Surgical disorders of the brain

Question 1

Risk of head injury requiring haematoma removal

Answer 1

Injury Conscious level Risk
Concussion, no fracture Orientated 1 in 6000
Concussion, no fracture Not orientated 1 in 120
Skull fracture Orientated 1 in 32
Skull fracture Not orientated 1 in 4

Question 2

Post car crash GCS 15 then GCS 3 hours later what cause

Answer 2

Epidural haematoma causing trans tectorial herniation

Question 3

Acute vs chronic subdural haeamtoma presentation

Answer 3

<72 hours, hyperdense, crescent- acute

Question 4

Painful third nerve palsy cause

Answer 4

Posterior communicating artery aneurysm

Question 5

Description of hernia causing 3rd nerve palsy

Answer 5

transtentorial herniation.
The medial aspect of the temporal lobe (uncus) herniates across the tentorium and causes pressure on the ipsilateral oculomotor nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil. In addition the brainstem is compressed

Question 6

Area in scalp where infection is dangerous

Answer 6

Loose areolar tissue

This area is most dangerous as infections can spread easily. The emissary veins that drain this area may allow sepsis to spread to the cranial cavity.

Question 7

What is a signature fracture

Answer 7

Depressed skull fracture

Question 8

Which muscle is tested in Babinski sign

Answer 8

EHL

Question 9

After SAH patient has hydrocephalus mx

Answer 9

VP shunt

Question 10

Where majority of aneurysm occur

Answer 10

> 80% aneuryms arise from the anterior circulation

Question 11

Mx of aneurysm

Answer 11

Craniotomy and clipping of aneurysm is the traditional treatment, alternatively suitable lesions may be coiled using an endovascular approach. Where both options are suitable data suggests that outcomes are better with coiling than surgery.