SANS November 2013 Flashcards
Kira-kira berapa persenkah pasien mengalami outcome yang baik (Engel Class I) 3-5 tahun setelah lobectomy temporal untuk epilepsi lobus temporal ?
A. 70 %
B. 50 %
C. 30 %
D. 90 %
E. 10 %
A. 70 %
After temporal lobectomy for temporal lobe epilepsy, approximately 70% of patients report 3-5 year favorable outcomes. Favorable outcomes may decrease to approximately 60% after 10 years, according to Yoon and colleagues.
Pasien yang masih menunjukkan kejang setelah lobectomy temporal untuk epilepsi lobus temporal dapat tetap mengalami penurunan frekuensi kejang secara keseluruhan sebesar 70 %. Tipe kejang apakah yang dilaporkan lebih menurun frekuensinya sebagai respon terhadap lobectomy temporal pada populasi pasien tersebut ?
A. Kejang dengan aura
B. Consciousness sparing seizures
C. Consciousness impairing seizures
D. Kejang tanpa aura
E. Kejang focal
C. Consciousness impairing seizures
Patients who continue to seize after temporal lobectomy for temporal lobe epilepsy experience larger reductions in consciousness impairing seizures (73% reduction in complex partial seizures and 78% reduction in generalized tonic clonic seizures) compared to 65% reduction in simple partial seizures. According to Englot and colleagues, overall, these reductions result in a 70% decrease in overall seizure frequency (t = 3.0, p
Bagaimanakah outcome Engel Class 1 dalam hal frekuensi kejang bila dibandingkan dengan status pra-terapi ?
A. Peningkatan dalam frekuensi kejang sebanyak 50%
B. Penurunan dalam frekuensi kejang sebanyak 50%
C. Penurunan dalam frekuensi kejang sebanyak 25%
D. Absennya kejang yang melumpuhkan atau aura
D. Absennya kejang yang melumpuhkan atau aura
Engel Class 1 outcome denotes freedom from disabling seizures after a surgical intervention. Although the scale has been intermittently applied to medical intervention it was originally used to denote surgical outcome. Engel Class 1 outcome can be divided further to denote whether the patient is off all antiepileptics (1a) and if they are seizure free however still on antiepileptic medications (1b).1 Engel class 2 and 3 outcome denote a reduction in seizure frequency to levels considered “rare disabling seizures (almost seizure free)” and “worthwhile improvement” respectively. Engel class 4 is equivalent to no worthwhile improvement. This long-standing classification is commonly used in surgical publications; however the reader should be aware of guidelines produced by the International League of Against Epilepsy (ILAE) (recommendations of this international group on the grading of seizure outcomes in respect to both medications and surgical treatments). These guidelines try to establish a more objective representation of postoperative seizure outcomes, and consist of class 1: Completely seizure free without aura; class 2: only auras without other seizures; class 3: 1 to 3 seizures per day; class 4: 4 seizures per day to at least a 50% reduction in baseline seizures; class 5: less than 50% reduction in baseline seizures; class 6: worsening of seizures postoperatively. However, the criticism of this classification is that it is too numbers based, and really it is the clinical interpretation of worthwhile seizure improvement postoperatively that is important.
Gejala apakah yang paling umum muncul dalam unruptured temporal AVMs ?
A. Gangguan memori
B. Kejang
C. Defisit lapang pandang
D. Defisit motorik
E. Perubahan kepribadian
B. Kejang
Seizures are the most common presentation of unruptured temporal AVMs. With temporal lobe AVMs, seizures have been reported to be more common, occurring in 46% of patients, compared with 24% in nontemporal AVMs. In a series reported by Lopez-Ojeda et al., the incidence of epilepsy as an initial symptom was 41.3%. Several studies have reported that between 12 to 57% of AVM patients experience seizures, and epilepsy could persist even after surgical resection. Visual field deficits on presentation are usually attributed to hemorrhage and have been reported in 14-16% of temporal AVMs. Memory, motor and personality disorders are not the most common presentations as reported in different surgical series.
Ketika mengkonsulkan seorang pasien dalam hal lobectomy temporal untuk epilepsi lobus temporal, predictor apakah yang paling penting dan konsisten untuk meprediksi outcome yang sangat baik setelah pembedahan ?
