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Block 9 - Neuro > CM: Neurosurgery > Flashcards

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?

surgical clipping
endovascular coiling


What is the etiology of vasospasm?

blood in subarachnoid space leads to irritation and spasm of cerebral arteries


What is the treatment of vasospasm?

Ca channel blockers, HHH therapy (hypervolemia, hemodilution, HTN), mechanical balloon dilatation for focal areas
clinical window is post bleed day 3-14