Passmed Neurosurgery and Paeds Surgery Mushkies

Question 1

Diffuse axonal injury MOA?

Answer 1

Occurs as a result of mechanical shearing following deceleration, causing disruption and tearing of axons

Question 2

Classification of head injury?

Answer 2

1. Focal = contusion/haematoma

2. Diffuse (DAI)

Question 3

Classification of SAH?

Answer 3

1. Traumatic

2. Spontaneous

Question 4

Causes of spontaneous SAH?

Answer 4

1. Berry aneurysms (85%)
2. AVM
3. Pituitary apoplexy
4. Arterial dissection
5. Mycotic (infective) aneurysms

Question 5

Ix of SAH?

Answer 5

1. CT = Acute blood (hyperdense/bright on CT) is typically distributed in the basal cisterns, sulci and in severe cases the ventricular system.
2. LP = used to confirm SAH if CT -ive, at least 12 hours after onset of sx to allow development of xanthochromia

Question 6

Ix after a spontaneous SAH is confirmed?

Answer 6

CT cranial angiogram

Question 7

Complications of aneurysmal SAH?

Answer 7

1. Re-bleeding
2. Vasospasm
3. Hyponatraemia due to SIADH
4. Seizures
5. Hydrocephalus
6. Death

Question 8

Vasospasm post SAH Mx?

Answer 8

21 day course of nimodipine (CCB targeting brain vasculature)

Question 9

Most sensitive scan for DAI?

Answer 9

MRI

Question 10

Blown pupil after head trauma

Answer 10

Transtentorial herniation causing third cranial nerve compression

Question 11

Binocular vision post-facial trauma?

Answer 11

Depressed fracture of the zygoma

Question 12

Hyphaema defn?

Answer 12

Collection of blood inside the anterior chamber of the eye, between the cornea and iris

Question 13

Mx of extradural haematoma?

Answer 13

Parietotemporal craniotomy

Question 14

What drug should be prescribed for SAH?

Answer 14

Nimodipine to prevent vasospasm

Question 15

Criteria for brain stem death testing?

Answer 15

1. Deep coma of known aetiology
2. Reversible causes excluded
3. No sedation
4. Normal electrolytes

Question 16

Testing for brain death?

Answer 16

1. Fixed pupils
2. No corneal reflex
3. Absent VOR
4. No response to supraorbital pressure
5. No cough reflex to bronchial stimulation
6. No respiratory effort in response to disconnection of ventilator for 5 mins

Question 17

What is coning?

Answer 17

Brainstem compression

Question 18

Subfalcine herniation?

Answer 18

Displacement of cingulate gyrus under falx cerebri

Question 19

Central herniation?

Answer 19

Downward displacement of the brain

Question 20

Uncal/transtentorial herniation?

Answer 20

Displacement of the uncus of the temporal lobe under the tentorium cerebelli

Question 21

Tonsillar herniation?

Answer 21

Displacement of the cerebellar tonsils through the foramen magnum (‘coning’)

Question 22

Transcalvarial herniation?

Answer 22

When brain is displaced through a defect in the skull e.g. a fracture or craniotomy site

Question 23

Raccoon eyes and Battle’s sign?

Answer 23

Basilar skull fracture