Neurology #5 Flashcards
(33 cards)
A subarachnoid hemorrhage is MC due to
A ruptured berry aneurysm at the anterior communicating artery
Risk factors for a subarachnoid hemorrhage
- Smoking
- Hypertension
- PKD, CAD, smoking, alcohol, marfan Syndrome, family history
Symptoms of a subarachnoid hemorrhage
- Sudden, intense thunderclap headache
- Worst headache of my life
- Nausea, vomiting, meningeal symptoms (neck stiffness, fever, photophobia)
- May have LOC initially
Diagnostics for a subarachnoid hemorrhage
- CT scan without contrast: initial
- LP: xanthrochromia (yellow-pink color of CSF due to breakdown of RBCs)
What diagnostic is done AFTER confirmed subarachnoid hemorrhage to identify source of bleeding and other aneurysms?
4-vessel angiography
Treatment for a subarachnoid hemorrhage
-Supportive: bed rest, stool softeners, lower intracranial pressure (Nimodipine)
How to prevent a rebreeding of a SAH
-Endovascular coiling or surgical clipping of aneurysm or AVM
Lowering the BP may reduce the risk of rebleeding in a SAH. What medications are preferred?
Labetolol, Nicardipine, Enalapril
What medications are given to reduce increased intracranial pressure, in an intracerebral hemorrhage?
IV mannitol
Physical exam signs of a basilar skull fracture
- Periorbital ecchymosis (Raccoon eyes)
- Mastoid ecchymosis (Battle Sign)
- Hemotympanum (blood behind TM)
- Rhinorrhea (CSF leak)
True or False: most basilar skull fractures are nonoperative without underlying brain injury?
True
What is a Jefferson (Burst) Fracture?
Fracture of the Atlas (C1)
-Bilateral fractures of both anterior and posterior arches of the atlas
Stability of the Burst/Jefferson Fracture is determined by what?
Involvement of the transverse ligament
Mechanism of injury for a Burst/Jefferson Fracture
-Axial load on the back of the head or hyperextension of the neck (diving)
What two views of XR are ordered with a Burst Fracture?
- Lateral radiographs: increase in predental space between C1 and odontoid (Dens)
- Odontoid views: step off of lateral masses of atlas
Management, both nonoperative and operative, for a Burst Fracture
- Nonoperative: external immobilization for 6-12 weeks for stable fractures
- Operative: C1-C2 fusion if unstable
An odontoid fracture (fracture of dens/odontoid process of the axis/C2) is from what?
Head placed in forced flexion or extension in anterior-posterior orientation (forward fall onto the forehead)
With a hangman’s fracture (C2/axis pedicle) fracture, what is one complication that can occur?
Spondylolisthesis between C2 and C3 (anterior dislocation of C2)
MOA of a Hangman’s Fracture
-Extreme hyperextension (MVA, chin hitting the steering wheel)
What is the difference between a nonoperative and an operative Hangman’s Fracture?
Nonoperative (Type I): < 3 mm horizontal displacement = right cervical collar for 4-6 weeks. (Type II) 3-5 mm displacement = closed reduction and immobilization 8-12 weeks
Operative (Type II): > 5 mm displacement with angulation
What is a Clay-Shoveler’s Fracture?
Spinous process avulsion fracture (C6-T3)
Where does a Clay Shoveler’s Fracture MC occur?
C7 MC
MOA of a Clay Shoveler’s Fracture
Forced neck flexion after sudden deceleration injuries (MVA)
-Usually a stable injury
Treatment for a Clay Shoveler’s Injury?
Nonoperative: NSAIDs, rest, immobilization for support
Surgical excision only needed if persistent pain or nonunion
