >=65
Any Hx of bleeding or clotting disorder
Dangerous mechanism of injury
>30 mins retrograde amnesia of events before the injury
