Ward Notes Flashcards
What are the priorities for Preop patients?
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
What does T2 hyperdensity around ventricle indicate?
Transependymal flow, sign of increased ICP and chronic white matter tract disease
What should patients with hemangioblastomas be worked up for?
Von Hippel Landau, pheochromocytomas
What are good indications for GBM GTR?
Highly accessible and respectable area
Seizure foci
What disorder is associated with multiple meningiomas?
NF2
What are the key considerations for meningioma surgery?
Early interruption of blood flow
Do not divide SSS posterior to coronal suture
What do you do if INR is >1.4 preop?
Give vit K 10mg IV and recheck later
What causes trigon cephaly?
Metopic suture sealing frontal bones
What is the cephalic index?
Biparietal diameter/oculofrontal diameter X 100
What should be done if shunt is working well proximally to brain?
Don’t move it, risk of tearing tissue on vessels along old tract
Check distal flow
What is the most definitive way to rule out small aneurysms?
Angiogram
What is the bleeding risk of cavernous malformations?
1%/year
4% if in basal ganglia
Where should femoral punctures be made? Why?
Enter in bottom 1/3 of femoral head I.e 3 fingers breadth below
To avoid retroperitoneal space
What are the most common s/s of AVMs?
#1 is hemorrhage (50% vs 92% of aneurysms) Also seizure, stroke, HA, hydro in peds
What factors increase bleed risk in AVM?
Deep location of nidus, smaller size, and deep venous drainage
What is the Spetzler-Martin scale?
Determines morbidity and mortality risk of AVM surgery
1 pt for eloquent cortex, 1 pt for deep venous drainage, size 0-3
What are the characteristics of Chiari 1.5 malformations? Treatment?
Compression at pontomedullary junction by retro flexed odontoid
Obax down to spinal cord
Tx: odontoidectomy, suboccipital cranial fusionC1-2
What are the common symptoms for Chiari headaches?
Tension type, worse with retroflexion and valsalva
What do patients with cav mals and family need to be screened for?
Aneurysms, high association
What determines the bleed risk for AV fistulas?
Retrograde flow via venous sinuses
What is RCVS?
Reversible cerebral vasoconstriction syndrome or, beading of blood vessels on angiogram
Associated with AV fistula, risk of small multi hemorrhagic strokes
What is the name for flattening of vertebral bodies, and what may be associated with this?
Vertebrum planum
Histiocytosis, inflammatory condition causing bony lesions in the spine
What are the most common posterior fossa masses in adults and less?
Adult - mets
Peds - JPA
What needs to be monitored for patients on DI watch?
Last 3 sodium levels, osmolality, and urine output
Urine output > 250 for 2 hrs or >500 for 1 hr may be sign of DI
What motor function would be preserved with spinal cord injury at levels C5-T1 and L2-4?
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
What is responsible for cord signal in SCI?
Hemorrhagic and vasogenic edema
What are patients with high T/C spine SCI immediately at risk for?
Neurogenic shock (severe HoTN and Brady) from decreased sympathetic impulses and drop in vascular tone
Immunodeficiency from decreased blood flow to spleen
What is central cord syndrome, how is it caused and who is at risk for it?
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
What are the ASIA classifications of SCI?
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
What are the key SCI sensor level locations to check?
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
What is diffusion tensor imaging and what is it used for?
Extension of DWI, profiling white matter Tracts
since fluid takes path of least resistance, can show deformation of WMT by tumors etc
What is DWI good for?
Characterization of tumors (I.e. To see areas of necrosis or hypercellularity) and cerebral ischemia
