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Flashcards in Pestana Neurosurgery Deck (17):

What are the two most common locations of occlusion that cause TIA?

>70% stenosis of internal carotid or an ulcerated plaque at the carotid bifurcation.


A patient complained that earlier in the day they suffered a 5 minute bout of aphasia. They experienced no headache? What is this predictive of? Tests? Treatment?

Transient Ischemic Attack. Future strokes. Duplex studies (sonogram + Doppler). Carotid endarterectomy.


A patient with a history of HTN presents with sudden severe neurological deficits for several hours. He doesn't complain of a headache? Is effective revascularization likely? Tests? Treatment?

Ischemic stroke. No. CT scan. IV tissue-type plasminogen activator (t-PA) started between 1.5-3 hours after onset of symptoms. Rehab.


A patient with a history of HTN presents with a severe headache and goes on to develop neurologic deficits? Tests? Treatment?

Hemorrhagic stroke. CT scan. Therapy and rehab.


A patient complains of the worst headache of their life, meningeal irritation and nuchal rigidity (neck stiffness)? If they are sent home, why would they return 10 days later? Tests? Treatment?

Subarachnoid bleed from intracranial aneurysm. Same symptoms, second bleed (first bleed called sentinel bleed). CT scan, arteriogram (find aneurysm often found at circle of Willis. Clipping or endovascular coiling.


A patient complains of a few months of increasingly painful headaches that is worse in the mornings, blurred vision, papilledema, projectile vomiting. They eventually develop bradycardia and hypertension? Tests? Treatment?

Brain tumor. MRI. Give steroids to treat ICP before surgery.


Symptoms of a brain tumor at the base of the frontal lobe (4)? Name?

Inappropriate behavior, ipsilateral optic nerve atrophy, contralateral papilledema, and anosmia (can't smell). Foster-Kennedy syndrome.


A young patient who appears short for their age presents with bitemporal hemianopia? Tests and sign?

Craniopharygioma. CT scan = calcified lesion above the sella.


A young female patient presents with amenorrhea and galactorrhea. Which conditions must be ruled out? Cause? Tests? Treatment?

Prolactinoma. Hypothyroidism and Pregnancy. Pituitary pumping out prolactin. Measure Prolactin and MRI. Bromocriptine (dopamine agonist), potentially trans-sphenoidal surgical removal.


A man presents with big ass hands, feet, tongue and jaws. He also has diabetes, HTN, and a history of hats that no longer fit? Cause? Tests? Treatment? Reversibility?

Acromegaly. Pituitary pumping out growth hormone. Measure somatomedin-C (IGF-1), and MRI of pituitary. Surgical removal. No, somatic changes are permanent.


A man with a PMH of headache and visual loss presents with severe headache and further deterioration of his vision, he soon becomes hypotensive? Cause? Tests? Treatment? Cause of hypotension?

Pituitary apoplexy. Destruction of gland from bleeding of a pituitary tumor. MRI or CT. Urgent steroid replacement. No ACTH.


A patient presents with loss of upper gaze (sunset eyes)? Name?

Pineal gland tumor. Parinaud syndrome.


A child has recently been stumbling around, and presents with terrible headaches that are relieved by assuming a knee-chest position? Location?

Brain tumor. Posterior fossa.


What are the major differences between the presentation of brain tumor and abscess? What tests are used for brain abscess? Treatment?

Abscess has shorter timetable (two weeks), has fever and evident associated infection (otitis media or mastoiditis). CT scan (MRI not needed). Resection.


You notice a 65 year old patient has an unshaven area of their face, you touch it during exam and they scream from the extremely severe sharp shooting pain. The pain resolves after 60 seconds? Tests? Treatment?

Trigeminal neuralgia (tic douloureux). MRI. Anticonvulsants or radiofrequency ablation.


A patient complains of constant, burning, agonizing limb pain that does not respond to analgesics. The extremity appears cold, moist, and cyanotic. They elicit that they injured the limb in a car accident several months ago? Tests? Treatment?

Reflex sympathetic dystrophy (causalgia). Sympathetic block - conclusive if this improves symptoms. Surgical sympathectomy.


What is Cushing Reflex? Physiology of each sign?

Response to increased ICP: Increased BP (sypmathetic alpha1 vasoconstriction), Bradycardia (sympathetic induces increased BP, but aortic arch baroreceptors induce bradycardia via vagus nerve), irregular respiration (increased pressure on brainstem).