Neurosurgical Emergencies Flashcards
1
Q
What are common neurosurgical emergencies?
A
- Cranial
- head injury: extradural/subdural haematoma, contusions, depressed skull fractures
- hydrocephalus
- infections: intracerebral abscess, subdural empyema - Spinal
- cauda equina
- acute spinal cord compression” bleed, infection, disc, trauma
2
Q
What is a classic history of extradural haematoma?
A
- Headache, vomiting, fluctuating consciousness
- GCS 10/15
- Right pupil larger than left
- Sluggish reaction to light
- CT scan: bioconvex, fractured skill (disrupts MMA), brain intact
3
Q
How is extradural haematoma managed?
A
- ALTLS
- Admit, bloods, mannitol
- Prevent secondary brain injury: hypotension, hypoxia, infection
- Contact neurosurgeon for urgent craniotomy for evacuation of haematoma
4
Q
What is a subdural haematoma?
A
- Concave towards brain
- Ruptures bridging veins
- Worse outcome due to underlying brain injury
- Older patients - brain atrophy = only need minor injury for acute subdural which becomes chronic
5
Q
How are contusions managed?
A
- Swell + mature over 72 hours
- Initially conservatively (ICU + ICP)
- Observe for signs of ICP
- Prevent hypoxia + hypotension to prevent secondary brain injury
- Surgery for persistent increased ICP
- Craniotomy or craniectomy (bone fragment not immediately put back in craniectomy)
6
Q
How is a depressed skull fracture managed?
A
- Majority conservatively
- Clean + suture overlying lacerations
- +/- antibiotics
- Epilepsy
- Surgery only for significant depression causing neurosurgical deficit, cosmetic purposes or dirty wounds
7
Q
What are the types of spontaneous intracranial haemorrhage?
A
- Subarachnoid
- Intracerebral
- Intraventricular
8
Q
What are the causes of intracranial haemorrhage?
A
- Cerebral aneurysms
- Arteriovenous malformation
- Hypertension
- Antocoagulants
- Drug abuse
9
Q
What are common signs of subarachnoid haemorrhage?
A
- Sudden onset occipital headache
- Neck stiffness
- Nausea, vomiting
10
Q
How is subarachnoid haemorrhage managed?
A
- Bed rest
- IV fluids
- Nimodipine
- Analgesics
- Refer to neurosurgeon for angiogram
- Can either treat by
1. Embolisation (coiling)
2. Clipping of aneurysm
11
Q
How is intracranial haemorrhage managed?
A
- Stop warfarin/aspirin
- Control hypertension
- Surgery for large superficial haematomas causing mass effect
12
Q
How is intraventricular haemorrhage managed?
A
- Symptomatic
- Investigate cause of bleeding
- Treat hydrocephalus - ECD, VP shunt
13
Q
What is hydrocephalus?
A
Either imbalance between producing + absorbing CSF or physical obstruction to flow of CSF
14
Q
What are the causes of hydrocephalus?
A
- Obstructive (non-comm)
- Tumours
- Abscess
- Cysts
- Congenital aqueduct stenosis
- Chiari malformations - Non-obstructive (communicating)
- IC haemorrhage (SAH, IVH)
- Infection - meningitis
- Post-traumatic
15
Q
How is hydrocephalus managed?
A
- Insertion of ventriculo-peritoneal shunt - for communicating all ventricles in communication so only have to drain 1 part & whole system gets drained)
- Enoscopic 3rd ventriculostomy - for non-communicating (hole in 2rd ventricle so CSF drains into subarachnoid space)
