Neurosurgery Topics Flashcards
What are the general features of a radiculopathy?
- Pain in dermatomal distribution
- Unilateral
- Pain at rest
- LMN signs (fasiculations, weakness, less reflexes)
- Decreased sensation pain/temp
L5 herniation syndrome
Pain: in SI joint, hip, lateral thigh
Numb: lateral leg, first three toes
Weak: dorsiflexion (foot drop)
Reflexes: decreased medial hamstring
S1 herniation syndrome
Pain: SI joint, hip, posterolateral thigh to heel Numb: posterior calf, lateral heel Weak: Plantar flexion Atrophy: Gastrocnemius, soleus Reflexes: decreased ankle jerk
C4-C5 herniation syndrome
Numb: neck, lateral shoulder
Weakness: deltoids, biceps, supraspinatus
Reflexes: decreased biceps?
C5-C6 herniation syndrome
Numb: thumb
Weakness: biceps
Reflexes: biceps
C6-C7 herniation syndrome
Numb: middle finger
weakness: triceps
reflexes: decreased triceps
C7-T1 herniation syndrome
Numb: 4th/5th digits
Weakness: intrinsic hand muscles, finger flexors
Reflexes: Hoffman’s sign
Myelopathy
Compression of spinal cord
Meningioma
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
Glioma-high grade
Epi: 30-40s Sx: focal neuro sx Ix: Diffuse margins and edema must biopsy Tx: Radiation +chemo
Glioma-low grade
Epi: increases with age
Sx: seizures with normal neuro exam
Ix: Located at cerebral convexities, insula, sensorimotor cortex, non-enhancing
Tx: Surgery, radiation
Medullablastoma
Epi: most common in children
Sx: ataxia if cerebellar
Ix: enhancing mass
tx: resection + radiation
Pituitary tumor
Sx: Bitemporal hemianopsia, hormone changes
Ix: do prolactin, IGF-1, cortisol etc
Tx: dopamine agonists if prolactinoma, or surgery trans-sphenoidal
Primary CNS lymphoma
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
CT shows multiple lesions in brain, next Ix?
CT chest abdo pelvis to look for primary
Nerve sheath tumour
Epi: most common extramedullary tumour
Sx: Radiculopathy
Ix: Usually in lumbosacral spine,
Ependymoma
Epi: most common intramedullary tumour in adults
Sx: insidious onset of myelopathic sx, pain
Ix: Hyper in T2, distinct margins
Astrocytoma
Epi:most common intramedullary tumour in children
Sx: motor weakness, gait disturbance
Ix: poorly defined margins
Imaging features suggestive of metastatic cancer
Spherical shape Grey-white matter junction Ring enhancing Edema Multiple
Treatment of metastatic tumour of brain
Whole brain radiation
Surgery
Steroids
What is the coup injury vs the contre-coup?
- Coup= spot where the brain hits first
2. Contre-coup= rebound injury
What are the 3 key parts of a head trauma assessment?
- GCS**
- Pupils- reactive, symmetry, dilated?
- CT head
What is the typical symptom course for epidural hematoma?
- Initial injury
- Lucid period
- Decline- watch out for herniation syndromes
Hydrocephalus
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
Investigations with suspected hydrocephalus
- Physical exam- gaze palsies, gait, full fontanelle in babies
- Cranial U/S (babies)
- CT head
- MRI scan + CSF flow studies
Normal pressure hydrocephalus
Enlarged ventricles with normal CSF pressure. Occurs in elderly. Triad of: 1. Ataxia 2. Incontinence 3. Dementia
Chronic hydrocephalus
Aka “ARRESTED”.
Sx: insidious progression, similar to NPH
Tx: need to address so cognitive function is maintained
Treatment hydrocephalus
Shunt- ventriculoperitoneal most common
Removal of mass
LPs for transient relief
