SANS April 2013 Flashcards
SANS
Apakah yang menjadi prediktor yang paling penting dari outcome jangka panjang untuk cavernous malformations yang melibatkan batang otak, thalamus dan basal ganglia?
A. Pendekatan Bedah B. Jenis Kelamin C. Usia D. Pre Operative mRS E. Waktu pembedahan
D. Pre Operative mRS
Several predictors of outcome for cavernous malformations involving the brainstem, thalamus and basal ganglia have been studied in the past. In the study by Pandey et al., older age (>40 years), presence of preoperative cranial nerve deficits, ataxia or hemiparesis, poor preoperative mRS (modified Rankin Score), surgery more than 8 weeks after last hemorrhage and multiple hemorrhages correlated with poor long-term outcome in univariate analysis. In multivariate analysis, age >40 (for brainstem CM sites), poor preoperative mRS and surgery > 8 weeks after last hemorrhage were significant predictors of worse outcome. Poor preoperative mRS was the strongest predictor of long-term outcome (P
Terapi radiasi memiliki peran yang penting dalam managemen multidisiplin dari sisa adenoma pituitary atau adenoma pituitary yang kambuh kembali. Radiasi terhadap struktur apakah yang memiliki resiko akan hypopituitarism onset baru ?
A. Hipothalamus
B. Posterior Pituitary
C. Chiasma Opticum
D. Gyrus Cingulate
A. Hipothalamus
Historically, radiation to the hypothalamus has been considered an important causative factor for new onset hypopituitarism. Delayed hypopituitarism is the most common adverse effect following SRS for pituitary adenoma. In this study by Xu et al., the suprasellar extension of a pituitary adenoma was an important predictive factor of hypopituitarism. In planning stereotactic radiosurgery, it is important to create a favorable distance between the suprasellar region and residual tumor if complete TSA is not feasible. Other studies have also reported an association between dose to the normal anterior pituitary gland and the distal infundibulum and post-radiation hypopituitarism, although this is less often cited.
Seberapakah insidensi dari delayed hypopituitarism yang mengikuti SRS untuk adenoma pituitary ?
A. 40-60% B. 20-40% C. 0-20% D. 60-80% E. 80-100%
B. 20-40%
Most studies note an incidence of hypopituitarim in the range of 20-40%. In the study by Xu et al, the authors note a rate of delayed hypopituitarism of 30% in their large retrospective series. However, it should be noted that this is over an approximate four year follow-up time period. It remains possible (as has been suggested in the literature) that more extended follow up periods may reveal higher rates of hypopituitarism with SRS.
Kira-kira berapakah persentase dari pasien yang mengalami subarachnoid hemorrhage (SAH) spontan yang memiliki cerebral angiogram awal negative atau tidak menunjukkan bukti adanya abnormalitas vascular ?
A. 20-30% B. 10-20% C. 0-10% D. 30-40% E. 40-50%
B. 10-20%
This percentage refers to patients presenting with spontaneous SAH evaluated with catheter-based digital subtraction angiography, the gold standard for identifying vascular lesions.
Hypertrophic olivary degeneration (HOD) adalah sebuah fenomena radiografi dan patologis langka yang muncul setelah terjadinya injury pada jalur dentato-rubro-olivary. Apakah karakteristik klinis dari HOD ?
A. Palatal tremors, nistagmus, dan oscillopsia
B. Internuclear opthalmoplegia, hemiballismus dan palatal tremors
C. Palatal tremors, internuclear opthalmoplegia, dan ipsilateral spastisitas
D. Oscillopsia, internuclear opthalmoplegia, dan hemiballismus
E. Ipsilateral spastisitas, past pointing dan nistagmus
A. Palatal termors, nystagmus dan oscillopsia
The typical symptoms of HOD are palatal myoclonus, nystagmus and oscillpsia..While nystagmus is not necessary to make the diagnosis; the two pillars of HOD are palatal tremors and oscillopsia. Anatomically HOD has been associated with injury to the dentate nucleus, superior cerebellar peduncle or the central tegmental tract. Guillain and Mollaret described a triangle, which connects dentate nucleus of cerebellum, red nucleus of mesencephalon and inferior olivary nucleus of the medulla, and insults to these tracts can lead to HOD.60 The proposed mechanism for this pathology is transsynaptic degeneration, and the inferior olivary nucleus shows hypertrophy of both neurons and glia. Oscillopsia appears to result from interruption of the dento-rubro-olivary pathway. Further, palatal tremor is one of the few tremors that does not suppress with sleep. HOD appears to be poorly responsive to benzodiazepines and further poorly treated medicinally. Currently there are few effective treatments reported. Internuclear ophthalmoplegia, hemiballismus, spasticity or cerebellar ataxia are not caused by interruption of the dento-rubro-olivary pathway.
