SANS Juli 2013 Flashcards
Selama craniotomy dimana pasien sadar untuk lesi di gyrus temporal superior hemisfer kiri, pasien mengalami sebuah kejang focal yang terus-menerus sehingga membutuhkan anastesi umum. Bagaimanakah kemungkinan outcome postoperativenya ?
A. Long-term motor deterioration, longer hospital stay
B. Short-term motor deterioration, average hospital stay
C. Long-term motor deterioration, average hospital stay
D. Short-term motor deterioration, longer hospital stay
D. Short-term motor deterioration, longer hospital stay
The most likely outcome is a short-term motor deterioration with a longer hospital stay. In the study by Nossek et al., patients who experienced intraoperative seizures during awake craniotomies had a much higher incidence of short-term motor deterioration (P=0.02) and longer hospitalization stay (P=0.045). This worse postoperative neurological outcome in the seizure group could be associated with the post ictal state, as seen in “Todd’s Palsy” phenomenon. Further, in contrast to previous studies that linked the use of Electrocorticography (ECoG) with a reduced rate of intraoperative seizures, this recent study found an increase incidence of intraoperative seisures with the use of ECoG. In addition, it is important to recognize that patients whose seizures last for more than 5 minutes or evolve into status epilepticus should be reloaded with an antiepileptic agent, accompanied by general anesthesia and urgent intubation.
Selama craniotomy dimana pasien sadar, lokasi tumor manakah yang menunjukkan peningkatan resiko yang signifikan akan kejadian kejang intraoperative ?
A. Parietal
B. Temporal
C. Frontal
D. Occipital
C. Frontal
During awake craniotomy, frontal tumors have a significantly greater risk of experiencing an intraoperative seizure than any other location. In a recent retrospective study by Nossek et al. analyzing over 470 patients who underwent awake craniotomy for resection of intracranial lesions in eloquent cortical areas, intraoperative seizures occurred in 12.6% of patients. Patient’s presenting with tumor involvement within the frontal lobe displayed a statistically significant increased risk of developing a seizure. In the same study, 86% of patients who experienced intra-operative seizure had lesions involving the frontal lobe, compared to 57% of patients who experienced no seizure (P
Manakah dari hal-hal berikut yang merupakan faktor resiko signifikan untuk terjadinya kejang intraoperative selama craniotomy dimana pasien sadar ?
A. Blood levels of antiepileptic drugs
B. Age > 60 years
C. Treatment with only a single antiepileptic drug
D. History of seizures
D. History of Seizures
During awake craniotomy procedures, several studies have shown that intraoperative seizures were more prevalent in younger patients, patients with a history of seizures, patients treated with multiple antiepileptics (AED), tumor extent involving the frontal lobes and patients with low grade gliomas. Nossek et al. did not find any correlation between the type or blood levels of antiepileptic drug (AED), and the incidence of intraoperative seizures. In addition, there is no evidence that pre- and intraoperative drug administration, or timing of drug loading may affect the incidence of intraoperative seizures.
Berapakah batas persentase kesalahan yang dapat diterima yang dibutuhkan untuk menentukan cortex persepsi bahasa ketika melakukan mapping cortical intraoperative ?
A. 60% B. 40% C. 20% D. 80% E. 100%
A. 60%
During cortical stimulation for language, the presence of an error at a stimulated site is not sufficient to classify it as a language site. The currently accepted error rate required to determine language cortex during intra-operative cortical mapping is approximately 60% based on cortical mapping studies. It is used as the null hypothesis threshold in numerous studies including Serafini et.al. 2013.
Apakah nilai tambahan dari penamaan akustik terhadap penamaan objek visual selama mapping bahasa cortical intraoperative ?
A. Less variability between surgicl epilepsy centers
B. Easier administration of intra-operative assessments
C. Identification of additional regions of primary language cortex
D. Decresed length of surgery
E. Lower stimulation voltage tresholds
C. Identification of additional regions of primary language cortex
The addition of auditory naming enables identification of additional regions of primary language cortex. In particular, language areas within the angular gyrus and posterior supramarginal gyrus could be identified with superior confidence using auditory naming. Given the increased complexity of these tests, there is potentially increased variability between surgical centers. Integrating additional language tasks also adds time to the overall length of surgery and can be more difficult to administer to the patient. There is no effect on the voltage threshold stimulation.
Pengetesan bahasa manakah yang mewakili gold standard untuk intra-operative assessment dari fungsi bahasa selama mapping bahasa cortical ?
A. Auditory sentence completion B. Reading C. Visual object naming D. Auditory responsive naming E. Visual gesture naming
C. Visual object naming
The gold standard for intra-operative assessment of language function during cortical language mapping is visual object naming. This technique is typically performed with line drawings and assesses visual object recognition and language function. Several studies report that intraoperative testing of visual confrontation naming can be reliably used to guide surgical resection and predict language deficits 6 months after surgery. The reliability of other language tests have not been systematically established.
Manakah dari gen-gen berikut yang telah diidentifikasi sebagai gen untuk dystonia bawaan primer ?
A. DVT-4 B. DYT-2 C. DYT-1 D. DVT-5 E. DVT-13
C. DYT-1
Only one gene (DYT-1) has been identified for primary inherited dystonia. DYT-1 dystonia often presents in childhood in a single limb and progresses to generalized dystonia. There are many exceptions to the typical presentation. The disorder is autosomal dominant with a 30-40% penetrance. Other described phenotypes of primary dystonia are linked to alterations in DYT-2, DYT-4, DYT-6, DYT-7 and DYT-13 [16]. Four dystonia plus syndromes have been characterized. The most common form of dop-responsive dystonia is linked to the DYT-5 gene (GTPcyclohydrolase I).
Manakah dari hal-hal berikut yang merupakan karakteristik dari dystonia umum primer ?
A. Familial predisposition
B. Neurological symptoms
C. Involvement of one body part
D. A distinct neuropathology
A. Familial predisposition
Dystonia is characterized by muscle contractions resulting in abnormal postures and motions. Primary generalized dystonia (PGD) involves more than one body part, lacks other neurological symptoms, and has an absence of distinct neuropathology. Patients with PGD have a familial predisposition.
Manakah dari hal-hal berikut yang merupakan terapi linea pertama untuk dystonia cranial atau dystonia cervical primer ( tidak termasuk oromandibular ) ?
A. Selective peripheral denervation
B. Botulinum toxin
C. Deep brain stimulation
D. Intrathecal baclofen
B. Botulinum toxin
The first line treatment for primary cervical or cranial dystonia (excluding oromandibular) is Botulinum toxin. Botulinum toxin type A or if there is resistance type B can also be beneficial in writing dystonia. Currently, Botulinum toxin is the preferred primary therapy but there are no definitive comparative efficacy studies comparing anticholinergic and antidopaminergic drugs. Pallidal deep brain stimulation is an effective alternative treatment for generalized or cervical dystonia in patients who have failed medical therapy. Selective peripheral denervation is an effective alternative therapy for cervical dystonia. Intrathecal baclofen is a beneficial alternative therapy in patients with secondary dystonia and spasticity.
