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Neurosurgery Flashcards

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1
Q

Definition of extradural haematoma

A

Bleeding into the space between the dura mater and skull

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2
Q

Causes of extradural haematoma

A

Acceleration-deceleration injury
Blow to the side of the head
Often temporal region due to bleeding in the middle meningeal artery

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3
Q

Symptoms and signs of extradural haematoma

A 
Brief post-trauma LOC follwed by lucidity, reduced consciousness, hemiparesis and ipsilateral pupil dilation
Headache
Vomiting
Seizure
Hemi hyperreflexia
Abnormal babinski (hemi)
Increased CSF opening pressure
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4
Q

Diagnosis of extradural haematoma

A

CT scan- typical lemon appearance
May cross midline unlike subdural
Frequently mass effect

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5
Q

Management of EDH

A

Less than 1cm and minimal symptoms without herniation- admit, observe, several days of steroids
Serial CT scans to follow up
If not- evacuation

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6
Q

Definition of subdural haematoma

A

Bleeding into the most external meningeal layer

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7
Q

Causes of SDH

A

Acute:
- Traumatic secondary to parenchymal laceration or acceleration deceleration
- Anticoagulant therapy
Chronic
- Past bleeds that are smaller but continue

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8
Q

Symptoms of SDH

A 
Headache
Vertigo
Amnesia
Lethargy
Decreased consciousness
Often no signs
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9
Q

Diagnosis of SDH

A

CT scan- smooth crescent shaped bleed

Oedema present, usually over the haematoma but can be diffuse

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10
Q

Management of SDH

A

Analgesia, fluids and NBM
Midline shift more than 5mm or focal signs- evacuation
Otherwise watchful waiting and serial CT scans

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11
Q

Definition of SAH

A

Haemorrhage of blood into the subarachnoid space

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12
Q

Causes of SAH

A

Trauma (most common)
Ruptured intracranial aneurysm (assoc with PKD, ehlers danlos and aortic coarctation)
Cerebral AVM
Others- CA rupture or dissection, coagulation disorders, idiopathic

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13
Q

Sx of SAH

A 
Sudden onsent severe, thunderclap headache
Nausea and vomiting
Syncope or apoplexy
Neck pain
Photophobia
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14
Q

Signs of SAH

A 
Focal nerve issues
Increased ICP and coma
Meningismus with positie Kernig's/Brudzinski sign- key SDH point of difference
Occular haemorrhage
3rd nerve palsy
HTN
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15
Q

Diagnosis of SAH

A

CT scan detects >95% of cases within 48h
LP is most definitive but must remember to take only a small amount of CSF due to rebleed risk
Sees increased opening pressure, non clotting bloody fluid, xanthochromia, increased RBC and protein
Cerebral angiogram gold standard for evaluation

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16
Q

Management of SAH

A 
ICU and hourly neuro checks
Prophylactic leviteracetam
Sedation, analgesics, dexamethasone, stool softener, oxygen, BP management
Bloods
coliling, clipping bleeders in surgery
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17
Q

Complications of SAH

A

Vasospasm- need 21 day nimodipine course to prevent
Re bleeds
Hyponatraemia secondary to SIADH but must give saline, not diuretics and fluid restriction
Seizures
Hydrocephalus

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18
Q

Definition of hydrocephalus

A

Excessive volume of ECF within the ventricular system due to production absorption-imbalance

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19
Q

Causes of hydrocephalus (categories)

A

Obstructive/non communicating
Non obstructive/communicating
Normal pressure

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20
Q

Cause of obstructive hydrocephalus

A

Blackage of CSF flow by a structure such as
tumour
avm
post haemorrhage
Aqueductal stenosis
Chiari malformation (brain tissue extending into spinal cord)

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21
Q

Causes of non obstructive hydrocephalus

A

Reduced reabsorption due to
meningitis
post-haemorrhage
Increased production due to a choroid plexus tumour

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22
Q

Causes of normal pressure hydrocephalus

A

Often idiopathic

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23
Q

Symptoms and signs of hydrocephalus

Study These Flashcards
A

O/NO: Increased ICP so

  • Headache, worse in morning lying and valsalva
  • Nausea/vomiting
  • Papilloedema
  • upgaze/abducens palsy
  • Gait change

Paeds

  • Bulging fontanelle
  • Increased head circumference relative to face size
  • Reduced upward gaze

Normal pressure
- TRIAD: dementia, incontinence and disturbed gait

24
Q

Investigations for hydrocephalus

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A

CT suggests enlargement of temporal horns

LP is diagnostic and therapeutic but NOT if obstructive due to risk of brain herniation

