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1
Q

Osler Weber Rendu

A

Hereditary hemorrhagic telangiectasia
- mucocutaneous telangiectasias
- AVMs
- Mutations that involve signaling of TGF-beta
- bevacizumab being used as investigation treatment

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2
Q

Wyburn Mason Syndrome

A

Multiple AVMs predominantly affecting face and brain

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3
Q

Spetzler Martin grade

A
  • size (<3, 3-6, >6cm)
  • Venous drainage (superficial vs deep)
  • Eloquence (yes vs no)
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4
Q

AVM rupture risk

A

2.2%/year unruptured, 4.5% ruptured

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5
Q

ICH score

A

GCS 3-4 (2), 5-12 (1), 13-15 (0)
Age greater than or equal to 80 (1)
Volume greater than or equal to 30 (1)
Intraventricular (1)
Infratentorial (1)

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6
Q

Heparin reversal

A

20mg protamine

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7
Q

Coumadin reversal

A

Kcenter (4 factor prothrombin complex concentrate), FFP, vitamin K

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8
Q

Dabigatran (pradaxa) reversal

A

Idarucizumab

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9
Q

Hypercoagulable workup

A

Antithrombin
Protein C
Protein S
Factor V Leiden
Prothrombin mutations
Lupus anticoagulant
Anticardiolipin

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10
Q

NASCET

A

Endarterectomy, death or disabling stroke at 2 years, symptomatic patients

90-99% 26% ARR
>70% 17% ARR
50-69% 7% ARR

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11
Q

CREST

A

Stent vs CEA, asymptomatic and symptomatic
More perioperative strokes with stenting
More MIs with CEA

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12
Q

ACAS

A

Asymptomatic, CEA, stroke or death at 3 years
>60% stenosis 6% ARR
Greater in med

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13
Q

tPA dosing

A

0.9mg/kg, 10% over 1 min, rest over 1 hr

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14
Q

Spinous process avulsion

A

Hyperflexion

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15
Q

Clay shoveler’s fracture

A

C7 spinous process avulsion (sudden contraction of trapezius muscles)

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16
Q

Teardrop fracture

A

Fracture of anterior inferior vertebral body
Hyperflexion + axial loading
Unstable with concomitant disruption of ALL
Usually accompanied by retrolisthesis of anterior vertebral body

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17
Q

Avulsion fracture

A

Anterior inferior vertebral body without malalignment
Hyperextension
Usually stable (without PLL injury)

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18
Q

Quadrangular fracture

A

C spine fracture obliquely through vertebral body from anterior superior margin to inferior endplate
Flexion + compression + axial loading
Assess ligamentous structure to determine stability

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19
Q

Wedge fracture

A

Fracture of >50% of vertebral body without disruption of anulus or posterior ligament. (C spine)
Flexion + compression
Stable

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20
Q

Burst fracture

A

Flexion + compression + axial loading
Unstable, disruption of anterior and middle column
ALL and PLL disrupted

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21
Q

Subluxation spine

A

C spine
Distraction + flexion
Accompanied by fracture or disruption of at least 1 facet joint
Anterior translation >3.5mm or angulation >11 degrees indicates mechanical instability

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22
Q

C spine facet fracture

A

Extension + compression + rotation
Unstable

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23
Q

Traumatic spondylolisthesis

A

Anterior displacement of vertebral body as a result of single and/or bipedicular fracture and/or pars interarticularis
Extension + axial loading
Unstable

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24
Q

Type 2 dens fracture prognostic factors

A

Age >65
Angulation
Displacement/distraction
Posterior displacement of dens
Displacement in >1 plane
Delay in diagnosis

