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Ultimate Neurosurgery > Rapid Review > Flashcards

Rapid Review Flashcards

1
Q

The inferior parietal lobule is composed of what two structures?

A
  1. supramarginal gyrus and angular gyrus.
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2
Q

Where does the Sylvian fissure terminate and what Brodman area?

A
  1. in the supramarginal gyrus (Brodman area 40).
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3
Q

Where does the superior temporal gyrus terminate and what Brodman area?

A
  1. in the angular gyrus (Brodman area 39).
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4
Q

Brodman area for the primary motor cortex?

A
  1. Area 4.
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5
Q

Brodman area for Broca’s area?

A
  1. Area 44.
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6
Q

Brodman area for Wernicke’s area?

A
  1. Area 40 and 39.
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7
Q

Brodman area for the primary auditory area?

A
  1. Area 41 and 42.
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8
Q

Brodman area for the frontal eye fields?

A
  1. Area 8.
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9
Q

Brodman area for the primary somatosensory area?

A
  1. Areas 3,1 and 2.
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10
Q

Brodman area for the premotor area?

A
  1. Area 6.
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11
Q

Brodman area for the primary visual cortex?

A
  1. Area 17.
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12
Q

What is the terminal part of the cingulate sulcus?

A
  1. Pars marginalis.
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13
Q

Where does the central sulcus terminate?

A
  1. Paracentral lobule.
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14
Q

What bones make up the pterion?

A
  1. Frontal.
  2. Greater wing of the sphenoid.
  3. Parietal.
  4. Temporal.
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15
Q

What sutures converge to make up the asterion?

A
  1. Lamboid.
  2. Occipitomastoid.
  3. Parietomastoid.
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16
Q

What does the asteroid overlie?

A
  1. Transverse and sigmoid sinuses.
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17
Q

Where is the external landmark for the angular gyrus?

A
  1. Just above the pinna (important as part of Wernicke’s area in the dominant hemisphere).
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18
Q

What cervical levels does the thyroid cartilage lie?

A
  1. C4-5.
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19
Q

What cervical levels does the hyoid bone lie?

A
  1. C3-4.
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20
Q

What nerves traverse the superior orbital fissure?

A
  1. CN III.
  2. CN IV.
  3. Nasociliary nerve.
  4. Frontal nerve ophthalmic division.
  5. Lacrimal nerve.
  6. CN VI.
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21
Q

What is another name for the transverse crest in the IAC?

A
  1. Crista falciformis.
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22
Q

Vascular supply to the anterior limb of the internal capsule?

A
  1. Lateral striate branches of MCA.
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23
Q

Vascular supply to the posterior limb of the internal capsule?

A
  1. Lateral striate branches of MCA.
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24
Q

Vascular supply to the ventral posterior limb of the internal capsule?

A
  1. Anterior choroidal.
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25
Q

Vascular supply to the genu of the internal capsule?

A
  1. Direct branches of the ICA.
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26
Q

Vascular supply to the optic radiations?

A
  1. Anterior choroidal.
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27
Q

What ligaments are most important in maintaining atlanto-occipital stability?

A
  1. Tectorial membrane and the alar ligaments.
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28
Q

How is the lateral spinothalamic tract somatotopically organized?

A
  1. Cervical is medial.

2. Sacral is lateral.

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29
Q

What motor tract facilitates extensor tone?

A
  1. Vestibulospinal tract.
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30
Q

What motor tract facilitates flexor tone?

A
  1. Rubrospinal tract.
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31
Q

Branches of the cavernous carotid artery?

A
  1. Meningohypophyseal trunk.

2. Anterior meningeal artery.

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32
Q

Branches off the meningohypophyseal trunk?

A
  1. Dorsal meningeal.
  2. Inferior hypophyseal.
  3. Tentorial artery of Bernasconi and Cassinari.
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33
Q

Occlusion of what artery leads to Sheehan necrosis?

A
  1. Inferior hypophyseal.
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34
Q

The inferior hypophyseal artery supplies what?

A
  1. Posterior lobe of pituitary.
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35
Q

What structures do the anterior choroidal artery supply?

A
  1. Globus pallidus.
  2. Optic tract.
  3. Genu of IC.
  4. Optic radiations.
  5. Uncus.
  6. Posterior limb of IC.
  7. Lateral geniculate body.
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36
Q

What 3 segments are included in the carotid siphon?

A
  1. Cavernous.
  2. Ophthalmic.
  3. Communicating.
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37
Q

Where does the recurrent artery of Heubner typically originate?

A
  1. A1/A2 junction.
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38
Q

What structures are supplied by the recurrent artery of Heubner?

A
  1. Head of caudate.
  2. Putamen.
  3. Anterior limb of the internal capsule.
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39
Q

What percentage of people have a fetal PCOM?

A
  1. 15-35%.
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40
Q

What are the branches of the vertebral artery?

A
  1. Anterior meningeal.
  2. Posterior meningeal.
  3. Medullary.
  4. Posterior spinal.
  5. PICA.
  6. Anterior spinal.
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41
Q

What are the 3 branches of PICA?

