Large Group 4-Neurosurgeons Flashcards Preview

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Flashcards in Large Group 4-Neurosurgeons Deck (29):
1

What 3 things do you use to determine a complete vs incomplete spinal injury?

1. Bulbocavernosus Reflex
2. Motor function
3. Sensation

2

If BCR is negative is the injury complete or incomplete?

Can't tell! Negative BCR means test is non-diagnostic

3

If BCR is positive, motor is positive and sensory is negative (or vice versa on the last 2) is the injury complete or incomplete?

Incomplete

4

If BCR is positive and both motor and sensory are negative is the injury complete or incomplete?

Complete

5

What is Central Cord Syndrome?

- Motor loss is greater in UE than LE
- Common in elderly w/spinal stenosis
- More involved w/UE function

6

Does the presence of peri-anal pinprick sensation, sacral sparing or rectal tone suggest complete or incomplete injury?

Incomplete

7

If you suspect a traumatic brain or spinal cord injury should you use steroids? If no, why not?

NO; increases risk of sepsis, death & pneumonia

8

What test is the gold standard for a cerebral aneurysm?

Four vessel cerebral angiogram

9

What is the most common cause of a SAH besides trauma?

Ruptured aneurysm

10

Describe the anatomy of an aneurysm.

- Degenerated or absent internal elastic membrane
- Adventitia of loosely woven, sometimes abnormal collagen
- There is no muscular tissue and essentially no internal elastic membrane

11

What do SAHs look like on a non-contrast CT?

Bright starburst pattern

12

What are some common problems after a ruptured aneurysm?

- 50% chance of re-rupturing in 6 months
- Hydrocephalus
- Vasospam

13

Which surgical option (clip or coil) is best for un-ruptured MCA aneurysms in young pts?

Clip

14

After a trauma, what is the most important secondary event affecting outcome?

Cerebral ischemia

15

Why is hyperventilation bad?

- Causes less perfusion → death of penumbra tissue (ischemia)
- If there is no elevated ICP then chronic prolonged hyperventilation therapy is not indicated

decrease PCO2 (<32mmHg)

16

Why is hypotension bad?

- Hypotension → vasodilation → increasing the flow of blood → increase in ICP
- A single episode of hypotension (SBP<90mmHg) double mortality

17

Where is the most common place to have an aneurysm?

Anterior communicating artery (40%)

18

In patients with ruptured intracranial aneurysm the outcome is significantly better with...

Endovascular coiling

19

What is quadriplegia?

Spinal cord injury from upper cervical to T1

20

What is paraplegia?

Spinal cord injuries below T1, sparing the upper extremities

21

If someone with a spinal cord injury has a positive perianal pinprick exam, is their prognosis good or bad?

Good!

22

What kind of solutions can decrease ICP?

Hypertonic solutions

23

What is anterior cord syndrome?

usually from flexion/extension (diving)
Loss of all motor and pain and temperature below lesion and preservation of posterior column sensation; bowel/bladder also affected
The poorest prognosis for any recovery of incomplete syndromes

24

What is posterior cord syndrome?

Rare
Preservation of motor and pain and temperature function with loss of posterior column function (proprioception, two-point tactile discrimination,vibration modalities)
can walk but rely on visual input

25

What is conus medullaris syndrome?

Isolated injury to this part of the cord produces loss of bowel and bladder control
Exam reveals loss of perirectal sensation and poor rectal muscle tone
Bilaterally symmetrical
Saddle distribution of sensory loss
No motor signs in legs (if pure), if motor loss, it is symmetrical and nor marked, ankle jerk absent –S1
Prognosis is poor for significant return of bowel and bladder

26

What profusion pressure do we want to maintain after spine injury?

60 mmHg

27

What is ischemia?

tissue PO2 anaerobic respiration and decrease pH

28

How much will CBF change for each 1mmHg change in PCO2?

3-4%

29

What should MAP be maintained at?

above 90mmHg

through the infusion of fluid