Oxford Cases (WM) Flashcards
What is best operation for CSDH?
Burrhole craniostomy (Lega JNS 2010 meta-analysis - higher reccurence than craniotomy but lower complication)
What’s the evidence for leaving a drain?
48 hours. Significant reduction of recurrence: 24% to 9%.
Mortality 18–>9 at 6 months.
When can a burrhole drainage resume driving?
On clinical recovery
What is risk of thromboembolic complication with metal heart valve?
4-12% per year
What’s risk of thromoembolic complication with AF?
2-18%
What’s risk of PE in DVT/PE?
15% per year (40% in first month, 10% per month thereafter)
What is evidence for seizure prophylaxis in head injury?
Phenytoin for early (first 7 days) Temkin et al. 1990
Explain PRx
PRx is the correlation coefficient between intracranial pressure and cerebral perfusion pressure. Negative values indicate intact autoregulation. PRx is then compared to CPP. At the CPP where PRx is lowest this is then targeted at optimal CPP.
What’s the optimal BP for TBI without ICP monitoring?
>100 for 50-69 >110 otherwise
What’s optimal CPP
60-70 or PRX
What’s optimal PC02 PO2 in head injury?
PC02 4.5-5 PO2 11-13 (not in BTF)
What’s criteria in rescue ICP?
ICP>25 for more than 1 hour despite 1st and second tier therapy
What’s the urine sodium in SIADH and CSW?
Elevated
What are the ligaments providing stability to the craniocervical junction?
Anterior atlanto-occipital membrane Apical ligament (tip of dens to occiput) Alar ligaments (tip to dens to medial condyle) Tectorial membrane
Posterior atlanto-occipital membrane
Give a classification of C1 fractures
- Isolated anterior/posterior
- Bilateral fractures of ant and post arch (Jefferson)
- Unilateral lateral mass
(Landell classification)
Transverse ligament defines stability
Draw C1
