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Clinical Medicine > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

Definition of extradural haematoma

A

Bleeding into the space between the dura mater and skull

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2
Q

Causes of extradural haematoma

A

Acceleration-deceleration injury
Blow to the side of the head
Often temporal region due to bleeding in the middle meningeal artery

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3
Q

Symptoms and signs of extradural haematoma

A 
Brief post-trauma LOC follwed by lucidity, reduced consciousness, hemiparesis and ipsilateral pupil dilation
Headache
Vomiting
Seizure
Hemi hyperreflexia
Abnormal babinski (hemi)
Increased CSF opening pressure
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4
Q

Diagnosis of extradural haematoma

A

CT scan- typical lemon appearance
May cross midline unlike subdural
Frequently mass effect

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5
Q

Management of EDH

A

Less than 1cm and minimal symptoms without herniation- admit, observe, several days of steroids
Serial CT scans to follow up
If not- evacuation

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6
Q

Definition of subdural haematoma

A

Bleeding into the most external meningeal layer

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7
Q

Causes of SDH

A

Acute:
- Traumatic secondary to parenchymal laceration or acceleration deceleration
- Anticoagulant therapy
Chronic
- Past bleeds that are smaller but continue

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8
Q

Symptoms of SDH

A 
Headache
Vertigo
Amnesia
Lethargy
Decreased consciousness
Often no signs
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9
Q

Diagnosis of SDH

A

CT scan- smooth crescent shaped bleed

Oedema present, usually over the haematoma but can be diffuse

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10
Q

Management of SDH

A

Analgesia, fluids and NBM
Midline shift more than 5mm or focal signs- evacuation
Otherwise watchful waiting and serial CT scans

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11
Q

Definition of SAH

A

Haemorrhage of blood into the subarachnoid space

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12
Q

Causes of SAH

A

Trauma (most common)
Ruptured intracranial aneurysm (assoc with PKD, ehlers danlos and aortic coarctation)
Cerebral AVM
Others- CA rupture or dissection, coagulation disorders, idiopathic

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13
Q

Sx of SAH

A 
Sudden onsent severe, thunderclap headache
Nausea and vomiting
Syncope or apoplexy
Neck pain
Photophobia
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14
Q

Signs of SAH

A 
Focal nerve issues
Increased ICP and coma
Meningismus with positie Kernig's/Brudzinski sign- key SDH point of difference
Occular haemorrhage
3rd nerve palsy
HTN
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15
Q

Diagnosis of SAH

A

CT scan detects >95% of cases within 48h
LP is most definitive but must remember to take only a small amount of CSF due to rebleed risk
Sees increased opening pressure, non clotting bloody fluid, xanthochromia, increased RBC and protein
Cerebral angiogram gold standard for evaluation

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16
Q

Management of SAH

A 
ICU and hourly neuro checks
Prophylactic leviteracetam
Sedation, analgesics, dexamethasone, stool softener, oxygen, BP management
Bloods
coliling, clipping bleeders in surgery
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17
Q

Complications of SAH

A

Vasospasm- need 21 day nimodipine course to prevent
Re bleeds
Hyponatraemia secondary to SIADH but must give saline, not diuretics and fluid restriction
Seizures
Hydrocephalus

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18
Q

Definition of hydrocephalus

A

Excessive volume of ECF within the ventricular system due to production absorption-imbalance

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19
Q

Causes of hydrocephalus (categories)

A

Obstructive/non communicating
Non obstructive/communicating
Normal pressure

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20
Q

Cause of obstructive hydrocephalus

A

Blackage of CSF flow by a structure such as
tumour
avm
post haemorrhage
Aqueductal stenosis
Chiari malformation (brain tissue extending into spinal cord)

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21
Q

Causes of non obstructive hydrocephalus

A

Reduced reabsorption due to
meningitis
post-haemorrhage
Increased production due to a choroid plexus tumour

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22
Q

Causes of normal pressure hydrocephalus

A

Often idiopathic

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23
Q

Symptoms and signs of hydrocephalus

A

O/NO: Increased ICP so

  • Headache, worse in morning lying and valsalva
  • Nausea/vomiting
  • Papilloedema
  • upgaze/abducens palsy
  • Gait change

Paeds

  • Bulging fontanelle
  • Increased head circumference relative to face size
  • Reduced upward gaze

Normal pressure
- TRIAD: dementia, incontinence and disturbed gait

24
Q

Investigations for hydrocephalus

A

CT suggests enlargement of temporal horns

LP is diagnostic and therapeutic but NOT if obstructive due to risk of brain herniation

25
Q

Management of hydrocephalus

A

Surgical: Shunt / 3rd ventriculostomy / choroid plexectomy / external ventricular drain if acute or severe
Medical: Diuretics, but only temporarily and cocasionally in infants