25
Management of hydrocephalus
Surgical: Shunt / 3rd ventriculostomy / choroid plexectomy / external ventricular drain if acute or severe Medical: Diuretics, but only temporarily and cocasionally in infants
26
What is the cushings reflex
Occurs late and often pre-terminal following brain trauma | - Bradycardia AND hypertension
27
What does a unilateral pupil dilation and sluggish/absent light reflex mean
3rd nerve palsy | May be due to tentorial herniation
28
What does a bilateral pupil dilation and sluggish/absent light reflex mean
Poor perfusion | Bilateral 3rd nerve palsies
29
What does unilateral normal/dilated pupil with marcus gunn light reaction mean
Optic nerve injury
30
What does bilateral constructed pupils with a difficult to visualise light reflex mean
Opiates Pontine lesion Metabolic encephalopathy
31
What does unilateral constructed pupils with a normal light reflex mean
Sympathetic disruption (eg. horners)
32
Definition of trigeminal neuralgia
A pain syndrome characterized by severe unilateral pain
33
Causes of trigeminal neuralgia
Often compression of trigeminal nerve by the SCA Idiopathic Tumour Vascular anomalies (rare)
34
Signs and symptoms of trigeminal neuralgia
``` Unilateral electric shock like pains coming and going abruptly Commonly evoked by light touch Frequently spontaneous Shows periods of remission No other neurology present ```
35
Red flags for trigeminal neuralgia
``` Sensory changes Hearing or ear issues History skin or oral lesions that may spread Bilateral pain Solely ophthalamic pain Optic neuro issues personal or familial MS Under 40yo ```
36
Management of trigeminal neuralgia
Carbamazepine 1st line | Peripheral branch blocks or neurectomy
37
Definition of aneurysm
A weakening of the arterial wall leading to a pressurized outpouch
38
Causes of aneurysm
``` Congenital with a defective muscular layer of artery (called medial gap) Hypertension Embolic due to atrial myxoma Infection Trauma ```
39
Varieties of aneurysm
Berry/saccular: Normally major vessels and apex of branch points such as ant or post communicating arteries Fusiform- all sides bulge, more common in basilar circulation
40
Symptoms of aneurysm
``` Rupture is the most common presentation- SAH May also cause intracranial, intraventricular or subdural bleeds Mass effect- hemiparesis Cranial neuropathy of 3rd nerve Visual loss facial pain Headache TIA Seizure ```
41
Management of aneurysm
Coiling by IR- good for elderly, poor clinical grade, post. circulation, small necked aneurysm, inaccessible by clip Clipping via surgery- good for young, MCA, giant, mass effect, small, wide necked aneurysm, previous coil failure Otherwise control HTN, soften stool etc
42
Define AVM
A vascular abnormality usually congenital and incidentally found if asymptomatic Blood flows directly into draining veins without capillary beds
43
Causes of AVM
Congenital | Often progress from low to med/hi pressure
44
Symptoms of AVM
``` Haemorrhage most common presentation Headache Seizure Ischaemic sx by steal Face or limb weakness Mass effect ```
45
Diagnosis of AVM
Unenhanced CT rules out active bleeds MRI for examining AVM and oedema Angiography shows tangle, feeding and draining vessels Graded by spetzler-martin system
46
Management of AVM
``` Depends on grade and symptoms Surgery is treatment of choice Radiation Endovascular embolization Combination therapy ```
47
Describe glioblastoma
Most common primary tumour Disrupts BBB Assoc with vasculogenic oedema
48
How does glioblastoma show on imaging
Solid centrally necrotic tumour with an enhancing rim | Pleiomorphic cells on histology
49
Treatment of glioblastoma
Surgery +/- adjuvant chemo/rad Dexamethasone for oedema
50
Describe meningioma
2nd most common primary brain tumour Typically benign Arise from dura mater
51
Where are meningiomas found
Falx cerebri, sup saggital sinus, skull base | Causes sx due to mass effect
52
How does meningioma show on imaging
CT- contrast enhancement MRI useful Histology shows spindle cells in concentric whorls, calcified psammoma bodies
53
Treatment of meningioma
Watch and wait | If troublesome sx- surgery +/- radiotherapy
54
What cancers commonly metastasize to the brain
``` Lung Breast Kidney Colorectal Skin ```
55
Describe 3rd nerve palsy sx
Eye is down and out Drooped eyelid Constricted unilateral pupil
56
Describe 4th nerve palsy sx
Affected eye moves upwards the more medially it looks
57
Describe 6th nerve palsy sx
Affected eye cannot look laterally

Clinical Medicine (5 decks)

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