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25
Dens fracture mechanism
Horizontal shear and compression
26
C1 screws
Lateral mass Entry point: half way between junction of posterior arch and inferior posterior part of C1 lateral mass 5-10 degrees medial Parallel to C1 posterior arch Palpate medial border 3.5mm diameter, 18-30mm length
27
C2 screws
Pars Pedicle Intralaminar Pedicle: Starting point in superior medial quadrant of C2 inferior articular process 20 degrees medial, 20 degrees cephalad 3.5mm screw, 30-35mm length Pars: starting point 3mm rostral and lateral to inferior/medial inferior articular process 20-30 degrees medial, toward anterior ring of C1
28
Hangman's fracture
Bilateral fracture of C2 pars/pedicle Hyperextension + axial loading Look for vert injury Effendi classification: Type 1: hairline fracture without angulation or displacement Type 2: anterolisthesis C2 on C3 Type 3: type 2 + C2 body angulated External immobilization for patients without neurologic injury and with anatomic alignment C2/3 ACDF C1 and C3 posterior fusion (+/- skip C2)
29
Thoracolumbar burst
Axial loading, +/- flexion
30
Chance fracture
Fracture through middle and posterior columns (pedicles and vertebral body) Can be ligamentous only -- splaying of spinous processes Flexion distraction Can trial bracing in poor operative candidates/those without ligamentous injury Posterior fusion
31
Cervical jumped facets
Flexion/distraction/rotation CTA to assess verts
32
Lateral mass screws
Starting point: 1mm medial to center (medial and inferior, aim to superolateral corner) 30 degrees lateral (lay against spinous process) 20 degrees superior (parallel to spinous process)
33
Atlanto axial dislocation/AOD
Basion dens interval (BDI) >10mm in adults or >12mm in children Condylar gap: occipital condyl to superior articular facet of atlas >2mm in adults or >5mm in children Type 1: anterior displacement of occiput with respect to atlas Type 2: Vertical displacement of occiput Type 3: posterior occiput displacement Posterior fusion if reducible
34
Basilar invagination
Mcrae's line: basion to opisthion, dens should not cross Wackenheim's clivus-canal line: line along clivus, dens should not cross Fischgold's digastric line: connects digastric notches, distance <10mm between this and middle of AA joint suggests BI Fischgold's bimastoid line: connects mastoid tips, AA joint should not cross
35
Radiation resistant tumors
Triple negative breast Renal NSCLC Melanoma Colon
36
Spinal ependymomas
Myxopapillary: grade 1, lumbar cistern Cellular: grade 2, from ependymal lining Anaplastic: grade 3
37
Ankylosing spondylitis
HLA B27 Sulfasalazine, methotrexate, TNF alpha antagonists
38
NF1
Neurofibromas MPNST
39
NF2
Vestibular schwannomas Meningiomas Chromosome 22 (merlin)
40
Acoustic approaches
Retrosig: chance of hearing preservation, good for tumors in CPA with limited extension into IAC Translab: no hearing preservation, allows access to lateral recess of IAC and identification of facial nerve at labyrinthine segment to help preserve Middle fossa: best hearing preservation, posterior fossa extension <0.5-1cm
41
Cystic tumors
Metastasis Hemangioblastoma -- goal remove enhancing nodule Glioma (juvenile pilocytic astrocytoma)
42
Von Hippel Lindau
Hemangioblastoma Pheochromocytoma
43
Pituitary labs
Prolactin, TSH, Free T4, FSH, LH, ACTH, cortisol, IGF-1, GH, testosterone, estradiol
44
Adamantimomatous craniopharyngioma
WHO grade 1 Children
45
Papillary craniopharyngioma
Adults BRAF
46
GBM mutations
Primary: EGFR amplification, PTEN mutations Secondary: TP53 mutations MGMT promotor methylation: associated with greater response to temozolomide
47
Stupp protocol
Radiation: 60Gy in 30 fractions over 6 weeks (M-F x 6 wks) Temozolomide: during radiation 75mg/square meter bsa 7 days/week Adjuvant: 6 cycles of 150-200mg/ square meter BSA for 5 days/28
48
Oligodendroglioma genetics
1p/19q codeletion -- more sensitive to radiation and alkylating chemotherapy
49
Anaplastic oligodendroglioma chemo
Temozolamide PCV (procarbazine, lomustine, vincristine)
50
