Neurosurgery Module- Trauma and CSF Flashcards
what does the glasgow coma scale measure?
a patient’s level of consciousness in response to a stimulus
decorticate posturing indicates brain damage to where?
cerebrum
internal capsule
thalamus
what area is spared in decorticate posturing?
midbrain
what kind of posturing presents with arm flexion?
decorticate
what is the more severe out of decorticate and decerebrate posturing?
decerebrate
decerebrate posturing indicates brain damage to what area specifically?
area below the red nucleus in the midbrain
the reticulospinal tract causes flexion/extension
extension
the body is primarily in extension/flexion in decerebrate posturing
extension
total volume of CSF is…
150ml
how much CSF is produced daily?
450ml
why do you get ischaemia from increased CSF?
the increased ICP decreases cerebral blood flow physiologically
diplopia can be caused by what kind of herniation and why?
central herniation of the brainstem
can cause a CN6 palsy
an extradural haematoma is accumulation of blood between…
bone and dura
most common source of bleeding is from disruption of what artery?
middle meningeal
what common location for an EDH
temporoparietal region
young adult with closed head trauma who has loss of consciousness that quickly resolves followed by symptoms…
EDH
what symptoms present in EDH after consciousness is regained?
headache
N+V
contralateral hemiparesis
ipsilateral pupillary dilatation
why do pupils dilate in EDH
haematoma causes the uncus of the temporal lobe to herniate and compresses on the pupillary fibres of CN 3
imaging modality of choice in patients with head trauma?
CT head
haematoma looks white/black on CT
white
most SDH’s present __laterally in adults
uni
bilateral SDHs are more common in…
why is this?
children
less adhesions in the subdural space
how long does chronic SDH take to present?
3-7 weeks
does EDH or SDH deteriorate faster? why?
EDH because arteries are there, SDH involves veins
driving pathological factor for chronic SDH
brain atrophy causes veins to stretch and become easily ruptured which then causes an osmotic gradient
acute SDH clinical features
SEVERELY decreased state of consciouscness
PC of chronic haematoma
headache
confusion
“crescent shaped hyperdensity on CT”
acute SDH
“crescent shaped hypodensity o nCT”
chronic SDH
name the triad of symptoms in normal pressure hydrocephalus
- shuffling gait
dementia
incontinence
how do communicating and non-communicating hydrocephalus differ?
communicating is enlargement of the ventricular system with NO obstruction of flow whereas non-communicating does
how could you tell on imaging if the hydrocephalus is communicating or non-communicating?
if the 4th ventricle is small in comparison to the other ventricles -> non-comm
congenital hydrocephalus is mainly due to what condition?
aqueductal stenosis
“cracked pot sound on head percussion”
congenital hydrocephalus
there is impaired _gaze in hydrocephalus
upgaze
hydrocephalys history q’s?
antenatal and birth history
milestones
ICP symptoms
recent trauma/infection
when should you do a CT and MRI in hydrocephalus?
CT best for acute scenario to confirm diagnosis
MRI for cause and site of obstruction
chiari malformations are located in what area of the brain?
hindbrain
most common chiari malformation?
chiari 1 malformation
associated conditions along with a chiari 1 malformation?
syringomyelia
what is the patients headache like in a chiari 1 malformation?
headache worse on coughing and neck extension with sub-occipital pain
“cape-like sensory loss of pain and temperature”…
syringomyelia
which chiari malformation is more severe?
chiari 2
chiari 2 malformations are related to what condition?
spina bifida
Tx of chiari malformations?
surgery for decompression
what is the headache like in IIH?
throbbing, worse in morning, relieved on standing
“slit-like ventricles”
IIH