A
  1. Choroidal.
  2. Tonsillohemispheric.
  3. Inferior vermian.
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42
Q

What are the 3 segments of the PCA?

A
  1. P1 - peduncular.
  2. P2 - ambient.
  3. P3 - quadrigeminal.
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43
Q

What is the artery of Percheron?

A
  1. Anatomic variant where a solitary trunk arises from one PCA to supply bilateral paramedian thalami and rostral midbrain.
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44
Q

What are the 4 types of persistent fetal anastomoses?

A
  1. Trigeminal.
  2. Otic.
  3. Hypoglossal.
  4. Proatlantal.
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45
Q

What are the main contributors to the vein of Galen?

A
  1. Precentral cerebellar.
  2. Basal vein of Rosenthal.
  3. Internal cerebral vein.
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46
Q

The junction of the septal vein and thalamostriate vein with the internal cerebral vein forms what on angio?

A
  1. Venous angle.
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47
Q

Where does the junction of the septal vein, thalamostriate vein and internal cerebral vein occur?

A
  1. At the foramen of Monro.
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48
Q

Which cranial nerve is the only one in the cavernous sinus that does not pass through the superior orbital fissure?

A
  1. V2.

2. It exits the skull through the foramen rotundum.

49
Q

Which sites of the brain have no BBB?

A
  1. Pituitary.
  2. Pineal.
  3. Preoptic recess.
  4. Tuber cinereum.
  5. Area postrema.
50
Q

If unilateral, a Hoffman sign indicates a lesion above which level?

51
Q

Which nucleus is the primary coordinating center for bladder function?

A
  1. Nucleus locus coeruleus in the pons.
52
Q

Which is more common with cauda equina…urinary retention or incontinence?

A
  1. Urinary retention is more common with cauda equina although overflow incontinence can occur.
53
Q

Pure word blindness is caused by what?

A
  1. Lesion in the parietooccipital lobe on the dominant side.
54
Q

What syndrome causes alexia without agraphia?

A
  1. Pure word blindness (meaning they can write but cannot read).
55
Q

What syndrome causes agraphia without alexia?

A
  1. Gerstmann syndrome (meaning they can read but cannot write).
56
Q

Symptoms in Weber syndrome?

A
  1. CN III palsy.

2. Contralateral hemiparesis.

57
Q

What is the syndrome of the Sylvian aqueduct?

A
  1. Parinaud’s syndrome combined with downgaze palsy.
58
Q

What is the posterior pituitary derived from?

A
  1. Derived from downward evagination of neural crest cells from the floor of the third ventricle.
59
Q

What is the anterior pituitary derived from?

A
  1. Derived from evagination of epithelial ectoderm which is also called Rathke’s pouch.
60
Q

Presentation of Waterhouse-Friderichsen syndrome?

A
  1. Large petechial hemorrhages in the skin and mucous membranes.
  2. Fever.
  3. Septic shock.
  4. Adrenal failure.
  5. DIC.

Seen in children with disseminated meningococcal infection.

61
Q

Empiric antibiotics used for spinal epidural abscess?

A
  1. Ceftriaxone or cefepime.
  2. Vancomycin.
  3. Metronidazole.
  4. +/- rifampin.
62
Q

What percentage of patients with SCI with no function on initial exam will develop some recovery within 24 hours?

63
Q

Central cord syndrome usually results from hyperflexion or hyperextension?

A
  1. Hyperextension.
64
Q

Which type of incomplete SCI has the best prognosis?

A
  1. Brown-Sequard.
65
Q

What are some indications for surgery in central cord syndrome?

A
  1. Spinal instability.

2. Continued cord compression in a patient who fails to improve or progressively worsens.

66
Q

What is the normal atlantodental interval (ADI) in adults?

A
  1. Less than 3mm.
67
Q

Describe the 3 types of atlanto-occipital dislocation.

A
  1. Type 1 - anterior.
  2. Type 2 - superior.
  3. Type 3 - posterior.
68
Q

What structure is the cephalad extension of the ALL?

A
  1. Anterior antlanto-occipital membrane.
69
Q

What structure is the cephalad extension of the PLL?

A
  1. Tectorial membrane.
70
Q

What two structures are most important in maintaining atlanto-occipital stability?

A
  1. Tectorial membrane.

2. Alar ligaments.

71
Q

AOD is suspected if the atlanto-occipital interval is greater than what?

72
Q

What are 4 causes of atlanto-axial rotatory subluxation?

A
  1. Spontaneous.
  2. Trauma.
  3. Upper respiratory tract infection (Grisel syndrome).
  4. RA.
73
Q

What are 3 causes of vertical nystagmus?

A
  1. Posterior fossa pathology.
  2. Sedatives.
  3. AEDs.
74
Q

Seesaw nystagmus occurs with a lesion where?

A
  1. Diencephalon.
75
Q

Nystagmus retractorius occurs with a lesion where?

A
  1. Upper midbrain tegmentum.
76
Q

Where is the lesion that results in ocular bobbing?

A
  1. Pontine tegmentum.
77
Q

How long does it take for papilledema to develop?

