Ward Notes

Question 1

What are the priorities for Preop patients?

Answer 1

Check labs: H/H, PT, PTT, INR, BMP, CBC, UA
Gen med clearance
NPO, fluids, DC SQH and blood thinners
X-ray and ekg if needed

Question 2

What does T2 hyperdensity around ventricle indicate?

Answer 2

Transependymal flow, sign of increased ICP and chronic white matter tract disease

Question 3

What should patients with hemangioblastomas be worked up for?

Answer 3

Von Hippel Landau, pheochromocytomas

Question 4

What are good indications for GBM GTR?

Answer 4

Highly accessible and respectable area

Seizure foci

Question 5

What disorder is associated with multiple meningiomas?

Answer 5

NF2

Question 6

What are the key considerations for meningioma surgery?

Answer 6

Early interruption of blood flow

Do not divide SSS posterior to coronal suture

Question 7

What do you do if INR is >1.4 preop?

Answer 7

Give vit K 10mg IV and recheck later

Question 8

What causes trigon cephaly?

Answer 8

Metopic suture sealing frontal bones

Question 9

What is the cephalic index?

Answer 9

Biparietal diameter/oculofrontal diameter X 100

Question 10

What should be done if shunt is working well proximally to brain?

Answer 10

Don’t move it, risk of tearing tissue on vessels along old tract

Check distal flow

Question 11

What is the most definitive way to rule out small aneurysms?

Answer 11

Angiogram

Question 12

What is the bleeding risk of cavernous malformations?

Answer 12

1%/year

4% if in basal ganglia

Question 13

Where should femoral punctures be made? Why?

Answer 13

Enter in bottom 1/3 of femoral head I.e 3 fingers breadth below

To avoid retroperitoneal space

Question 14

What are the most common s/s of AVMs?

Answer 14

#1 is hemorrhage (50% vs 92% of aneurysms)
 Also seizure, stroke, HA, hydro in peds

Question 15

What factors increase bleed risk in AVM?

Answer 15

Deep location of nidus, smaller size, and deep venous drainage

Question 16

What is the Spetzler-Martin scale?

Answer 16

Determines morbidity and mortality risk of AVM surgery

1 pt for eloquent cortex, 1 pt for deep venous drainage, size 0-3

Question 17

What are the characteristics of Chiari 1.5 malformations? Treatment?

Answer 17

Compression at pontomedullary junction by retro flexed odontoid

Obax down to spinal cord

Tx: odontoidectomy, suboccipital cranial fusionC1-2

Question 18

What are the common symptoms for Chiari headaches?

Answer 18

Tension type, worse with retroflexion and valsalva

Question 19

What do patients with cav mals and family need to be screened for?

Answer 19

Aneurysms, high association

Question 20

What determines the bleed risk for AV fistulas?

Answer 20

Retrograde flow via venous sinuses

Question 21

What is RCVS?

Answer 21

Reversible cerebral vasoconstriction syndrome or, beading of blood vessels on angiogram

Associated with AV fistula, risk of small multi hemorrhagic strokes

Question 22

What is the name for flattening of vertebral bodies, and what may be associated with this?

Answer 22

Vertebrum planum

Histiocytosis, inflammatory condition causing bony lesions in the spine

Question 23

What are the most common posterior fossa masses in adults and less?

Answer 23

Adult - mets

Peds - JPA

Question 24

What needs to be monitored for patients on DI watch?

Answer 24

Last 3 sodium levels, osmolality, and urine output

Urine output > 250 for 2 hrs or >500 for 1 hr may be sign of DI

Question 25

What motor function would be preserved with spinal cord injury at levels C5-T1 and L2-4?

Answer 25

``` C5- delts and biceps C6 - wrist flex/ext C7 - tricep ext C8 - finger flex T1 - finger abductors ``` L2 - hip flex L3 - knee ext L4 - ankle dorsi flex or foot ext

Question 26

What is responsible for cord signal in SCI?

Answer 26

Hemorrhagic and vasogenic edema

Question 27

What are patients with high T/C spine SCI immediately at risk for?

Answer 27

Neurogenic shock (severe HoTN and Brady) from decreased sympathetic impulses and drop in vascular tone Immunodeficiency from decreased blood flow to spleen

Question 28

What is central cord syndrome, how is it caused and who is at risk for it?

Answer 28

Occurs in elderly with cervical spondy and stenosis who sustain hyperextension injury from falls Sx: hands and arm weak, burning dysesthesia in cape like pattern, decreased bowel and bladder function

Question 29

What are the ASIA classifications of SCI?

Answer 29

A: complete injury, no sens/motor in S4-5 B: motor complete, sensory incomplete below level C: Motor incomplete - motor fxn present below level, more than half of key muscles below level have muscle grade <3 D: Motor incomplete - motor fxn present below level, at least half of key muscles below level have muscle grade 3 or more E: normal motor and sensory fxn

Question 30

What are the key SCI sensor level locations to check?

Answer 30

C6-thumb, c8- pinky, t1- base of forearm, t4 - nipple, t8- bottom of ribs, t10 -umbilicus, L1 - medial groin, L4 - medial malleolus, S1- lateral calcaneus

Question 31

What is diffusion tensor imaging and what is it used for?

Answer 31

Extension of DWI, profiling white matter Tracts since fluid takes path of least resistance, can show deformation of WMT by tumors etc

Question 32

What is DWI good for?

Answer 32

Characterization of tumors (I.e. To see areas of necrosis or hypercellularity) and cerebral ischemia