A. Gender pria
B. Umur 50 tahun
C. Absennya kejang umum pra-operative
D. Konfirmasi adanya lateralisasi berdasarkan pada monitoring invasif
E. Durasi epilepsi 20 tahun
C. Absennya kejang umum pra-operative
The most consistent and important predictor of a very favorable outcome after temporal lobectomy for temporal lobe epilepsy is the absence of generalized seizures preoperatively. A very favorable outcome after temporal lobectomy for temporal lobe epilepsy is defined as an Engel class I outcome, meaning patients are completely free of seizures or free of all disabling seizures. Englot and colleagues systematically analyzed predictors of very favorable outcomes after temporal lobectomy and found on univariate analysis that both lack of premorbid generalized seizures (i.e., seizures causing impairments of consciousness) as well as abnormal preoperative imaging were significant predictors of favorable outcomes after surgery. However, on multivariate analysis, only the absence of generalized seizures preoperatively was significant, consistent with several other studies. Duration of epilepsy greater than 20 years has been associated with persistent auras after temporal lobectomy and is therefore an unfavorable factor. Age, gender, and use of intracranial monitoring have not consistently been shown to be predictors of outcomes after temporal lobectomy for temporal lobe epilepsy
Lokasi manakah dalam gambar berikut yang berkaitan dengan Meyer’s loop, radiatio optic dalam lobus temporal ?
A. C
B. B
C. A
D. D
A. C
C corresponds to the location of Meyer’s loop. The temporal optic radiation initially passes forward in the roof of the temporal horn, which then turns backward forming Meyer’s loop, and proceeds posteriorly along the superolateral surface of the temporal horn (C). The inferior, inferolateral, and choroidal fissure are considered safe zones for the surgical access of the temporal horns.
Penyebab apakah yang paling umum untuk terjadinya peningkatan tekanan intracranial pada anak-anak dengan moderate hingga severe traumatic brain injury ?
A. Intracranial hemorrhage
B. Vasogenic edema
C. Excessive sedation
D. Open frontanelles
E. Depressed skull fractures
A. Intracranial hemorrhage
Intracranial hematomas, most specifically epidural hematomas, are the most common cause of elevated intracranial pressure in children with moderate to severe traumatic brain injury. Intracranial hematomas (epidural, subdural subarachnoid or parenchymal) can cause pathologically elevated intracranial pressures (ICP) for pediatric head trauma patients.
Vasogenic edema is usually due to tumor blood brain barrier disruption and not associated with traumatic brain injury. Increasing sedation is used to decrease ICP. Open fontanelles are thought to possibly relieve ICP elevation to a small degree. Isolated depressed skull fractures are common in pediatric head injury, however they do not cause increase ICP without significant involvement of the major dural sinuses.
Manakah dari hal berikut yang benar berkaitan dengan epidemiologi traumatic brain injury pada pediatric di United States ?
A. Kebanyakan pasien ditangani di trauma center level 1 pediatric yang berdedikasi
B. Pria secara jumlahnya jauh melebihi jumlah pasien wanita
C. Infant secara jumlahnya jauh melebihi pasien remaja
D. Adanya variasi geografi secara signifikan dalam kejadian
B. Pria secara jumlahnya jauh melebihi jumlah pasien wanita
Male pediatric traumatic brain injuries greatly outnumber female pediatric traumatic brain injuries. Males account for 64% of all pediatric traumatic brain injuries.
With respect to age distribution of such injuries, adolescents (13 to <18yo) account for 47% of all injuries whereas infants (<1yo) only account for 8.2%. Only 4.4% of pediatric traumatic brain injuries were treated at dedicated pediatric level I trauma centers, whereas 36% were treated at adult level I/II trauma centers and 42.1% were treated at mixed adult/pediatric level I/II trauma centers. No significant geographical variation has been identified.
Manakah dari hal berikut yang benar berkaitan dengan penggunaan monitoring tekanang intracranial atau craniotomy/craniectomy untuk severe pediatric brain trauma ?
A. Sebuah rekomendasi level I dalam guidelines Brain Trauma Foundation
B. Lebih sering pada trauma center khusus dewasa
C. Lebih sering untuk infant dibanding untuk pasien remaja
D. Hanya direkomendasikan pada trauma center pediatric level I
B. Lebih sering pada trauma center khusus dewasa
The use of intracranial pressure monitoring and craniotomy/craniectomy for severe pediatric brain trauma is more frequent at adult-only trauma centers. In a recent study by Van Cleve et al., surgical intervention for ICP monitoring or craniotomy/craniectomy was found to be more frequent at adult-only trauma centers. The possible explanation is that more familiarity with pediatric exams and pediatric TBI experience may be associated with less use of monitors at centers with pediatric expertise.
Monitoring is less frequent in infants compared to adolescents. Use of ICP monitoring or craniotomy/craniectomy is a level III recommendation of the pediatric TBI guidelines, and not restricted for use only at level I pediatric trauma centers.