WHO grade 1 gliomas
Pilocytic astrocytoma Subependymal giant cell astrocytoma
51
WHO grade 2 gliomas
Pilomyxoid astrocytoma Pleomorphic xanthoastrocytoma Fibrillary/protoplasmic/gemistocytic astrocytoma Oligodendroglioma Oligoastrocytoma Ganglioglioma Gangliocytoma Dysembryoplastic neuroepithelial tumors
52
NF1
Low grade gliomas more common
53
Most common brain metastases
Lung, breast Of those with melanoma ~70% have brain mets
54
Radiation sensitive cancers
SCLC Breast Lymphoma Multiple myeloma
55
Brain abscess organisms
Direct extension: strep milleri Hematogenous: Strep viridans Trauma: Staph aureus, staph epi
56
Pediatric posterior fossa tumors
Ependymoma Medulloblastoma Pilocytic astrocytoma AT/RT PNET
57
Ependymoma types
Grade 1: subependymoma, myxopapillary Grade 2: papillary, clear cell, tanycytic, mixed Grade 3: analplastic
58
Myxopapillary ependymoma
Grade 1, filum terminale/conus
59
Clear cell ependymoma
Pediatric Supratentorial
60
Tanycytic ependymoma
Grade 2, ventricular
61
Anaplastic ependymoma
Grade 3
62
Ependymoma genetics
NF2 Loss of 12 or 14q High expression of HOX genes
63
STN neural firing
20-50Hz
64
GPI neural firing
60-100Hz
65
STN side effects
Paresthesias: lemniscal pathway, posterior Dysarthria: lateral, internal capsule Contralateral gaze deviation: CN III nucleus medial
66
GPI side effects
Dysarthria/contractions: capsule, medial Scintillations/phosphenes: optic tract inferior
67
Spasticity scale
Modified Ashworth
68
Baclofen overdose
Physostigmine
69
Disconnection syndrome
Mutism Apraxia Hemiparesis Ideomotor apraxia
70
Intrathecal pain pump meds
Approved: morphine, baclofen, ziconotide Off label: mixed opioids and local anesthetics, other neuropathic agents
71
Progressive multifocal leukoencephalopathy
JC virus Treat HIV
72
MS serum markers
anti-myelin oligodendrocytic protein and anti-myelin basic protein
73
ALS gene
SOD1 D90A
74
Guillan Barre syndrome diagnosis
EMG: abnormal H reflex, low amplitude/prolonged F-waves, distal latencies prolonged by >150% UNL, temporal dispersion of CMAP, slow conduction velocity, within 3 weeks demyelination Anti-ganglioside antibodies" GQ1b, GT1b, GM1, Ga1Nac-GD1a CSF with protein cytological dissociation (albuminocytologic dissociation --elevated protein, not elevated WBC) MRI L spine with contrast with diffuse nerve root enhancement
75
Neuromyelitis optica antibodies
NMO-IgG, anti-AQP4
76
Status protocol
ABCs, labs (Na, etc) Thiamine 100mg Dextrose 50cc D50 Vitamin B6 100mg (neonate) Meds: Ativan 2mg/min (max 0.1mg/kg) with 1 min between doses Fosphenytoin (20mg/kg at 150mg/min) Keppra (60mg/kg) (vs Depakote (20mg/kg)) intubate Pentobarb (10mg/kg over 30min load, maintenance 2mg/kg/hr for burst suppression
77
Transverse myelitis CSF
IgG Pleocytosis Elevated protein +/- oligoclonal bands, increased IgG index, 14-33 protein, IL-6, non-specific enolase, myelin basic protein, S-100 protein
78
Peroneal nerve
Dorsiflexion EHL Foot eversion
79
Froment's sign
Thumb interphalangeal flexion when trying to hold paper between thumb/index finger (ulnar weakness)
80
Wartenberg's sign
Little finger abducted (unopposed extensor digiti minimi due to palmar interosseous weakness; ulnar weakness)
81
Anterior interosseous syndrome
Branch of median 6cm distal to elbow Weakness of: flexor digitorum profundus (index and middle), flexor pollicis longus. No sensory branches "O" sign Often compressed at tendinous arch of the sublimis muscle (FDS)
82
Nerve transfers for shoulder function
Distal spinal accessory to suprascapular Triceps branches of radial nerve to axillary nerve
83
Nerve transfer elbow flexion
Motor median to musculocutaneous
84
Oberlin procedure
Ulnar (wrist flexion fasicle) to biceps motor branch of musculocutaneous (to brachialis)
85
Lumbar foramen borders
Anterior: disk, superior/inferior endplates of vertebral bodies Posterior: supior/inferior articular processes/facet joint Superior/inferior: pedicles
86
Neurocysticercosis
Praziquantel Albendazole
87
Toxoplasmosis
Pyrimethamine and sulfadiazine, folinic acid

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