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Fiser's ABSITE Ryan > Chapter 41 - Neurosurgery > Flashcards

Chapter 41 - Neurosurgery Flashcards

1
Q

What is neuropraxia?

A

No axonal injury (temporary loss of function)

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2
Q

What is axonotmesis?

A

Disruption of axon with preservation of axon sheath, will improve

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3
Q

What is neurotmesis?

A

Disruption of axon and axon sheath (whol enerve disrupted), may need surgery for recovery

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4
Q

What is the rate of regeneration of nerves?

A

1mm/d

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5
Q

What are the Nodes of Ranvier? What is the purpose?

A

Bare sections

Allow salutatory conduction

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6
Q

Release of ADH controlled by what?

A

Supraoptic nucleus of hypothalamus which descends into the posterior pituitary gland

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7
Q

What stimulates release of ADH?

A

In response to high plasma osmolarity

Leads to increased water absorption in collecting ducts

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8
Q

What are the manifestations of DI (low ADH)?

A

Increased urine output, decreased urine specific gravity, increased serum Na, increased serum osmolarity

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9
Q

When can DI occur?

A

ETOH, head trauma

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10
Q

Treatment for DI?

A

DDAVP, free water

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11
Q

What are the manifestations of SIADH (high ADH)?

A

Decreased urine output, concentrated urine, low serum Na, low serum osmolarity

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12
Q

When will SIADH occur?

A

With head injury

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13
Q

Treatment for SIADH?

A

Fluid restriction, diuresis; can give hypertonic saline if initial treatment fails

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14
Q

How do AV malformations present 50% of the time?

A

Hemorrhage

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15
Q

Treatment of AV malformation?

A

Resection if possible; can coil prior to resection

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16
Q

How do cerebral aneurysms present?

A

Bleeding, mass effect, seizures, infarcts

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17
Q

Where do cerebral aneurysms occur?

A

At branch points in artery, most in carotid or anterior circulation; most congenital

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18
Q

Cause of SDH?

A

Torn bridging veins

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19
Q

CT findings with SDH?

A

Crescent shape on head CT; conforms to brain

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20
Q

Cause of epidural hematoma?

A

Injury to middle meningeal artery?

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21
Q

CT findings with epidural?

A

Lens shape, pushes brain away

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22
Q

What is the cause of nontraumatic SAH?

A

Cerebral aneurysms and AVMs

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23
Q

Symptoms of SAH?

A

Nuchal rigidity, severe headache, photophobia, neurologic defects

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24
Q

Treatment for SAH?

A

Hypervolemia, calcium channel blockers

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25
Q

What lobe is most often affected by intracerebral hematoma?

A

Temporal lobe

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26
Q

Cerebral perfusion pressure = what?

A

MAP - ICP

27
Q

Goal CPP?

A

> 60-70

28
Q

Treatment for head trauma and decreased CPP?

A

Elevate HOB, sedate/paralyze, moderate hyperventilation (Pco2 30-35), mannitol to decrease brain edema, may need craniectomy

29
Q

When does maximum brain swelling occur after trauma?

A

48-72h

30
Q

Symptoms of elevated ICP? Signs?

A

Stupor, headache, n/v, stiff neck

HTN, HR lability, slow respirations

31
Q

What is Cushing’s triad?

A

HTN, bradycardia, slow respiratory rate

32
Q

What does dilated pupil after trauma indicate?

A

Ipsilateral temporal herniation onto 3rd cranial nerve

33
Q

Symptoms of complete cord transection?

A

Areflexia, flaccidity, anesthesia, autonomic paralysis below the level of lesions

34
Q

Signs of spinal shock?

A

Hypotension, normal or slow heart rate, warm extremities

35
Q

Spinal shock can occur with what level of cord injury?

A

T5 and above (loss of sympathetic tone)

36
Q

Treatment for spinal shock?

A

Fluids, phenylephrine (alpha-agonist)

37
Q

What is anterior spinal artery syndrome?

A

Most commonly occurs with acutely ruptured cervical disc
Bilateral loss of motor, pain, and temperature sensation below the level of lesion (preservation of position-vibratory sensation and light touch)

38
Q

What % of anterior spinal artery syndromes recover to ambulation?

A

10%

39
Q

What is Brown-Sequard syndrome?

A

Hemisection of cord; most commonly due to penetrating injury

Loss of ipsilateral motor, contralateral pain and temp below level of lesion

40
Q

What % of Brown-Sequard recover to ambulation?

A

90%

41
Q

What is central cord syndrome?

A

Most commonly occurs with hyperflexion of C spine

Bilateral loss of motor pain and temperature sensation in upper extremities, lower extremities spared

42
Q

What is cauda equina syndrome?

A

Pain and weakness in lower extremities due to compression of lumbar nerve roots

43
Q

What tract carries pain and temp sensory neurons?

A

Spinothalamic tract

44
Q

What tract carries motor neurons?

A

Corticospinal and rubrospinal tract tract

45
Q

What nerve roots are generally afferent; carry sensory fibers?

A

Dorsal nerve roots

46
Q

What nerve roots are generally efferent; carry motor neruon fibers?

A

Ventral nerve roots

47
Q

The majority of adult brain tumors are supra or infratentorial? Children?

A

Adult: 2/3 supratentorial
Children: 2/3 infratentorial

48
Q

What is the most common primary brain tumor? Most common subtype?

A

Glioma

Glioma multiforma

49
Q

What is the #1 tumor with mets to the brain?

A

Lung

50
Q

What is the most common brain tumor in children?

A

Medulloblastoma

51
Q

What is the most common metastatic brain tumor in children?

A

Neuroblastoma

52
Q

Where does an acoustic neuroma arise from? Symptoms?

A

From 8th cranial nerve

Hearing loss, unsteadiness, vertigo, nausea/vomiting

53
Q

1 tumor overall of the spine?

A

Neurofibroma

54
Q

What type of tumors are most likely benign?

A

Intradural tumors

55
Q

What lab tests are checked with paraganglionoma?

A

Metanephrine in urin, MIGB for extramedullary chromatin tissue

56
Q

When is intraventricular hemorrhage seen in children?

A

In premies secondary to rupture of the fragile vessels in germinal matrix

57
Q

Risk factors for IVH in children?

A

ECMO, cyanotic congenital heart disease

58
Q

Treatment of IVH in children?

A

Ventricular catheter for drainage and prevention of hydrocephalus

59
Q

What is a myelomeningocele?

A

Neural corde defect with herniation of spinal cord and nerve roots through defect in vertebra

60
Q

Where is the most common location for myelomeningocele?

A

Lumbar region

61
Q

Where is Wernicke’s area? What is its function?

A

Speech comprehension

Temporal lobe

62
Q

Where is Broca’s area? What is its function?

A

Speech motor

Posterior part of anterior lobe

63
Q

What is the diagnosis for a patient with pituitary adenoma, undergoing XRT, now in shock? Treatment?

A

Pituitary apoplexy

Steroids

64
Q

What cells act as brain macrophages?

A

Microglial cells

Fiser's ABSITE Ryan (50 decks)

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