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Flashcards in Neurosurgery emergencies Deck (18)
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1
Q

Why can’t a spinal cord lesion lead to complete hemiparalysis?

A

much more likely to be cortex as the damage to the spinal cord would have to be high up and is more likely to have bilateral effects due to proximity of tracts within the spinal cord. Not impossible but highly unlikely

2
Q

Why is GCS useful?

A

intubation <8. However total score doesn’t reflect individual components…therefore could be some serious issues. Therefore always specify individual components

3
Q

What does a score of M3 suggest on GCS?

A

you have no more cortical input…reliance on primitive tracts of brainstem (rubrospinal response)

4
Q

Why does herniation of uncus cause third nerve palsy?

A

uncus=innermost part of temporal lobe
Left sided intracranial mass, close proximity of uncus and third CN, therefore compression, leading to dilated pupil and down and outwards gaze

5
Q

Where is the most common site of extradural haematoma?

A

middle meningeal artery- pterion

6
Q

How to manage traumatic brain injury without intervention?

A

keep head up (unless neck injury ID) to encourage venous flow and to reduce pressure within cranial system

Avoid coughing, vomiting, pain, constipation

Mannitol

7
Q

Three differentials for shooting pains down back of leg with lower back pain?

A
sciatica
radiculopathy 
slipped disc
discitis
ilias psoas abscess
malignancy
spinal stenosis
vascular arterial insufficiency!!!!
8
Q

At what level does the spinal cord terminate?

A

L1/L2

9
Q

What do the sacral nerve innervate?

A

lower limbs
bladder and bowel
perianal region

10
Q

Does cauda equina syndrome cause bilateral or unilateral symptoms

A

bilateral as there is a central prolapse

11
Q

Which points in history would worry you about bilateral leg pain

A
bilateral
urination problems
numbness/tingling in perianal region
altered bowel function 
altered sensation of passing urine
12
Q

Would you have UMN or LMN signs in cauda equina syndrome?

A

UMN…spinal cord terminated in lumbar not sacral

13
Q

Describe three aspects of a clinical examination of a patient with bilateral leg pain with concern for cauda equina

A
lower limb sensation
lower limb motor
saddle anaesthesia
anal tone absence
perianal reflex- absent
14
Q

What are the four stages of cauda equina syndrome development

A

suspected
incomplete
with retention
complete

15
Q

List two features of suspected cauda equina

A

bilateral sensory and motor weakness

16
Q

Incomplete?

A

beginnings of sphincteric involvement
not in urinary retention
urinary symptoms
saddle/perianal anaesthesia

17
Q

Complete?

A

no bowel or bladder control
no sexual function
therefore do no leavea a patient with cauda equina syndrome!!!

18
Q

List two investigations for cauda equina syndrome

A

post-void bladder scan

non-contrast MRI lumbrosacral spine