Pada pasien dengan subarachnoid hemorrhage (SAH) spontan yang tanpa adanya bukti kelainan vascular pada cerebral angiography awal, kira-kira berapa persenkah lesi vascular yang ditemukan pada pemeriksaan angiography ulang ?
A. 11% B. 7% C. 3% D. 15% E. 19%
B. 7%
In the study by Dalyai et al., of the 254 patients with angiography-negative SAH, 17 (6.7%) were eventually found to harbor a vascular lesion. Of the 17, 10 were identified on the short-term (1 week) angiogram, and 7 were identified on the long-term (6 week) angiogram. These findings were similar to previous studies using long-term repeat digital subtraction angiography to identify occult vascular lesions.
Pada pasien dengan subarachnoid hemorrhage (SAH) spontan yang tanpa adanya bukti kelainan vascular pada cerebral angiography awal, hal apakah yang berkaitan dengan kemungkinan besar untuk menemukan lesi vascular pada angiography ulang ?
A. Hunt-Hess Grade >3
B. Non-perimesencephlic hemorrhage pattern
C. Perimesencephalic hemorrhage pattern
D. Lack of Hydrocephalus on initial head CT
E. Fisher Grade > 2
B. Non-perimesencephlic hemorrhage pattern
In the study by Dalyai et al., of 136 patients with a NPM pattern, 17 (12.5%) were found to have a vascular lesion on short- or long-term repeat angiography. Of the 118 patients with a perimesencephalic (PM) pattern, none had a vascular lesB. Non-perimesencephlic hemorrhage patternion on repeat angiography. Hunt-Hess Grade, Fisher Grade, and lack of hydrocephalus were not associated with increased likelihood of identifying a vascular lesion on repeat angiography. In fact, a greater proportion of NPM patients had hydrocephalus requiring VP shunt compared to PM patients (21.3% vs. 6.8%).
Seberapa banyakkah annual bleeding rate (ABR) untuk cavernous malformations (CMS) pada batang otak ?
A. 10,2% B. 5,1% C. 0% D. 15,3% E. 20,4%
B. 5,1%
I.n the study by Pandey et al., the observed retrospective bleed rate for cavernous malformations was 5.1%. Higher annual rates of symptomatic hemorrhage (10.6%) for deep compared to superficial lesions (0%) have been demonstrated.6 This can be explained by higher eloquence of the deeper structures, with even a small bleed causing symptoms, as compared to the supratentorial lesions, where a small bleed may go unnoticed. What is further pointed out is that small incidental brainstem CMs found on routine MR imaging may have different bleeding rates than those presenting with hemorrhages. The annual bleeding rate of 5.1% would not apply to small incidental brainstem CMs found on routine MR imaging.
Apakah yang menjadi prediktor paling penting dalam menentukan outcome jangka panjang untuk cavernous malformations yang melibatkan batang otak, thalamus, dan basal ganglia ?
A. Surgical approach B. Sex C. Age D. Preoperative mRS E. Timing of surgery
D. Preoperative mRS
Several predictors of outcome for cavernous malformations involving the brainstem, thalamus and basal ganglia have been studied in the past. In the study by Pandey et al., older age (>40 years), presence of preoperative cranial nerve deficits, ataxia or hemiparesis, poor preoperative mRS (modified Rankin Score), surgery more than 8 weeks after last hemorrhage and multiple hemorrhages correlated with poor long-term outcome in univariate analysis. In multivariate analysis, age >40 (for brainstem CM sites), poor preoperative mRS and surgery > 8 weeks after last hemorrhage were significant predictors of worse outcome. Poor preoperative mRS was the strongest predictor of long-term outcome (P
