Paediatrics Flashcards
What are causes of macrocephaly?
hydrocephalus SOL - e.g. tumour, arachnoid cyst, CSDH Venous hypertension due to AVM Metabolic causes Syndromic overgorwth syndromes (Soto’s syndrome) Cranial hyperostosis
Describe the ETV success score?
Age (0-50) Aetiology (post infectious 0, myelomeningocoele 20, aquaductal stenosis/tectal tumour 30) No previous shunt 10
What is natural history of MM without treatment?
Without treatment 25% survive infancy of these 50% ambulatory and 70% normal IQ With treatment 80% ambulatory 70% normal IQ 85% ‘social continence’ 5% normal urinary function
What is shunt rate after myelomeningocoele?
80% post natal closure Goes down to 40% prenatal closure (Improvement of 1 level or more is 40% in prenatal and 20% post natal)
What are the radiological findings of Chiari II?
Small post fossa with low torcula Elongated and low lying fourth ventricle Beaking of tectal plate (elongated inferior colliculus) Large massa intermedia Thin corpus callosum Medullary, tonsillar and vermian herniation through FM
Risk of open neural tube defects
1:1000 - up to 2% if 1 previous birth with MM
Name three disorders of gastrulation relevant to neurosurgeons?
e.g. these three disorders (all disorders of notochord integration) - neurenteric cysts - dorsal enteric fistula - split cord malformation
What are the two types of split cord malformation?
Type 1 - two hemicords within separate dural tubes Type 2 - single dural tube
Name a disorder of secondary neurulation
Tight filum terminale
What types of disorders of primary neurulation are there? And what’s the mechanism
Closed dysraphism - Premature dysjunction - lipomyelomeningocoele - lipmyeloceole - intradural lipoma Open dysraphism - Nondysjunction - dorsal dermal sinus - myelomeningocoele (open or closed) -
What are features of Dandy-Walker malformation?
Vermian agenesis Cystic dilatation of 4th ventricle High-lying torcula with inverted tentorial angle
What are considerations in paediatric pineal?
Neuraxis MRI Steroids Treat hydrocephalus Eyes
What are layers of myelomengicoele?
Neural placode, zona epitheliosa, abnromal skin, normal skin
What are principles of myelomeningocoele surgery?
Incise to normal skin, identify dural sac, reduce placode into dural sac, oversow sac +/- fascia
What are most common conditions producing focal CNS lesions in AIDS?
Toxoplasmosis Primary CNS lymphoma (can look atypical) PML (progressive mulifocal leukencephalopathy - JC virus) Cryptococcal abscess TB (tuberculoma)
How do you work up an AIDS patient with cerebral lesion?
Toxoplasmosis IgG serology Consider lumbar puncture - cytology for primary CNSlymphoma LP - PCR for JCvirus and EBV
What staging of medulloblastoma is there?
Chang’s staging - based on tumour size and extent of metastases
What are the groups of medulloblastoma and prognosis:
WNT - good prognosis SHH - intermediate prognosis Group 3 - poor prognosis Group 4 - intermediate prognosis
What is total volume of CSF in adult vs Newborn?
150ml vs 5mls
What is circulating blood volume?
75ml/kg (up to 85mls/kg term 100mls/kg in premature)
What is paediatric fluid requirement?
Over 24 hours 100ml/kg first 10kg 50ml/kg next 10kg 20ml/kg thereafter Bolus is 1/6th bodyweight
What are the attachments of lillequest’s membrane?
Y shaped Dorum sellae to mamillary bodies Inferiorly there is a mesencephalic leaf
Draw floor of third ventricle
To place mamillary bodies Intermammillary space Tuber cinereum Infundibulum Chiasm
What is the velum interpositum?
It’s the double layer of tela choroidea which contains a potential space above the internal cerebral veins
How do you disconnect a fatty filum?
At L5/S1
Distinguish positional plagiocephaly from lamboid synostosis
in lamdoid synostosis ear is posterior and down In positional plagiocephaly there is ipsilateral frontal prominence
What’s the cause of vein of galen malformation?
Persistant median prosencephalic vessel of Markowski
Dive DVLA return to drive advice for
Meningioma
TBI
GBM
Seizure
CSDH
Elective Clipping
SAH and treated aneurysm
Meningioma - 6/12
TBI - case dependent, 6-12/12 depending
(If minimal post traumatic amnesia, normal scan, no impairment can drive on clinical recovery)
GBM - 2 years after completion of primary treatment
Seizure - typically 1 year (not drive whilst meds being withdrawn + 6 months after last dose)_
Chronic subdural - clinical recovery
Elective clipping - clinical recovery
Treated anuerysm and SAH - clinical recovery
What’s the difference between cut and coag?
