Clinical assessment of neurosurgical patient

Question 1

Give examples of different people you can take a history from

Answer 1

the person, bystander, family member, paramedic, the notes?

Question 2

3 main things to do on an obtunded patient?

Answer 2

ABC
GCS
pupils

Question 3

CPP=

Answer 3

MAP-ICP

Question 4

What can uncal herniation lead to and why?

Answer 4

permanently dilated pupil

uncus squeezed under tentorium presses on brainstem (midbrain) and on cranial nerves

Question 5

What is cushings response and the 3 parts

Answer 5

compensate for rising ICP

raised blood pressure, bradycardia, apnea

Question 6

Observations of non communicative patient

Answer 6

posture, focal lack of eye movement, neglect of part of face or body, eye movements

Question 7

What else would you assess in a non communicative patient?

Answer 7

speech

MMS - confused

Question 8

What can you assess in a communicative patient of neurological function? (split into 3 parts)

Answer 8

cranial eg which lobe, cerebellum, cranial nerves
spinal eg radiculopathy, myelopathy, which level
spinal nerve

Question 9

2 MRI techniques to view neurological function

Answer 9

functional MRI and tractography

Question 10

List some parts of the frontal lobe and their function

Answer 10

precentral gyrus - voluntary control of movements
pars opecularis+triangularis - speech
higher order - restraint, initiative, order

Question 11

Examining frontal lobe

Answer 11

inspection eg urinary catheter 
UMN signs 
pronator drift 
saccadic eye movements 
speech

Question 12

2 tests for restraint eg socially acceptable language

Answer 12

go/no go tests

stroop test

Question 13

Supplementary motor cortex signs of dysfunction

Answer 13

lack of motivation
apathy
depression
abulia

Question 14

Abulia

Answer 14

Inability to act decisively

Question 15

Ways to examine language

Answer 15

hearing 
fluency eg brocas 
aphasia 
repetition 
3 step command 
baby hippopotamus 
orofacial movement eg ppp,ttt,mmm
reading and writing

Question 16

Parietal lobe functions

Answer 16

body image representation 
visuospatial awareness
language - wernickes 
multimodality assimilation 
numeracy

Question 17

Astereoagnosia

Answer 17

Inability to identify an object by touch of the hand without visual input

Question 18

dysgraphaesthesia

Answer 18

Form of agnosia - inability to interpret sensations

Question 19

Examining parietal lobe

Answer 19

ideomotor apraxia, ideational apraxia, dressing apraxia, loss of spatial awareness, hemineglect

Question 20

Temporal lobe functions

Answer 20

process auditory input
language
encoding long term memory - hippocampus
emotion - amygdala

Question 21

Examining occipital lobe

Answer 21

Visual fields

Question 22

Cerebellum - DANISHP

Answer 22

Dysdiadochokinesia 
ataxia 
nystagmus 
inattention tremor 
slurred speech 
hypotonia 
past pointing

Question 23

Radiculopathy signs

Answer 23

unilateral, single myotome and dermatome - LMN

Question 24

Peripheral nerve signs

Answer 24

unilateral, motor and sensory - LMN

Question 25

Myelopathy signs

Answer 25

bilateral, motor and sensory, UMN

Question 26

Peripheral neuropathy - body parts to remember?

Answer 26

stocking and glove

Question 27

Where does a myelopathy happen (level) and why?

Answer 27

mostly cervical and thoracic as not much cord at lumbar region

Question 28

Long tract signs of myelopathy

Answer 28

clonus, upgoing plantars, proprioception

Question 29

What is Hoffman sign?

Answer 29

flexion of ipsilateral thumb

Question 30

Example of cause of myelopathy and radiculopathy

Answer 30

myelopathy - herniated disc | radiculopathy - mass