Neurosurgery Flashcards
what level does the spinal cord end?
L1 (called conus medullaris)
what can cause cauda equina?
disc herniation disc prolapse tumours trauma spinal stenosis
features of cauda equina?
poor anal tone saddle anaesthesia paralysis sensory loss weakness back pain urinary retention/incontinence
Ix for cauda equina?
PR
MRI
Tx for cauda equina?
laminectomy
IV steroids
(+ radiotherapy if malignancy caused)
cause of a SAH?
rupture of a berry aneurysm OR AVMs
often occur at bifurcations in the circle of willis
risk factors for SAH?
FHx smoking alcohol HT PKD
features of a SAH?
thunderclap headache vomiting neck pain photophobia focal neuro defecit
what ophthalmology sign can be seen in a SAH? what is the cause?
CNIII palsy (down and out) dilated pupil
caused by a posterior communicating artery aneurysm until proved otherwise
what is the triad of symptoms that make up meningism?
neck stiffness
headache
photophobia
Ix for SAH?
CT head
LP
Tx for SAH?
nimidopine
endovascular coil/clipping
what endocrine abnormality can SAH cause?
SIADH check Na (will be low as water being retained)
causes of spinal stenosis?
disc herniation
tumour
osteophytes
causes of sciatica?
disk prolapse
disc herniation
if there is a L3/4 prolapse, what symptoms result?
pain to ankle
reduced knee jerk
if there is a L4/5 prolapse, what symptoms result?
pain to dorsum of foot
if there is a L5/S1 prolapse, what symptoms result?
pain to sole of foot
what are the sciatic nerve roots?
L4-S3
features of sciatica?
leg pain >back shooting radicular (not below knee) worse on stretch/standing relieved when lying with knee bent
features of spinal stenosis?
back > leg
brought on by walking
claudication distance
cycle without pain
Tx for lumbar back pain?
NSAID + PPI baclofen amitryptillin/gabapentin opiates acutely physio
laminectomy (back pain often worse after)
what happens in an extra dural haematoma? causes?
rupture of vessels in dura
in region of middle meningeal artery (temporal bone)
features of extra dural haematoma?
trauma
lucid interval
Ix and Tx for extra dural haematoma?
lemon on CT
surgery
what types of intradural haemorrhages can occur?
SAH
intracerebral
subdural
what happens in a sub dural haematoma? causes?
blood between dura and arachnoid pools
due to disruption of the bridging veins
elderly
HT
falls
anticoag
features of sub dural haematoma?
symptoms fluctuate drowsy headaches vomiting confused
Ix and Tx for sub dural haematoma?
banana on CT
surgery
what nerve causes the knee jerk reflex?
L3/4
what nerve causes the ankle jerk reflex?
S1/2
what nerve causes the biceps reflex?
C5/6
what nerve causes the triceps reflex?
C7/8