Cut is continuous
Coag is pulsed and higher voltage
What is root level of shoulder muscles?
All C5/6 apart from shrugging (accessory)
What are carried by
Aalpha
Abeta
Agamma
Adelta
B
C
fibres?
Aalpha - motor
Abeta - touch and pressure
Agamma - proprioception
Adelta - fast pain and temperature
B - autonomic
C - slow pain and temperature
What are three nerves that can cause winging of the scapula?
Dorsal scapula nerve
Accessory
Long thoracic
Describe nurick scale
0-5 from no myelopathy through to bedridden (on mobility)
What are the four kinds of OPLL in Japanese Ministry of Health and Welfare classification?
Continuous
Segmental
Mixed
Localised
Mechanisms of anticoagulants
Warfarin
Heparin
Dabigatran
Apixaban
Warfarin - II, VII, IX, X
Heparin - inactivates II and X (via antithrombin 3), LMWH same
Dabigatran - direct anti thrombin (factor II)
Apixaban - Xa inhibitors
How does
Aspirin
Clopidogrel/ticagrelor/prasugrel
dypyridamole
Tirofiban
Work?
Aspirin - COX1
Clopidogrel/ticagrelor/prasugrel - ADP receptor antagonists (later blocking G2b3a pathway)
Dipyridamole - prevents adenosine updake
Tirofiban - direct G2b3a inhibotor (IV only)
Explain clotting cascade?
Extrinsic and intrinsic pathway
Both lead to activation of factor X
Which activates factor II (thrombin)
Which cleaves fibrinogen to fibrin
Draw the hippocampus
Subiculum
Dentate gyrus
CA1-CA4
Dentate gyrus
Whaat sensory latency do you expect in CTS?
>3.5ms
What are sites of median nerve entrapment?
CTS
Anterior interosseous enuorpathy
Heads of pronator teres
Above elbow - struthers ligament
X and O on audiogram?
X is left, O is right
What are medical treatments for prolactinoma?
cabergoline
bromocriptine
What are the medical treatments for acromegaly?
Octreotide
Pegvisamant
Cabergoline
Klippel feil - triad
Congenital fusion of 2 or more vertebrae
Triad
Low posterior hairline
Short neck
Limited neck movement
Organisms in brain abscess?
Streptococcus (e.g. strep milleri, strep anginosus)
Otitis media can have bacteroides
Enterobacter
Describe briefly functional arrangement of basal ganglia?
Input = Striatum (caudate and putamen)
Outputs = GPi and Substantia nigra pars reticularis which project to ventrolateral thalamus
What’s pallister hall syndrome?
hypothalamic hamartoma
pituitary hypoplasia
polydactyly
Name three multiple tumour syndromes?
Turcot syndrome - GBM + bowel cancer
Li-Fraumeni - P53 includes astrocytomas and PNET
Cowden - multiple hamartoma syndrome associated with dysplastic gangliocytoma of cerebellum (lhermitte duclos)
What’s tolosa hunt?
Inflammation of cavernous sinus/superior orbital fissure
non-specific granulomatous
Rx is steroids
What’s the grade of haemangiopericytoma?
II or III if anaplastic
Arises from pericytes
Treatment is surgery + RTX
Can metastasize - chemo
Where’s MacCarty Keyhole?
7mm superior + 5mm posterior to frontozygomatic suture
Or at anterior termination of superior temporal line
When do you get the spasms of hemifacial spasm?
During sleep (unusually for movement disorder)
How do carbamazepine and gabapentin?
Carbamazepine is sodium channel blcoker
Gabapentin is gaba analogue
What are the neurosurgical associations in downs?
Basilar invagination secondary to atlantoaxial instability
What is embryological basis of Rathke’s cleft cyst?
Single layer of cuboidal epithelium
Rathke’s pouch has infolded from the pharynx to form anterior pituitary
Where are most common aneurysm locations?
Acomm 30%
PcommaA 25%
MCA 25%
Vertebrobasilar 5-15%
What are the features of lateral medullary syndrome of Wallenberg?
Ipsilateral facial pain and temperature loss
Ipsilateral horners
Contralateral body pain and temperature loss
Vertigo, nystagmus, ipsilateral ataxia, IXth, 10th nerve
