Neurosurgery Flashcards
(103 cards)
1
Q
Nonfluent aphasias, presentations
A
Brocas - poor speech output, pt aware
2
Q
Fluent aphasias, presentations, causes
A
Wernickes - comprehension and repetition impaired, normal melody of speech but incorrect words
Anomic - repetition and comprehension intact, poor naming, d/t ICP/Alzheimer’s/drugs
Conduction - comprehension good, but repetition poor, d/t arcuate fasciculus lesion
3
Q
Global aphasia presentation, cause
A
nonfluent speech, impaired comprehension and repetition
- MCA stroke
4
Q
Glasgow coma scale (GCS) measures degree of ________. It takes into account ___+____+____
A
- head trauma
- eye movements, verbal commands, motor response
5
Q
Explain the scoring for eye movements on GCS
A
4 - spontaneous
3 - to voice
2 - to pain
1 - not at all
6
Q
Explain the scoring for verbal commands on GCS
A
5 - oriented to person, place, time 4 - confused 3 - inappropriate words 2 - incomprehensible sound 1 - none
7
Q
Explain the scoring for motor movements on GCS
A
6 - obeys commands 5 - localizes pain 4 - nonpurposeful response to pain 3 - flexion in response to pain 2 - extension in response to pain 1 - no pain response
8
Q
What GCS scores indicate mild, moderate, and severe head injury?
A
Mild - 13-15
Moderate - 9-12
Severe - <8
9
Q
Indications for CT in context of head injury (3)
A
- LOC >5 min
- GCS <13
- symptomatic
10
Q
Management for moderate head injury per GCS
A
CT + q1h checks in ICU
11
Q
Management for severe head injury per GCS
A
CT + thorough w/u
12
Q
Decorticate posture
A
flexed UE, extended LE
13
Q
Decerebrate posture
A
extended UE and LE
14
Q
Intracranial hematoma/mass would produce ____ _____ posturing
A
contralateral decerebrate
15
Q
dilated pupil (unilateral) indicates ______
A
unilateral uncal herniation
16
Q
b/l dilated pupils _______
A
b/l uncal herniation
17
Q
b/l constricted pupils
A
pontine hemorrhage
18
Q
Cheyne-Stokes respiration
A
deep cerebral hemisphere injury
19
Q
Resuscitation for head injury? If focal injury? If unilateral posturing? If >5-10 mm shift?
A
IVF, +/- dexamethasone
if focal injury - phenytoin
if unilateral posturing - mannitol
if >5-10 mm shift - surgery
20
Q
Uncal herniation s/sx
A
- ipsilateral pupil dilatation (PSNS lost first)
- 3rd nerve palsy
- contralateral weakness/posturing (pyramidal compression
Nb. pupillary dilatation more representative of the side of herniation (as opposed to which side has the hemiparesis)
21
Q
Tx for uncal herniation (5)
A
Intubation, hyperventilation, mannitol, furosemide, surgery
22
Q
Foramen magnum herniation s/sx
A
- Early - posterior h/a, neck stiffness, vomiting, gait disturbance)
- drowsiness
- possible cushing response (HTN, bradycardia, resp arrest)
23
Q
Tx for foramen magnum herniation
A
emergency surgery for decompression
24
Q
Anterior SCI s/sx
A
Movement - lost b/l
Posterior column fxn intact
25
Central SCI s/sx (4)
- Weakness
- hypoesthesia of UE
- gait disturbance
- incontinence
26
Tx of SCI
alignment, Methylprednisolone, foley
| +/- CP resuscitation
27
Workup of SCI (6)
- assess neck
- document ext sensation/movement
- neuro assessment
- ABG
- CMP
- typing
28
Cervical SCI tx
traction ?probably a c-spine collar
29
spinal shock s/sx (2)
- hypotension
| - warm extremities d/t autonomic dysfxn
30
Para/quadriplegia causes? w/u (2)?
causes - acute disc herniation, epidural tumor
| w/u - spine films, MRI* or myelography
31
When you see ataxia think _____
cerebellar mass
32
cerebellar mass s/sx (3)
- h/a
- N/V
- weakness of conjugate gaze to side of lesion
33
cerebellar mass w/u?
