Neurosurgical issues in primary care

Question 1

ICP: define increased intracranial pressure

Answer 1

elevated intracranial pressure >200mmHg or >15mmHg

Question 2

ICP: common presentation of

Answer 2

headache (worse in morning and cough/sneeze), in setting of TBI, neuro abnormalities

Question 3

ICP: exam abnormalities

Answer 3

papilledema, cushing reflex (bradycardia and HTN), altered conceniousness

Question 4

ICP: imaging (what type to expect)

Answer 4

• hematoma/neoplasms/hydrocephalus
• normal pressure hydro (enlarged ventricles and sulci flatten)
• pseudotumor cerebri (empty sella, flatten f]globe, increase CSF by optic nerve (nerve looks tortuous)

Question 5

ICP: evaluation and management in clinic or ER

Answer 5

• ## sit up (30-40 degrees)-

Question 6

Closed head injury: results of a TBI

Answer 6

• skull fracture, laceration or contusion, hemorraghe

Question 7

closed head injury: clinical presentation

Answer 7

• contusion or lacerations, altered consciousness without focal signs

Question 8

primary and secondary neoplasms

clinical presi, imaging, eval/management, pathophysiology

Answer 8

clinical presentation: focal, late onset seizure, headache

diagnosis: imaging
tx: surgical, radiation or chemo

Question 9

GCS: eyes

Answer 9

4 (spontaneous, to name, to pain, none)

Question 10

GCS: verbal

Answer 10

5 (oriented, confused but conversation, inappropriate words, incomprehensible words, none)

Question 11

GCS: movement

Answer 11

6 (obey, localizes, withdraws from pain, flexor, extensor posturing, none)

Question 12

papilledema- how long before

Answer 12

8 hours of increased ICP