Passmed: Neuro

Question 1

What are the clinical signs of hydrocephalus? (5)

Answer 1

Inc head circumference, open ant fontanelle will bulge and become tense, failure of upward gaze, dilated scalp veins, bradycardia

Question 2

Why do pts w hydrocephalus px w failure of upward gaze?

Answer 2

Compression of the superior colliculus of the midbrain

Question 3

Aetiology of obstrc and non-obstrc hydrocephalus

Answer 3

Obstrc: tumour, intraventricular/subarachnoid haemorrhage, aqueduct stenosis

Non-Obstrc: meningitis, post-haemorrhagic, choroid plexus tumour

Question 4

What is the triad of sx for normal pressure non-obstrc hydrocephalus?

Answer 4

Dementia, incontinence, disturbed gait

Question 5

Typical subdural haematoma pt

Answer 5

Elderly alcoholic on anticoag w hx of head injury and insidious onset of fluctuating confusion and dec consciousness

Question 6

When does diffuse axonal injury occur?

Answer 6

When the head is rapidly ac/decelerated

Question 7

Imaging: Extradural vs Subdural

Answer 7

convEX=EXtradural

Question 8

Cushings triad of raised ICP

Answer 8

HTN, bradycardia, irregular respirations

Question 9

When should you CT head immediately following head injury?

Answer 9

GCS <13 on initial ass or <15 at 2hrs

Suspected open/depressed skull # or any sign of basal skull #

Post-traumatic seizure or focal neuro deficit

> 1 episode of vomiting

Question 10

What are the signs of basal skull #? (4)

Answer 10

Panda eyes, CSF leakage from nose/ear, Battle’s sign, haemotympanum

Question 11

When should you CT head within 8hrs following head injury?

Answer 11

If they’re on warfarin OR amnesia/LOC since injury who are 65+yrs, hx of clotting disorders, dangerous mech of injury, >30mins retrograde amnesia

Question 12

What is the minimum cerebral perfusion pressure in adults + children?

Answer 12

Adults: 70mmHg | Children: 40-70mmHg

Question 13

Oculomotor nerve lesion (3)

Answer 13

Down and out eye, loss of accommodation, pupillary dilation

Question 14

Ddx of bilaterally constricted eyes (3)

Answer 14

Opiates, pontine lesions, metabolic encephalopathy

Question 15

What are causes of spontaneous SAH? (3)

Answer 15

Intracranial aneurysm, AV malformation, pituitary apoplexy

Question 16

What conditions are a/w berry aneurysms? (3)

Answer 16

PCKD, Ehlers-Danlos, Coarctation of the Aorta

Question 17

How do you confirm SAH?

Answer 17

CT -> if neg perform LP @ 12hrs to distinguish b/w a traumatic tap

Question 18

What findings in the CSF would prove SAH?

Answer 18

Xanthochromia w N/raised opening pressure

Question 20

What should you do as soon as SAH is confirmed?

Answer 20

Refer to neurosurgery, identify cause w CT intracranial angiogram +/- catheter angiogram, keep on bed rest w well controlled BP

Question 21

Tx for spontaneous SAH caused by intracranial aneurysm

Answer 21

Ideally within 24hrs

Majority: coil by interventional neuroradiologist

Minority: craniotomy and clipping by neurosurgeon

Question 22

Comps of aneurysmal SAH (5)

Answer 22

Rebleeding, vasospasm, hypoNa, seizures, hydrocephalus

Question 23

How do you prevent vasospasm?

Answer 23

21d course of nimodipine