Neurosurgery Flashcards
(19 cards)
What is the difference between a myelopathy and radiculopathy?
Myelopathy- pinched nerve in the spinal cord - UMN
Radiculopoathy - pitched nerve root - LMN
Which brain injury type is associated with a lucid interval?
Epidural (extradural)
What are the risk factors for atlanto-axial subluxation?
Congenital (Down’s syndrome, os odontoiduem, marfans)
Arthritic (rheumatoid, reactive, ank-spond,)
Acquired (trauma, surgery)
What are the causes of cerebral ring enhancing lesions?
Dr magic
Demyelinating disease Radiation necrosis Metastisis Abscess Glioblastoma Infarct (sub-acute phase) Contusion
What is the triad for brain abscess?
Fever, headache, neurological signs (only seen in 20%)
Other symptoms are due to space-occupying lesson, infection and focal brain damage
Treatment for bacterial brain abscess?
Hyperbaric oxygen therapy (reduced ICP, kills bacteria, improves immune function)
Give IV abx
Surgical drainage
What is Hoffmans sign?
Finger flexor reflex. Tapping middle finger, thumb flexs (+ve)
Tests the corticospinal tract.
Present in cervical compression eg spondylitis
On a head injury, what GCS score prompts a immediate CT scan?
<13 on initial assessment
< 15 at 2 hours post-injury
Also in suspected skull fracture, basal skull fracture, post-traumatic seizure, focal neurology, vomiting >1.
What’s the definitive treatment for cranial aneurysms?
1* Endovascular coil (platinuim)
2* Craniotomy and clipping
What are the investigations in someone with a subarachnoid haemorrhage?
CT
LP
Then cerebral angiogram
Which nerves innovate the diaphragm?
C3,4,5
What symptoms would be present if there was a lesion at c6/c7?
Pain from compression.
Loss of motor below c7 (quad) would only be able to move shoulder and elbow.
Loss of sensory below c7
What would you get in a brown sequard syndrome?
Ipsilateral UMN weaken, ip fine touch and proprioception. Contralateral loss pain and temperature.
What’s central cord syndrome? How does it present?
Suspended sensory level
Damage where results in inability to adduct the eye?
MLF leads to internuclear ophthalmoplegia
What are the positive findings in a cn 3 palsy and why?
Pupils - dilated and there is ptosis. Lesion stops pupil from contracting - muscle innervated by cn3
Movements - down and out
What is a RAPD?
Problem with optic nerve or retina - dilation of pupil on affected side
What is a bulbar palsy?
Lesion in CN9/10/11
Dysphonia, dysphagia, aspiration
Complications of SAH
Rebleeding - commenest cause of mortality
Cerebral ischemia - due to vasospasm
Hydrocephalus - due to blockage of arachnoid granulation
Hyponatreamia - common
