Neurosurgery emergencies Flashcards
Why can’t a spinal cord lesion lead to complete hemiparalysis?
much more likely to be cortex as the damage to the spinal cord would have to be high up and is more likely to have bilateral effects due to proximity of tracts within the spinal cord. Not impossible but highly unlikely
Why is GCS useful?
intubation <8. However total score doesn’t reflect individual components…therefore could be some serious issues. Therefore always specify individual components
What does a score of M3 suggest on GCS?
you have no more cortical input…reliance on primitive tracts of brainstem (rubrospinal response)
Why does herniation of uncus cause third nerve palsy?
uncus=innermost part of temporal lobe
Left sided intracranial mass, close proximity of uncus and third CN, therefore compression, leading to dilated pupil and down and outwards gaze
Where is the most common site of extradural haematoma?
middle meningeal artery- pterion
How to manage traumatic brain injury without intervention?
keep head up (unless neck injury ID) to encourage venous flow and to reduce pressure within cranial system
Avoid coughing, vomiting, pain, constipation
Mannitol
Three differentials for shooting pains down back of leg with lower back pain?
sciatica radiculopathy slipped disc discitis ilias psoas abscess malignancy spinal stenosis vascular arterial insufficiency!!!!
At what level does the spinal cord terminate?
L1/L2
What do the sacral nerve innervate?
lower limbs
bladder and bowel
perianal region
Does cauda equina syndrome cause bilateral or unilateral symptoms
bilateral as there is a central prolapse
Which points in history would worry you about bilateral leg pain
bilateral urination problems numbness/tingling in perianal region altered bowel function altered sensation of passing urine
Would you have UMN or LMN signs in cauda equina syndrome?
UMN…spinal cord terminated in lumbar not sacral
Describe three aspects of a clinical examination of a patient with bilateral leg pain with concern for cauda equina
lower limb sensation lower limb motor saddle anaesthesia anal tone absence perianal reflex- absent
What are the four stages of cauda equina syndrome development
suspected
incomplete
with retention
complete
List two features of suspected cauda equina
bilateral sensory and motor weakness