- CT diagnostic
| - MRI for more thorough eval
34
coma + stiff neck = ___ or ____ or ____
meningitis
SAH
encephalitis
35
Causes of a coma (12)
```
Mnemonic: 2I'd (eye'd) HAMMSSTTEEr
Infection
Infarction
Hematoma
Abscess
Metabolic
Meningitis
SAH
Seizure
Trauma
Tumor
Encephalopathy
Encephalitis
```
36
W/u for coma (5)
- CT
- LP (if no mass)
- Vitals
- EKG
- CXR
37
Tx for coma (5)
- ABC
- IVF
- foley, NGT
- Thiamine/D50W/naloxone
- Cspine
38
Status epilepticus tx (4)
- ABC
- thiamine/D50W
- Phenytoin (50 mg/min to 1000 mg, i.e., for 20 min)
- Ativan 2 mg IV
39
Meningitis w/u (4)
- CT
- LP w/gram stain
- India ink stain
- cultures
40
____ strokes most common
ischemic (80%)
41
Symptomatic tight stenosis, >65% occlusion of vessels, or complex ulcer should get ____
endarterectomy
42
noncomplex ulcer of bvs tx'ed w/______
anticoagulation
43
thrombotic strokes tend to be 2/2 ____ and sx resolve in _____hr
- HTN
| - 48
44
Vertebrobasilar strokes usually 2/2 ______ which can cause ____ and ____, or can be 2/2 ______
atherosclerosis
subclavian steal
basilar artery stenosis
cervical osteophytes
45
Subclavian steal
pre/syncope 2/2 collateral blood flow from the vertebral arteries to the arm
46
Locked in syndrome can be caused by
basilar artery stenosis
47
If hypotensive stroke you would also expect to see?
anteriorly - shoulder/anterior thigh weakness
| posteriorly - visual difficulties, memory difficulties
48
RFs for hemorrhagic stroke
AVM, aneurysm, HTN, anticoagulation
49
Indications for surgical correction of hemorrhagic stroke (4)
- cerebellar stroke
- lobar (esp temporal)
- caudate
- putamen (non-dominant side)
50
h/a, gaze paresis towards lesion and ataxia are sx of ___ stroke
cerebellar
51
midline shift, drowsiness are sx of ____ stroke
lobar
52
behavioral disturbances is a sx of ___ stroke
caudate
53
hemipelgia and gaze paresis towards the lesion are sx of ____
non-dominant putamen stroke
54
nonsurgical strokes (4)
- thalamic
- pontine
- tegmental
- putamen (dominant side)
55
sensory dysfxn, poorly reactive pupils are sx of ____ stroke
thalamic
56
coma, qudriplegia, pinpoint pupils are sx of ___ stroke
pontine
57
ipsilateral horner's, ataxia, hemisensory loss, abnormal eye movements are sx of _____ stroke
tegmental
58
SAH causes (4)
- trauma
- aneurysms
- AVM
- HTN
59
Causes of aneurysms (7)
```
Mnemonic - "Make SAH"
Marfan's
Aortic coarctation
Kidney disease (polycystic AD)
Ehlers-Danlos
SSA
Atherosclerosis
Hx (FMHx)
```
60
S/sx of SAH
- Worst h/a of my life
- vision changes (compression of aneurysm if around PCA/superior cerebellar artery)
- mydriasis
- LOC
- Meningeal irritation (neck stiffness, photophobia, N/V)
- Sentinel bleed (d/w earlier, marked by abrupt onset of h/a, n/v, transient diplopia that resolved in min/hrs)
- hydrocephalus (presents as drowsiness; 2/2 increased absorption of blood into CSF sinuses causing communicating hydrocephalus)
61
Tx of SAH
- prevent rebleeding - SBP < 150 using Hydralazine or Nitroprusside
- head elevation (to decrease ICP)
- hyperventilation (decreases CO2 which decreases blood flow to the brain)
- Nimodipine (CCB) to decrease vasospasm
- Seizure ppx (phenytoin)
- +/- ventricular drain (if hydrocephalus)
- +/- surgery
62
Which requires early surgery and which requires non-emergent surgery of the following: Berry aneurysm, AVM
- Berry - ASAP surgery for clipping/intravascular coiling
| - AVM - non-emergent excision
63
______ is the most common vascular dz of the SC
Dural AV fistula (nidus w/in the dura)
64
Dx modality of vascular dz of SC _____
MRI
65
What vascular dz do you never see in the SC?
aneurysms
66
Tx of vascular dz of SC
hemilaminectomy w/coagulation of intradural draining vessel (for fistula)
67
Cervical disk disease in young patients presents as _________
severe neck and arm pain
68
Cervical disk disease in old patients presents as _____
chronic course w/recurrent episodes of arm and neck pain (spondylosis)
69
Etiology of cervical disk disease in old patients?
