Neurosurgical Clinical Assessment Flashcards Preview

Yr 2 Nervous System > Neurosurgical Clinical Assessment > Flashcards

Flashcards in Neurosurgical Clinical Assessment Deck (15)
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1
Q

Define an obtunded patient?

A

Altered level of consciousness, can be found in any situation
Most history will come from bystanders or paramedics

2
Q

How do you assess an obtunded patient?

A
  • ABC
  • Glasgow Coma Scale (Usually detecting some sort of perfusion issue)
  • Pupils (Strange pupils may mean cerebral herniation
3
Q

How do we calculate Cerebral Perfusion Pressure

A

CPP = MAP - ICP

4
Q

How does ICP change as the volume inside the skull increases? (E.g. froma haemorrhage)

A

At first the ICP stays relatively normal as the body compensates by shunting out CSF and blood

But after that it rises rapidly with increases in volume

(Monro-Kelly Doctrine - CSF+Blood+Brain+Other = VolumeICspace)

5
Q

How would examining the pupil indicate cerebral herniation?

A

Parts of temporal lobe can herniate through the tentorium cerebelli (Uncal Herniation), pressing on the III nerve causing relative afferent pupillary defect

6
Q

What is the cushing response?

A

A physiological response to raised ICP, usually indicating terminal head injury and imminent herniation:

  • Raised Systolic BP (Wide Pulse Pressure)
  • Bradycardia
  • Irregular breathing
7
Q

How would you assess a non-communicating patient?

A
  • Speech
  • Posture, movements, neglect, eye movement
  • Mini-mental score
8
Q

What tests can we use to assess what parts of the cortex and spinal cord are involved in different functions?

A
  • Functional MRI scans

- Diffusion Tensor Imaging (Tractography) to see active fibres in spinal cord

9
Q

which cerebral hemisphere handles language/speech?

A

Well both but in 90% of people the left is dominant

10
Q

What are the major Brodmans areas we need to know?

A

1-3 - Post Central Gyrus - Primary Somatosensory cortex
4- Precentral Gyrus - Primary Motor Cortex
5 - Sup Parietal Lobule - Somatosensory Association Cortex
6 - Pre motor & Supplementary motor areas
17 - Primary Visual Cortex
18 & 19 - Secondary Visual & Association Visual Cortex
22 - Sup Temporal Gyrus - includes Wernicke’s Area
41 & 42 - Heschl Gyrus -
Primary Auditory Cortex
44 & 45 - Inferior Frontal Gyrus - Broca’s Area

11
Q

How does a myelopathy present?

A
  • USually cervical or thoracic
  • Produces a motor and sensory level
    UMN signs:
  • Clonus
  • Babinski’s Sins
  • Hoffman’s Sign
  • Increased Tone/Spasticity
  • Hyperreflexia
  • Impaired proprioception
12
Q

How does a radiculopathy (e.g. Slipped Disc) present?

A
  • Sensory disturbance in a single dermatome
  • Weakness in matching myotome
  • Hyporeflexia
13
Q

How do numbers of a spinal nerve and its vertebrae relate?

A

Most spinal nerves exit under the peduncle of the same numbered vertebra.

In the C-spine there are 7 vertbrae and 8 nerves so they are numbered by the vertebrae they come above

14
Q

What is cauda equina syndrome?

A

Something compresses the nerve roots in the cauda equina.

e.g. herniated disc

15
Q

Some good example cases in this ppt

A

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