Pestana- 11. Neurosurgery Flashcards
How do you tell the difference between occlusive and hemorrhagic vascular brain problems?
hemorrhagic will have severe headache
What is the most common origin of a TIA?
High-grade stenosis (>70%) of ICA or ulcerated plaque at the carotid bifurcation
How do you work up a patient with a TIA?
Duplex studies
How long can you go before your ischemic stroke is no longer amenable to revascularization?
3 hours
What is the management for hemorrhagic stroke?
control HTN
What kind of brain bleed comes from a ruptured aneurysm?
subarachnoid
How do patinets with ruptured aneurysms present?
thunderclap headache (worst of their life)
Is the first aneurysmal bleed usually a patient’s last (fatal)?
no- often patients will have sentinel bleed then ten days later have a terrible one
After CT, what test is done to evaluate an intracranial aneurysm?
arteriogram
What is the treatment for intracranial aneurysm?
clipping or coiling
True or false: most brain cancers are mets.
True!
What is the most common tumor that goes to the brain?
lung (then breast and melanoma)
What are the components of Cushing reflex?
bradycardia and hypertension
What leads to the Cushing reflex?
increased ICP
What tumor is suspected in children short for their age with bitemporal hemianopsia?
craniopharyngioma
What do you see on CT with a craniopharyngioma?
calcified lesion above sella turcica
How do you work up a prolactinoma?
r/o pregnancy
TSH level (h/o hypothyroidism)
Prolactin level
MRI of sella
What is it called when there is a bleed into the pituitary gland that kills the gland?
pituitary apoplexy
What should be given first to a patient with pituitary apoplexy?
need to replace steroids
Where is a tumor in a patient who has loss of upper gaze (sunset eyes)?
pineal gland
Where are brain tumors typically located in children?
posterior fossa
What is the most common brain tumor in kids?
medulloblastoma (in cerebellum)
What is the diagnostic imaging for brain abscess?
CT
What do you expect in a patient with a 60 second long sharp shooting pain in the face after grazing their cheek?
trigeminal neuralgia
What is the typical medical treatment for trigeminal neuralgia?
carbamazapine
What is causalgia?
reflex sympathetic dystrophy (constant, burning pain after crushing injury that does not respond to analgesics)
How do you diagnose reflex sympathetic dystrophy?
decrease of pain with sympathetic block