A
  1. 24-48 hours.
78
Q

DDx for unilateral papilledema?

A
  1. Foster-Kennedy syndrome.
  2. Inflammation.
  3. Optic glioma.
  4. Multiple sclerosis.
79
Q

What are 3 causes of non-pupil sparing oculomotor palsy?

A
  1. Tumor.
  2. Aneurysm (Pcom, basilar tip).
  3. Uncal herniation.
80
Q

Where does the trochlear nucleus lie in relation to the aqueduct?

A
  1. Ventral at the level of the inferior colliculi.
81
Q

A trochlear nerve palsy results in the eye deviated in what direction?

A
  1. Up and in.
82
Q

What side does the head tilt in a trochlear nerve palsy?

A
  1. The opposite side of the lesion.
83
Q

What is Tolosa-Hunt syndrome?

A
  1. Nonspecific inflammation of the superior orbital fissure.
84
Q

What are two components of Raeder’s paratrigeminal neuralgia?

A
  1. Unilateral oculosympathetic paresis.

2. Homolateral trigeminal nerve involvement.

85
Q

What is Gradenigo’s syndrome?

A
  1. Apical petrositis.
86
Q

What is the classic triad of Gradenigo’s syndrome?

A
  1. Abducens palsy.
  2. Retro-orbital pain.
  3. Drainage from the ear.
87
Q

Ocular bobbing is associated with bilateral paralysis of what?

A
  1. Horizontal gaze.
88
Q

What is opsoclonus?

A
  1. Rapid, conjugate, irregular, non-rhythmic eye movement.
89
Q

What is oscillopsia?

A
  1. Visual sensation that stationary objects are vibrating or swaying from side to side.
90
Q

What is a type 1 occipital condyle fracture?

A
  1. Comminuted fracture.
91
Q

What is a type 2 occipital condyle fracture?

A
  1. Extension of basilar skull fracture.
92
Q

What is a type 3 occipital condyle fracture?

A
  1. Avulsion fracture.
93
Q

What are the indications for halo or fusion in occipital condyle fractures?

A
  1. Craniocervical misalignment.

2. Occipital-C1 interval > 2mm.

94
Q

What are 4 possible causes of atlanto-axial dislocation?

A
  1. Spontaneous.
  2. Trauma.
  3. Upper respiratory tract infection (Grisel syndrome).
  4. Rheumatoid arthritis.
95
Q

What mechanism causes Hangman’s fractures?

A
  1. Hyperflexion and axial loading.
96
Q

What determines disc disruption in Hangman’s fractures?

A
  1. Subluxation of C2 on C3 by more than 3mm.
97
Q

Myelopathy correlates with an AP canal diameter of less than what?

98
Q

What is another name for Paget’s disease?

A
  1. Osteitis deformans.
99
Q

What CN is most commonly affected in Paget’s disease as it exits through its bony foramina?

100
Q

Most common symptom in Paget’s disease?

A
  1. Bone pain.
101
Q

How does Paget’s disease present in the spine?

A
  1. Spans several contiguous levels and has thickened pedicles/lamina, dense vertebral bodies, and discs are replaced by bone.
102
Q

What is another name for ankylosing spondylitis?

A
  1. Marie-Strumpell disease.
103
Q

What is the first site usually affected by ankylosing spondylitis?

104
Q

What site of the spine is usually spared in DISH?

105
Q

What is Scheuermann’s kyphosis?

A
  1. Anterior wedging of at least 5 degrees of 3 or more adjacent thoracic vertebral bodies.
106
Q

What are 4 upper C-spine abnormalities associated with rheumatoid arthritis?

A
  1. Basilar impression.
  2. Atlantoaxial subluxation.
  3. Subaxial subluxation.
  4. Vertebral artery insufficiency - due to changes at the craniocervical junction.
107
Q

Most common presentation of a spinal AVM?

A
  1. Onset of back pain.

2. Progressive LE weakness and sensory loss.

108
Q

What is the eponym for acute onset of SAH and sudden excruciating back pain from a spinal AVM?

A
  1. Coup de Poignard of Michon.
109
Q

What is a Tarlov’s cyst?

A
  1. Spinal meningeal cyst.
110
Q

What percentage of aSAH patients die before reaching the hospital?

111
Q

What is the risk of rebleeding from an aSAH within 2 weeks?

112
Q

What is the risk of death from vasospasm after aSAH?

113
Q

What is the risk of severe deficit from vasospasm after aSAH?

114
Q

What is the 30 day mortality rate after aSAH?

A
  1. About 50%.
115
Q

What is the incidence of sentinel hemorrhage in aSAH?

116
Q

What percentage of aSAH patients will have acute onset of hydrocephalus?

117
Q

What is the most sensitive sequence on MRI for detecting blood in the subarachnoid space?

118
Q

To call an angiogram negative for aneurysm, you must see what two areas?

A
  1. Take off both PICAs and ACOM.
119
Q

What are the three criteria about an infundibulum?

A
  1. Triangular shape.
  2. Size of mouth is less than 3mm.
  3. Vessel at apex.

Ultimate Neurosurgery (16 decks)

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