26
Q

What is the cushings reflex

A

Occurs late and often pre-terminal following brain trauma

- Bradycardia AND hypertension

27
Q

What does a unilateral pupil dilation and sluggish/absent light reflex mean

A

3rd nerve palsy

May be due to tentorial herniation

28
Q

What does a bilateral pupil dilation and sluggish/absent light reflex mean

A

Poor perfusion

Bilateral 3rd nerve palsies

29
Q

What does unilateral normal/dilated pupil with marcus gunn light reaction mean

A

Optic nerve injury

30
Q

What does bilateral constructed pupils with a difficult to visualise light reflex mean

A

Opiates
Pontine lesion
Metabolic encephalopathy

31
Q

What does unilateral constructed pupils with a normal light reflex mean

A

Sympathetic disruption (eg. horners)

32
Q

Definition of trigeminal neuralgia

A

A pain syndrome characterized by severe unilateral pain

33
Q

Causes of trigeminal neuralgia

A

Often compression of trigeminal nerve by the SCA
Idiopathic
Tumour
Vascular anomalies (rare)

34
Q

Signs and symptoms of trigeminal neuralgia

A 
Unilateral electric shock like pains coming and going abruptly
Commonly evoked by light touch
Frequently spontaneous
Shows periods of remission
No other neurology present
35
Q

Red flags for trigeminal neuralgia

A 
Sensory changes
Hearing or ear issues
History skin or oral lesions that may spread
Bilateral pain
Solely ophthalamic pain
Optic neuro issues
personal or familial MS
Under 40yo
36
Q

Management of trigeminal neuralgia

A

Carbamazepine 1st line

Peripheral branch blocks or neurectomy

37
Q

Definition of aneurysm

A

A weakening of the arterial wall leading to a pressurized outpouch

38
Q

Causes of aneurysm

A 
Congenital with a defective muscular layer of artery (called medial gap)
Hypertension
Embolic due to atrial myxoma
Infection
Trauma
39
Q

Varieties of aneurysm

A

Berry/saccular: Normally major vessels and apex of branch points such as ant or post communicating arteries
Fusiform- all sides bulge, more common in basilar circulation

40
Q

Symptoms of aneurysm

A 
Rupture is the most common presentation- SAH
May also cause intracranial, intraventricular or subdural bleeds
Mass effect- hemiparesis
Cranial neuropathy of 3rd nerve
Visual loss
facial pain
Headache
TIA
Seizure
41
Q

Management of aneurysm

A

Coiling by IR- good for elderly, poor clinical grade, post. circulation, small necked aneurysm, inaccessible by clip
Clipping via surgery- good for young, MCA, giant, mass effect, small, wide necked aneurysm, previous coil failure
Otherwise control HTN, soften stool etc

42
Q

Define AVM

A

A vascular abnormality usually congenital and incidentally found if asymptomatic
Blood flows directly into draining veins without capillary beds

43
Q

Causes of AVM

A

Congenital

Often progress from low to med/hi pressure

44
Q

Symptoms of AVM

A 
Haemorrhage most common presentation
Headache
Seizure
Ischaemic sx by steal
Face or limb weakness
Mass effect
45
Q

Diagnosis of AVM

A

Unenhanced CT rules out active bleeds
MRI for examining AVM and oedema
Angiography shows tangle, feeding and draining vessels
Graded by spetzler-martin system

46
Q

Management of AVM

A 
Depends on grade and symptoms
Surgery is treatment of choice
Radiation
Endovascular embolization
Combination therapy
47
Q

Describe glioblastoma

A

Most common primary tumour
Disrupts BBB
Assoc with vasculogenic oedema

48
Q

How does glioblastoma show on imaging

A

Solid centrally necrotic tumour with an enhancing rim

Pleiomorphic cells on histology

49
Q

Treatment of glioblastoma

A

Surgery
+/- adjuvant chemo/rad
Dexamethasone for oedema

50
Q

Describe meningioma

A

2nd most common primary brain tumour
Typically benign
Arise from dura mater

51
Q

Where are meningiomas found

A

Falx cerebri, sup saggital sinus, skull base

Causes sx due to mass effect

52
Q

How does meningioma show on imaging

A

CT- contrast enhancement
MRI useful
Histology shows spindle cells in concentric whorls, calcified psammoma bodies

53
Q

Treatment of meningioma

A

Watch and wait

If troublesome sx- surgery +/- radiotherapy

54
Q

What cancers commonly metastasize to the brain

A 
Lung
Breast
Kidney
Colorectal
Skin
55
Q

Describe 3rd nerve palsy sx

A

Eye is down and out
Drooped eyelid
Constricted unilateral pupil

56
Q

Describe 4th nerve palsy sx

A

Affected eye moves upwards the more medially it looks

57
Q

Describe 6th nerve palsy sx

A

Affected eye cannot look laterally

Clinical Medicine (5 decks)

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