Pestana Neurosurgery Flashcards
Neurovascular problems can present these different ways if they are hemorrhagic vs occlusive.
hemorrhagic - sudden onset of very severe HA with subsequent development of severe neurological deficits
occlusive - sudden onset of neurological deficits, but without HA
How quickly do brain tumors occur and how do they usually present? What are some unusual presentations of ICP
months - usually presents with a constant, progressive and severe HA that is sometimes worse in the AM. May present with blurred vision, papilledema, and projectile vomiting at later stages due to increased ICP.
Bradycardia + HTN (due to Cushing reflex) may also occur
How quickly do infectious problems of the CNS present?
days - weeks, often presents with an identifiable source of infection in the history
How quickly do metabolic problems of the CNS present?
rapidly - on the order of hours - days
How quickly do degenerative problems of the CNS present?
years
common etiology of TIAs 2
stenotic ICA
- or -
ulcerated plaque at the carotid bifurcation
How do you work up a TIA?
non-invasive Duplex study (sonogram + doppler)
How is a TIA managed?
carotid endarterectomy (remember that most TIAs are due to stenotic ICA - or - ulcerated plaque at the carotid bifurcation) with angioplasty + stent if a filter can be placed to prevent further embolization of debris to the brain
complications of ischemic infarct
hemorrhage
Patient rolls into the ED with suspected ischemic stroke. What is the FIRST step in management?
get a CT scan to determine extent of infarct or the presence of hemorrhage
hemorrhagic strokes are often seen in this patient population.
patients with uncontrolled HTN
Patient rolls into the ED with suspected hemorrhagic stroke. What is the FIRST step in management?
CT to evaluate location and extent of hemorrhage
treatment of hemorrhagic stroke 2
control HTN
rehab
thunderclap headache without neurologic deficits
subarachnoid hemorrhage - absence of neurologic findings may be because the blood is in the subarachnoid space, some patients have nuchal rigidity secondary meningeal irritation
thunderclap headache with nuchal rigidity
subarachnoid hemorrhage - absence of neurologic findings may be because the blood is in the subarachnoid space, some patients have nuchal rigidity secondary meningeal irritation
management and treatment of patient with extremely headache of sudden onset
workup with
- CT to look for blood in the subarachnoid space
- arteriogram to locate the aneurysm
treatment
- clipping or
- endovascular coiling
preferred imaging for brain tumors
MRIs - better details compared to CT
management of increased ICP while awaiting surgical resection of brain tumor
high dose dexamethasone (decadron)
locate this tumor: inappropriate behavior with ipsilateral optic nerve atrophy and contralateral papilledema and anosmia
at base of frontal lobe
identify and locate this tumor: youngsters short for their age with bitemporal hemianopsia
craniopharyngioma - usually calcified lesion above sella is observed on CT
identify this tumor: amenorrhea + galactorrhea in young women
prolactinoma
w/u of a young women who presents with amenorrhea + galactorrhea
pregnancy test
TSH (r/o hypothyroidism)
prolactin levels
MRI (of sella)
treatment of prolactinoma 2
Bromocriptine
transnasal surgical resection (alternative is trans-sphenoidal approach for those who wish to get pregnant or those who fail to respond to medical therapy)
patient with HTN, DM, sweaty hands, HA complains that his wedding band no longer fits. Physical exam shows large hands, feet, tongue, and jaw
acromeagly
w/u of someone with suspected acromeagly 2
measure somatomedin C
pituitary MRI
w/u of someone with confirmed acromeagly
surgical removal (radiation is also an option)
patient complains of an acute severe headache with deterioration of vision. History is noted for a chronic headache with bitemoral hemianopsia. Rapidly becomes hypotensive and stuporous.
pituitary apoplexy
management 2 and treatment 2 of patients with suspected pituitary apoplexy
management: MRI or CT
urgent replacement of steroid + hormones
locate this tumor: loss of upper gaze + sunset eyes
pineal gland tumor
locate this tumor: mother complains that her child has truncal ataxia and has been stumbling around
posterior fossa tumor (cerebellar symptoms)
common etiologies of brain abscesses
otitis media and mastoiditis
management and treatment of patients with brain abscesses
CT (MRI not needed because brain abscess has a very typical appearance on CT)
Resection
patient complains of extremely severe sharp shooting pain in the face that lasts for ~1 minute, brought about touching a specific area.
trigeminal neuralgia (tic douloureux)
management and treatment of trigeminal neuralgia (tic douloureux)
MRI to r/o organic lesions
carbamazepine or radiofreuency ablation
what is causalgia? what causes it and how does it usually present?
aka “reflex sympathetic dystrophy”
etiologies: trauma/crushing injury or surgery that result in partial peripheral nerve injuries, commonly brachial plexus injuries
Symptoms: burning pain prominent in the hand or foot within 24H of injury; any sensory stimulation worsens the pain; often worsens over time. Does not respond to analgesics!
diagnosis and treatment for causalgia
diagnosis: sympathetic block (series of localized anesthetic injections to block signals from the sympathetic nervous system)
treatment: sympathectomy
