Flashcards in CM: Neurosurgery Deck (15):
What is the Glasgow scoring for best eye opening?
1 - none
2 - to pain
3 - to speech
4 - spontaneous
What is the Glasgow scoring for best verbal?
1 - none
2 - incomprehensible
3 - inappropriate
4 - confused
5 - oriented
What is Glasgow scoring for best motor?
1 - none
2 - extensor (decerebrate)
3 - flexion (decorticate)
4 - withdraws to pain
5 - localizes pain
6 - obeys
What are the interpretations of different Glasgow scores?
8 or less: severe head injury (coma)
9-12: moderate head injury
13-15: mild head injury
What are the different types of skull fractures?
open vs. closed - open require operative rx, closed may require elevation if depressed greater than thickness of bone
skull base fracture: dural lacerations may lead to CSF leak skull base --> rhinorrhea, otorrhea
What symptoms do fractures of the petrous portion of temporal bone lead to?
7th nerve palsy, Battle's sign (ecchymosis over mastoid), raccoon's eyes, hemotympanum
What are the main signs of an epidural hematoma?
dilated ipsilateral pupil, contralateral hemiparesis
= classic lens shape on imaging
What are the differences between chronic and acute subdural hematomas?
chronic - clot liquefies, won't see dense blood on imaging, rx is craniotomy or burr holes
acute - see dense blood on imaging, associated w parenchymal injury --> worse outcome, rx is surgical
What is the treatment for contusions/intracerebral hemorrhage?
generally nonsurgical unless mass effect
What is the Monroe-Kellie doctrine?
skull is fixed box - increase in one volume means increased pressure and compensatory decrease in other components
What are lumbar puncture findings in subarachnoid hemorrhage?
increased RBCs that don't clear w successive tubes, elevated opening pressure, xanthochromia
Where do saccular,fusiform and mycotic aneurysms tend to occur?
saccular - anterior circulation - related to hemodynamic factors
fusiform - posterior circulation - related to atherosclerosis
mycotic - distal branches
What are the treatment options for aneurysms?
What is the etiology of vasospasm?
blood in subarachnoid space leads to irritation and spasm of cerebral arteries