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surgery - quiz 3 > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

what are some drainage methods?

A

VP shunt

Burr hole

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2
Q

What do you use a craniotomy for?

A

excision/debulking of tumor

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3
Q

what do you use a cranioplasty/craniectomy for?

A
  1. elevation of depressed skull fx.

2. craniectomy + cranioplasty = replacement of bone flap

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4
Q

Type of bleeding of subdural hemorrhage?

A

venous, slow

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5
Q

Type of bleeding of epidural hemorrhage?

A

arterial, rapid

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6
Q

what is the MCC for intraparenchymal hemorrhage?

A

HTN

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7
Q

what is the MCC for subarachnoid hemorrhage?

A 
Berry anuerysm (80-90%) 
trauma
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8
Q

What are the layers covering the brain starting from the outside?

A

Scalp –> periosteum –> skull bone –> dura mater –> subdural space –> arachnoid –> subarachnoid space –> brain

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9
Q

what percentage of stroke is intracranial hemorrhage?

A

8-13%

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10
Q

what kind of hemorrhage is more likely to result in death (intracranial v. ischemic stroke)?

A

intracranial hemorrhage

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11
Q

Top three causes of ICH?

A

HTN, eclapsia,, drug abuse
ruptured aneurysm
AVM

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12
Q

MC location of ICH

A

basal ganglia, internal capsule

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13
Q

basal ganglia stroke sxs

A

contralateral hemiparesis

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14
Q

sxs of ICH

A 
Alterartion of level of consciousness 
n/v
HA
seizures 
focal neuro deficits 
nuchal rigidity
subhyaloid retinal hemorrhages 
anisocoria
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15
Q

when do you consider surgery for ICH?

A
  • hemorrhage >3cm
  • if there is vascular lesion
  • young pt c lobar hemorrhage.
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16
Q

what are the surgical approaches for an ICH?

A
  • craniotomy & clot evacuation under direct visual guidance.
  • sterotactic aspiration with thrombolytic agents.
  • endoscopic evacuation.
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17
Q

What is a subarachnoid hemorrhage?

A

extravasation of blood into the subarachoid space btwn pian and arachnoid membranes.

18
Q

subarachnoid hemorrhage presentation

A 
worst headache of life 
"thunderclap headache" 
-HA followed by imapaired consciousnes. 
-NO fever
LIFE THREATENING!
19
Q

MC of SAH?

A

trauma

20
Q

what is MC of nontraumatic SAH?

A

AVM

21
Q

what are CT findings of SAH?

A

focal high density in sulci & fissures or linear hyperdensity in the cerebral sulci.

22
Q

MC spot for cerebral aneurysm?

A

anterior circulation (anterior/posterior communicating a., MCA)

23
Q

what is a sentinel bleed?

A

sometimes the first sign of a hemorrhage. Milder sxs, pt might not have gone to the hospital.

24
Q

how many ppl with SAH get sentinel bleeds?

A

50%

sentinel bleeds can re-bleed w/in 2-6 wks.

25
Q

Diagnosis of SAH

A

CT
LP: RBC @3hrs, xanthochromia @12hours.

if +CT and LP, get angiography

26
Q

Hunt Hess for SAH: grade 0

A

asxs, unruptured aneurysm

27
Q

Hunt Hess for SAH: grade 1

A

awake, asxs, mild HA, mild nuchal rigidity

28
Q

Hunt Hess for SAH: grade 2

A

awake; moderate to severe HA, CN palsy, nuchal rigidity

29
Q

Hunt Hess for SAH: grade 3

A

lethargic; mild focal neruo deficits (eg. pronator drift)

30
Q

Hunt Hess for SAH: grade 4

A

stuporous; significat neurologic deficit (eg hemiplegia)

31
Q

Hunt Hess for SAH: grade 5

A

comatose; posturing

32
Q

what grade of Hunt Hess needs intubation & hemodynamic monitoring + stabilization?

A

grade 4 and 5

33
Q

SAH tx if ^ICP

A 
intubation and hyperventilation
Osmotic agents (eg, mannitol) 
Loop diuretics (eg, furosemide) 
IV steroids (controversial but recommended by some)
Antihypertensive agents (IV beta blockers) when mean arterial pressure >130 mm Hg 
Avoidance of nitrates (which elevate ICP) when feasible
34
Q

SAH medical managment

A
  • rebleeds
  • vasospasm
  • hydrocephalus
  • hyponatremia
  • seizures
  • pulmonary complications
  • cardiac complications
35
Q

SAH surgical tx to prevent rebleed

A
  • clipping of ruptured aneurysm

- Endovascular tx (coiling)

36
Q

SAH surgery f/u

A

1-3 wks of ICU care after aneurysm occlusion for medical complications that accompany neuro injury
need rehab after hospital

1/3 pts return to pre-SAH function

37
Q

what is an EDH?

A

hematoma btwn inner skull and the dura.

Meningeal a/temporal a. bleed.

acts as “space occupying” lesion

38
Q

EDH CT

A

lenticular shaped or convex accumulation

39
Q

what has been correlated to EDH mortality

A

-level of concsiousness prior to surgery: higher = better, coma = 20% mortality

40
Q

who does EDH affect more?

A

Males!

2-60yo (rare in age groups outside of this)

surgery - quiz 3 (2 decks)

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