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Neurology > Neurosurgery Topics > Flashcards

Neurosurgery Topics Flashcards

1
Q

What are the general features of a radiculopathy?

A
  1. Pain in dermatomal distribution
  2. Unilateral
  3. Pain at rest
  4. LMN signs (fasiculations, weakness, less reflexes)
  5. Decreased sensation pain/temp
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2
Q

L5 herniation syndrome

A

Pain: in SI joint, hip, lateral thigh
Numb: lateral leg, first three toes
Weak: dorsiflexion (foot drop)
Reflexes: decreased medial hamstring

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3
Q

S1 herniation syndrome

A 
Pain: SI joint, hip, posterolateral thigh to heel
Numb: posterior calf, lateral heel 
Weak: Plantar flexion
Atrophy: Gastrocnemius, soleus
Reflexes: decreased ankle jerk
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4
Q

C4-C5 herniation syndrome

A

Numb: neck, lateral shoulder
Weakness: deltoids, biceps, supraspinatus
Reflexes: decreased biceps?

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5
Q

C5-C6 herniation syndrome

A

Numb: thumb
Weakness: biceps
Reflexes: biceps

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6
Q

C6-C7 herniation syndrome

A

Numb: middle finger

weakness: triceps
reflexes: decreased triceps

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7
Q

C7-T1 herniation syndrome

A

Numb: 4th/5th digits
Weakness: intrinsic hand muscles, finger flexors
Reflexes: Hoffman’s sign

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8
Q

Myelopathy

A

Compression of spinal cord

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9
Q

Meningioma

A

Epi: most common primary intracranial neoplasm
occurs in those 60-70+ or NF2 mutation
Ix: MRI shows dural tail sign, well circumscribed isodense mass
Tx: conservative or surgical

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10
Q

Glioma-high grade

A 
Epi: 30-40s
Sx: focal neuro sx
Ix: Diffuse margins and edema
must biopsy
Tx: Radiation +chemo
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11
Q

Glioma-low grade

A

Epi: increases with age
Sx: seizures with normal neuro exam
Ix: Located at cerebral convexities, insula, sensorimotor cortex, non-enhancing
Tx: Surgery, radiation

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12
Q

Medullablastoma

A

Epi: most common in children
Sx: ataxia if cerebellar
Ix: enhancing mass
tx: resection + radiation

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13
Q

Pituitary tumor

A

Sx: Bitemporal hemianopsia, hormone changes
Ix: do prolactin, IGF-1, cortisol etc
Tx: dopamine agonists if prolactinoma, or surgery trans-sphenoidal

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14
Q

Primary CNS lymphoma

A

Epi: more common in immunosuppressed
Sx: behavioural and cognitive changes, seizures
Ix: Usually located in hemisphere in contact with CSF space, GAD may show diffusely enhancing mass
Biopsy
Tx: Chemotherapy, methotrexate

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15
Q

CT shows multiple lesions in brain, next Ix?

A

CT chest abdo pelvis to look for primary

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16
Q

Nerve sheath tumour

A

Epi: most common extramedullary tumour
Sx: Radiculopathy
Ix: Usually in lumbosacral spine,

17
Q

Ependymoma

A

Epi: most common intramedullary tumour in adults
Sx: insidious onset of myelopathic sx, pain
Ix: Hyper in T2, distinct margins

18
Q

Astrocytoma

A

Epi:most common intramedullary tumour in children
Sx: motor weakness, gait disturbance
Ix: poorly defined margins

19
Q

Imaging features suggestive of metastatic cancer

A 
Spherical shape
Grey-white matter junction
Ring enhancing
Edema
Multiple
20
Q

Treatment of metastatic tumour of brain

A

Whole brain radiation
Surgery
Steroids

21
Q

What is the coup injury vs the contre-coup?

A
  1. Coup= spot where the brain hits first

2. Contre-coup= rebound injury

22
Q

What are the 3 key parts of a head trauma assessment?

A
  1. GCS**
  2. Pupils- reactive, symmetry, dilated?
  3. CT head
23
Q

What is the typical symptom course for epidural hematoma?

A
  1. Initial injury
  2. Lucid period
  3. Decline- watch out for herniation syndromes
24
Q

Hydrocephalus

A

Accumulation of excess CSF in the brain
Epi: most are due to obstruction of flow (congenital stenosis, tumours, or acquired inflammation etc)- this can stretch neurons and disrupt tissue

25
Q

Investigations with suspected hydrocephalus

A
  1. Physical exam- gaze palsies, gait, full fontanelle in babies
  2. Cranial U/S (babies)
  3. CT head
  4. MRI scan + CSF flow studies
26
Q

Normal pressure hydrocephalus

A 
Enlarged ventricles with normal CSF pressure. Occurs in elderly. 
Triad of:
1. Ataxia
2. Incontinence
3. Dementia
27
Q

Chronic hydrocephalus

A

Aka “ARRESTED”.
Sx: insidious progression, similar to NPH
Tx: need to address so cognitive function is maintained

28
Q

Treatment hydrocephalus

A

Shunt- ventriculoperitoneal most common
Removal of mass
LPs for transient relief

Neurology (28 decks)

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