Neurosurgery Module- Trauma and CSF

Question 1

what does the glasgow coma scale measure?

Answer 1

a patient’s level of consciousness in response to a stimulus

Question 2

decorticate posturing indicates brain damage to where?

Answer 2

cerebrum
internal capsule
thalamus

Question 3

what area is spared in decorticate posturing?

Answer 3

midbrain

Question 4

what kind of posturing presents with arm flexion?

Answer 4

decorticate

Question 5

what is the more severe out of decorticate and decerebrate posturing?

Answer 5

decerebrate

Question 6

decerebrate posturing indicates brain damage to what area specifically?

Answer 6

area below the red nucleus in the midbrain

Question 7

the reticulospinal tract causes flexion/extension

Answer 7

extension

Question 8

the body is primarily in extension/flexion in decerebrate posturing

Answer 8

extension

Question 9

total volume of CSF is…

Answer 9

150ml

Question 10

how much CSF is produced daily?

Answer 10

450ml

Question 11

why do you get ischaemia from increased CSF?

Answer 11

the increased ICP decreases cerebral blood flow physiologically

Question 12

diplopia can be caused by what kind of herniation and why?

Answer 12

central herniation of the brainstem

can cause a CN6 palsy

Question 13

an extradural haematoma is accumulation of blood between…

Answer 13

bone and dura

Question 14

most common source of bleeding is from disruption of what artery?

Answer 14

middle meningeal

Question 15

what common location for an EDH

Answer 15

temporoparietal region

Question 16

young adult with closed head trauma who has loss of consciousness that quickly resolves followed by symptoms…

Answer 16

EDH

Question 17

what symptoms present in EDH after consciousness is regained?

Answer 17

headache
N+V
contralateral hemiparesis
ipsilateral pupillary dilatation

Question 18

why do pupils dilate in EDH

Answer 18

haematoma causes the uncus of the temporal lobe to herniate and compresses on the pupillary fibres of CN 3

Question 19

imaging modality of choice in patients with head trauma?

Answer 19

CT head

Question 20

haematoma looks white/black on CT

Answer 20

white

Question 21

most SDH’s present __laterally in adults

Answer 21

uni

Question 22

bilateral SDHs are more common in…

why is this?

Answer 22

children

less adhesions in the subdural space

Question 23

how long does chronic SDH take to present?

Answer 23

3-7 weeks

Question 24

does EDH or SDH deteriorate faster? why?

Answer 24

EDH because arteries are there, SDH involves veins

Question 25

driving pathological factor for chronic SDH

Answer 25

brain atrophy causes veins to stretch and become easily ruptured which then causes an osmotic gradient

Question 26

acute SDH clinical features

Answer 26

SEVERELY decreased state of consciouscness

Question 27

PC of chronic haematoma

Answer 27

headache | confusion

Question 28

"crescent shaped hyperdensity on CT"

Answer 28

acute SDH

Question 29

"crescent shaped hypodensity o nCT"

Answer 29

chronic SDH

Question 30

name the triad of symptoms in normal pressure hydrocephalus

Answer 30

1. shuffling gait dementia incontinence

Question 31

how do communicating and non-communicating hydrocephalus differ?

Answer 31

communicating is enlargement of the ventricular system with NO obstruction of flow whereas non-communicating does

Question 32

how could you tell on imaging if the hydrocephalus is communicating or non-communicating?

Answer 32

if the 4th ventricle is small in comparison to the other ventricles -> non-comm

Question 33

congenital hydrocephalus is mainly due to what condition?

Answer 33

aqueductal stenosis

Question 34

"cracked pot sound on head percussion"

Answer 34

congenital hydrocephalus

Question 35

there is impaired _gaze in hydrocephalus

Answer 35

upgaze

Question 36

hydrocephalys history q's?

Answer 36

antenatal and birth history milestones ICP symptoms recent trauma/infection

Question 37

when should you do a CT and MRI in hydrocephalus?

Answer 37

CT best for acute scenario to confirm diagnosis | MRI for cause and site of obstruction

Question 38

chiari malformations are located in what area of the brain?

Answer 38

hindbrain

Question 39

most common chiari malformation?

Answer 39

chiari 1 malformation

Question 40

associated conditions along with a chiari 1 malformation?

Answer 40

syringomyelia

Question 41

what is the patients headache like in a chiari 1 malformation?

Answer 41

headache worse on coughing and neck extension with sub-occipital pain

Question 42

"cape-like sensory loss of pain and temperature"...

Answer 42

syringomyelia

Question 43

which chiari malformation is more severe?

Answer 43

chiari 2

Question 44

chiari 2 malformations are related to what condition?

Answer 44

spina bifida

Question 45

Tx of chiari malformations?

Answer 45

surgery for decompression

Question 46

what is the headache like in IIH?

Answer 46

throbbing, worse in morning, relieved on standing

Question 47

"slit-like ventricles"

Answer 47

IIH