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Flashcards in neurosurg Deck (38):
1

Communicating hydrocephalus

All ventricles affected. Due to defect in absorption at the arachnoid granulations

2

Noncommunicating hydrocephalus

Obstructive; due to block in CSF proximal to arachnoid granulations. May not affect all ventricles dep on level of block (e.g. aqueductal stenosis spares the 4th ventricle)

3

Third type of hydrocephalus

ex vacuo

4

Indications for carotid endartectomy

Asymptomatic: > 70% Symptomatic: > 60% NB: pts should stay on aspirin leading up to the surgery. If post-CVA, wait 4-6 wks for procedure

5

Carotid dissection causes

Trauma, CT disease, iatrogenic (angiogram), vasculitis

6

Carotid dissection symptoms

May have neck pain, headache, ipsilateral Horner syndrome, sx of SAH or stroke; can be nonspecific.

7

Carotid dissection management

If extradural, use medical therapy (anticoagulation). If intradural, do endovascular stenting or surgical bypass of ECA to ICA. Follow for 3-6 mo for healing.

8

Carotid dissection epidemiology

Carotid artery dissection is a significant cause of ischemic stroke in all age groups, but it occurs most frequently in the 5th decade of life and accounts for a much larger percentage of strokes in young patients.

9

Carotid dissection pathophys

Begins as a tear in one of the carotid arteries of the neck, which allows blood under arterial pressure to enter the wall of the artery and split its layers. The result is either an intramural hematoma or an aneurysmal dilatation, either of which can be a source of microemboli, with the latter also causing a mass effect on surrounding structures.

10

Uncal herniation

CN 3 palsy (blown pupil, down and out). Hemiparesis: can cause contralateral (from ipsilateral peduncle pressure) or ipsilateral (from contralateral peduncle pressure due to midbrain shift, aka Kernohan's phenomenon)

11

Herniation syndromes

Cingulate (subfalcine) can affect ACA -> abulia. Cerebellar (upward) can occlude superior cerebellar arteries -> ataxia. Tonsillar can be rapidly fatal. CEntral (transtentorial) causes decreased consciousness, occlusion of PCAs leading to cortical blindness, Cheyne-Stokes etc

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12

Parinaud syndrome

Parinaud's Syndrome, aka dorsal midbrain syndrome and vertical gaze palsy, is an inability to move the eyes up. It is caused by a tumor of the pineal gland which compresses the vertical gaze center at the rostral interstitial nucleus of medial longitudinal fasciculus (riMLF). The eyes lose the ability to move upward.

13

Low-grade astrocytoma

Cerebral hemispheres or cerebellum. Asx lesions should be followed. Surgery usu not curative but used if sx. Radiotherapy used. Chemo if surgery/rads fail

14

Malignant glioma includes..

Anaplastic astrocytoma, glioblastoma multiforme

15

Glioblastoma multiforme

Have necrotic center, enhancing rim. Very poor prognosis (pretty much 0% 5 yr survival) despite surgery and radiation. Chemo does not help

16

Meningioma

F > M. Arise from arachnoid region. Seen on superior convexities, orbital rim, cerebellar tentorium, intraventricular. Slowly progressive growth. Homogeneous enhancement on MRI/CT, may have dural tail. Tx: surgical resection if sx. If can't resect, do external beam radiotherapy/gamma knife. 5 yr survival 90%, often recur. 

17

How to treat acromegaly from pituitary adenoma?

Surgical resection is curative 50% of time. Medical tx: octreotide (somatostatin analogue)

18

How to treat TSH adenoma?

Octreotide

19

How to treat prolactinoma?

Dopamine agonists first; surgical excision if no response to med tx

20

How to treat Cushing syndrome from pituitary adenoma?

Surgery

21

Neuromas most commonly affect what CN?

CN 8 (acoustic neuroma)

22

Bilateral acoustic neuromas are pathognomic for what syndrome?

NF2

23

Ependymoma

Most often in children, usu a posterior fossa mass. Tx: surgical resection; rads if in 4th ventricle or spinal cord.

24

Oligodenroglioma

Predilection for frontal lobes. Histology: "fried egg" or "chicken wire" appearance. Slowly progressive; most often presents with seizure. Tx: surgery, post-op rad often, chemo somewhat helpful.

25

Craniopharyngioma

Most often in childhood. Benign but difficult to cure. Presents with HA, visual disturbance.

26

Pineal tumors

More often in children. Possibly can be germinoma or teratoma, so measure HCG and AFP; recall that germinomas are radiosensitive.

27

CNS lymphoma

Tend to melt away after one round of steroids but will come back. Radiation therapy is mainstay of tx. MTX and CHOP chemo

28

Epidermoid and dermoid tumors

Non-neoplastic masses, congenital or 2/2 trauma. Rare type of brain mass. Surgical excision if sx

29

What is the most common pediatric malignant brain tumor?

Primitive neuroectodermal tumors (PNET). Located on cerebellar vermis. Tx: surgery followed by XRT

30

Glomus tumors aka paraganglioma

Arise from paraganglion cells, rare. May secrete catecholamines. Location: carotid bulb, jugular glomus body. Can present similarly to acoustic neuromas but distinguish by angiogram: glomus tumors are highly vascular.

31

What types of metastasis to the brain are radiosensitive?

SCLC, lymphoma, MM, germ cell tumors

32

Tuberous sclerosis

Ash leaf spots. Supependymal hamartomas, calcific. Causes seizures

33

Spurling's sign

Cervical spine finding- radicular pain produced with downward pressure on head when neck extended and tilted toward affected side

34

Herniated disc bulging vs protruding

Bulge is symmetric extension. Protrusion is asymmetric

35

Atlantoaxial (C1 = atlas) dislocation

RA underlies 1/4 of cases. Presents with local pain +/- hyperreflexia. If sx or atlantodental interval >6 mm, do C1-C2 fusion.

36

How to assess pathologic hyperreflexia vs benign normal variant?

In benign normal variant, jaw jerk reflex will also be hyperreflexic

37

Thoracic outlet syndrome

Thoracic outlet is the space defined by the clavicle and 1st rib- subclavian artery/vein and brachial plexus pass through. Vascular compromise > neurologic compromise. PE: rotating head away from affected side + elevation of arm reproducing sx, +/- reduction of radial pulse. Etiologies: fibrous band, elongated C7 transverse process. Tx: surgical.

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38

Papilledema

see in CHRONIC increased ICP, not acute