Neurosurgery

Question 1

Name the 4 major spinal trauma fractures/injuries according to the Denis classification

Answer 1

• compression fracture
• burst
• flexion-distraction or seat belt type fracture
• fracture-dislocation

Question 2

Cervical flexion myotome

Answer 2

C1,c2

Question 3

Cervical side flexion myotome

Answer 3

C3

Question 4

Scapula elevation myotome

Answer 4

C4

Question 5

Shoulder abduction myotome

Answer 5

C5

Question 6

Elbow flexion myotome

Answer 6

C6

Question 7

Wrist extension myotome

Answer 7

C6

Question 8

Wrist flexion myotome

Answer 8

C7

Question 9

Elbow extension myotome

Answer 9

C7

Question 10

Thumb extension myotome

Answer 10

C8

Question 11

Finger abduction myotome

Answer 11

T1

Question 12

Hip flexion myotome

Answer 12

L1 l2

Question 13

Knee extension myotome

Answer 13

L3

Question 14

Ankle dorsiflexion myotome

Answer 14

L4

Question 15

Big toe extension myotome

Answer 15

L 5

Question 16

Ankle plantarflexion myotome

Answer 16

S1

Question 17

Knee flexion myotome

Answer 17

S 2

Question 18

Name nine risk factors for blunt cerebro-vascular injury ( BCVI ) that needs Ct angio screening

Answer 18

• unexplained neuro deficit
• arterial epistaxis following blunt head trauma
• GCS <8
• petrous bone fracture evidence
• dai and GCS <6
• C spine fractures especially involving foramen transversarium
• C spine fractures with subluxation or rotational components
• Le fort 2-3 facial fractures or bilateral mandibular fracture
• near hanging or strangulation

Question 19

Name 4 signs of basal skull fracture

Answer 19

•Haemotympanum
• raccoon eyes
• CSF otorrhea or rhinorrhea
. Battles sign

Question 20

Primary arterial supply of spine?

Answer 20

Anterior spinal arteries that originate as paired branches of vertebral arteries that join just below basilar artery
Posterior columns supplied by posterior spinal arteries

Question 21

Venous drainage of spine? (3)

Answer 21

Batson’s plexus
• extradural vertebral venous plexus
• extravertebral venous plexus
• veins of bony structures of spine

Question 22

Define neurogenic shock cause and symptoms (6)

Answer 22

• occur due to loss sympathetic autonomic supply
• usually lesions above T 1
. Hypotension’s not responsive to fluids.vasopressors may be required (dobutamine)
• loss muscle tone, venous pooling, hypovolaemia
• bradycardia due to unopposed parasympathetic

Question 23

Define spinal shock cause and symptoms (4)

Answer 23

• Transient loss motor activity below level of lesion
. Return of bulbocavernosus reflex signal end
• poor prognostic sign for serious spinal cord injury
• abate 72 hours to weeks to months

Question 24

Define autonomic dysreflexia cause and symptoms ( 10)

Answer 24

• Opposite of neurogenic shock
• usually injuries above t6
. Bouts severe paroxysmal ht, due to sympathetic overdrive
• throbbing headaches, nasal stuffy, cognitiveimpair, feeling of doom
. Profuse sweating, skin flush, anxiety
• usual triggers are bladder distension, fecal impaction
• Medical emergency
• priapism poor prognostic sign!

Question 25

Where does spinal cord end?

Answer 25

L1/L2

Question 26

Where is t12 segment of spinal cord found in relation to vertebrae?

Answer 26

T 9

Question 27

Where is t8 segment of spinal cord found in relation to vertebrae?

Answer 27

T6

Question 28

Clinical level of t1-t6 lesion?

Answer 28

Add 1. Eg T 1 injury is clinical level t2

Question 29

Clinical level of t7-t 9 lesion?

Answer 29

Add Two. Eg t8 lesion at clinical level t10

Question 30

Clinical level of T10 lesion?

Answer 30

L1 l2

Question 31

Clinical level of t11 lesion?

Answer 31

L3 L 4

Question 32

Clinical level of t 12 lesion?

Answer 32

L5

Question 33

Clinical level of l1 lesion?

Answer 33

Sacrococcygeal

Question 34

Define incomplete spinal lesion (4)

Answer 34

• Any residual motor or sensory function more than 3 segments below level of injury . Preserved long tract signs • sensation or voluntary movement in lower limbs in presence of C spine or t spine injury . Sacral sparing (does not qualify with this alone)

Question 35

Define complete spinal cord lesion

Answer 35

• No preservation of any motor or sensory function more than 3 segments below level of injury • In absence of spinal shock • catastrophic trauma • 3% may develop some recovery in 24 hours

Question 36

Name injury and symptoms of brown Sequard syndrome (4)

Answer 36

• Hemi-transection of spinal cord • ipsilateral pyramidal tract loss • ipsilateral dorsal tract loss • contralateral spinothalamic tract loss

Question 37

Name injury and symptoms of central cord syndrome (2)

Answer 37

• Hyper extension injury in older patients with pre-existing spondylosis • motor weakness ul > ll

Question 38

Name injury and symptoms of anterior cord syndrome (4)

Answer 38

• Anterior compression or ASA occlusion • motor paralysis below level injury - corticospinal tracts • loss spinothalamic tracts • spare dorsal tracts

Question 39

Name symptoms of posterior cord syndrome (4)

Answer 39

• spare corticospinal. so motor function preserved • loss dorsal tracts •spinothalamic tracts spared

Question 40

Name symptoms of conus medullaris syndrome (4)

Answer 40

• Sudden and bilateral (last part spine) . Back pain more severe than radicular pain • numbness located to perianal area • urinary retention and atonic anal sphincter

Question 41

Name symptoms of cauda equina syndrome (4)

Answer 41

• Gradual and unilateral . Radicular pain more severe than back pain . Asymmetric areflexic paraplegia . Urinary retention

Question 42

Name the 5 grades of the aisa classification of spinal cord injury

Answer 42

A - no motor or sensory function preserved in sacral segments B- sensory but not motor function preserved in at least sacral segments C-motor function preserved below neurological level and most key muscles have motor score <3 D-motor score ≥3 E-motor and sensory normal

Question 43

Define an unstable vertebral fracture (5)

Answer 43

• > 50% columns involved (1 or more) • increased or decreased intervertebral space height • interspinous distance increased • facet joint widening • > 25% vertebral compression visible on xray

Question 44

Name the 4 minor spinal trauma fractures according to the Denis classification

Answer 44

• Transverse process fracture • burst • pars interarticularis • spinous process

Question 45

Cerebral perfusion pressure formula?

Answer 45

Map-icp

Question 46

Marshall radiologic classification of TBI (6)?

Answer 46

• Diffuse injury 1: no visible pathology • diffuse injury 2: midline shift 0-5mm • diffuse injury 3 (swelling): midline shift 0-5 mm and basal cisterns compressed or completely effaced • diffuse injury 4 (shift): midline shift > 5 mm • evacuated mass lesion 5: any lesion evacuated surgically • non-evacuated mass lesion 6: high or mixed density lesions > 25 cm3

Question 47

Appearance extradural haemorrhage on ct?

Answer 47

Lenticular shape

Question 48

Appearance subdural haemorrhage on ct?

Answer 48

Crescent shaped

Question 49

Normal ICP adults?

Answer 49

0-15

Question 50

What is neurotremesis?

Answer 50

Nerve transection