- osteophytes, hypertrophy of facet joints
| - C5-T1 affected
70
S/Sx of degenerative disk disease (5)
- pain
- parasthesia
- weakness
- h/a
- radiculopathy
71
Radiculopathy from C6 sx
- parasthesias of thumb + index finger
| - weakness of biceps
72
Radiculopathy from C7 sx
- parasthesias of middle finger
| - weakness of triceps
73
Radiculopathy from C8 sx
- parasthesias of ring and pinky fingers
| - weakness in intrinsic hand muscles
74
Tx of degenernative disk dz
- Anti-inflammatories
- Muscle relaxants
- moderate cervical traction
75
What is the utility of surgery in context of degenerative disk dz?
- not helpful for chronic pain, but may reduce radiculopathy or myelopathy
- indicated for severe pain 2/2 acute soft disk rupture
- usually posterior laminectomy performed
76
4 syndromes of lumbar disk dz
- recurrent lower back pain
- acute monoradiculopathy
- cauda equina
- "failed back"
77
Recurrent lower back pain
a/w back spasms, limited motion
78
acute monoradiculopathy
pain radiates to foot/leg, worse with sneezing or coughing
79
cauda equina syndrome
saddle anesthesia, bowel/bladder incontinence, pain in legs
80
Failed back
back pain following back surgeries
81
Radiculopathy vs. myelopathy
- radiculopathy - damage/compression of nerve roots (peripheral NS), non-emergent
- myelopathy - damage/compression of SC, emergent
82
Positive straight leg raise test indicates
HNP
83
Tx for HNPs
most resolve spontaneously over 12 wks (if greater = chronic), but can use epidural corticosteroid injections, NSAIDs/narcotics, PT/OT. If it's refractory can do surgical laminectomy/discectomy
84
Lumbar stenosis differs from HNP in that _____
HNP - unilateral leg pain (can be b/l but usually worse on one side)
LS - b/l leg pain
85
Etiology of LS
- degeneration of intervertebral disks causing increased stress on facet joints, causing hypertrophy of the ligamentum flavum and then compression of the nerve roots/spinal cord
86
disk degeneration to <9 mm indicates _____
- always pathologic
| - stenosis
87
S/sx of LS (5)
- worse w/walking/standing, and takes a while for the pain to abate when sitting
- a/w numbness
- a/w spasticity
- NEGATIVE straight leg raise test
- neurogenic claudication, proximal first, shopping cart sign
88
DDx for LS
- vascular claudication (pain decreases rapidly when movement stops)
- Cauda Equina syndrome (saddle anesthesia, bowel/bladder dysfxn, impotence)
- Hematoma
- AVN
- tumors
- Pagets
- Ankylosing spodylitis
89
Tx for LS
- Medical pain management first (heat, analgesics, antispasmodics)
- Laminectomy for more advanced disease
90
In the setting of increased ICP, steroids (i.e., ____) are ONLY used for ____ and _____
- decadron (dexamethasone)
- decreasing cerebral edema 2/2 abscess
- decreasing cerebral edema 2/2 tumor
91
When an adult has a brain tumor, think ___, ___, or ___
- mets
- GBM
- meningioma
92
When an child has a brain tumor, think ___, or ___
- medulloblastoma
| - pilocytic astrocytoma
93
Most common brain mets (first 5)
lungs > breast > kidney > GI > melanoma
94
Tx for brain tumors
- chemo/XRT
- decadron (dexamethasone ) for vasogenic edema
- anti-epileptics (AEDs)
- surgery (debulking)
95
(T/F) Most brain abscesses are 1 microbe
False - most are polymicrobial
96
Leading organisms (7)
- anaerobic (bacteroides)
- staph, strep, gram (-)'s
- Fungal - aspergillus, candida
- Toxo
97
S/Sx of brain abscess
```
Triad:
- H/a
- Focal neurologic deficit
- FEVER
Increased ICP can cause CN III and VI deficits
```
98
Dx of brain abscesses
- CT scan for ring enhancing lesions
- ESR
- CRP
- NO LP!
99
ophthalmoplegia (EOM paralysis) + severe H/a + visual field defect = _______
Pituitary apoplexy (hemorrhage into pre-existing tumor d/t vasculature of pit tumor)
100
Syringomyelia S/Sx (4)
- b/l pain and temp loss in upper extremities
- UE weakness
- sensory loss in cape distribution
- leg spasticity
101
Causes of syringomyelia
- trauma
- Potts (TB of vertebrae)
- ependymomas
- Chiari type I
- arachnoiditis (causes scar formation/adhesions forming syrinx and hydrocephalus)
102
Dx of syringomyelia
MRI of c spine
103
treatment of syringomyelia (4)
- decompression
- dural grafting
- peritoneal shunting
- ventricular shunting
