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Flashcards in Pestana Neurosurgery Deck (36)
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1

Neurovascular problems can present these different ways if they are hemorrhagic vs occlusive.

hemorrhagic - sudden onset of very severe HA with subsequent development of severe neurological deficits

occlusive - sudden onset of neurological deficits, but without HA

2

How quickly do brain tumors occur and how do they usually present? What are some unusual presentations of ICP

months - usually presents with a constant, progressive and severe HA that is sometimes worse in the AM. May present with blurred vision, papilledema, and projectile vomiting at later stages due to increased ICP.

Bradycardia + HTN (due to Cushing reflex) may also occur

3

How quickly do infectious problems of the CNS present?

days - weeks, often presents with an identifiable source of infection in the history

4

How quickly do metabolic problems of the CNS present?

rapidly - on the order of hours - days

5

How quickly do degenerative problems of the CNS present?

years

6

common etiology of TIAs 2

stenotic ICA
- or -
ulcerated plaque at the carotid bifurcation

7

How do you work up a TIA?

non-invasive Duplex study (sonogram + doppler)

8

How is a TIA managed?

carotid endarterectomy (remember that most TIAs are due to stenotic ICA - or - ulcerated plaque at the carotid bifurcation) with angioplasty + stent if a filter can be placed to prevent further embolization of debris to the brain

9

complications of ischemic infarct

hemorrhage

10

Patient rolls into the ED with suspected ischemic stroke. What is the FIRST step in management?

get a CT scan to determine extent of infarct or the presence of hemorrhage

11

hemorrhagic strokes are often seen in this patient population.

patients with uncontrolled HTN

12

Patient rolls into the ED with suspected hemorrhagic stroke. What is the FIRST step in management?

CT to evaluate location and extent of hemorrhage

13

treatment of hemorrhagic stroke 2

control HTN
rehab

14

thunderclap headache without neurologic deficits

subarachnoid hemorrhage - absence of neurologic findings may be because the blood is in the subarachnoid space, some patients have nuchal rigidity secondary meningeal irritation

15

thunderclap headache with nuchal rigidity

subarachnoid hemorrhage - absence of neurologic findings may be because the blood is in the subarachnoid space, some patients have nuchal rigidity secondary meningeal irritation

16

management and treatment of patient with extremely headache of sudden onset

workup with
- CT to look for blood in the subarachnoid space
- arteriogram to locate the aneurysm

treatment
- clipping or
- endovascular coiling

17

preferred imaging for brain tumors

MRIs - better details compared to CT

18

management of increased ICP while awaiting surgical resection of brain tumor

high dose dexamethasone (decadron)

19

locate this tumor: inappropriate behavior with ipsilateral optic nerve atrophy and contralateral papilledema and anosmia

at base of frontal lobe

20

identify and locate this tumor: youngsters short for their age with bitemporal hemianopsia

craniopharyngioma - usually calcified lesion above sella is observed on CT

21

identify this tumor: amenorrhea + galactorrhea in young women

prolactinoma

22

w/u of a young women who presents with amenorrhea + galactorrhea

pregnancy test
TSH (r/o hypothyroidism)
prolactin levels
MRI (of sella)

23

treatment of prolactinoma 2

Bromocriptine

transnasal surgical resection (alternative is trans-sphenoidal approach for those who wish to get pregnant or those who fail to respond to medical therapy)

24

patient with HTN, DM, sweaty hands, HA complains that his wedding band no longer fits. Physical exam shows large hands, feet, tongue, and jaw

acromeagly

25

w/u of someone with suspected acromeagly 2

measure somatomedin C
pituitary MRI

26

w/u of someone with confirmed acromeagly

surgical removal (radiation is also an option)

27

patient complains of an acute severe headache with deterioration of vision. History is noted for a chronic headache with bitemoral hemianopsia. Rapidly becomes hypotensive and stuporous.

pituitary apoplexy

28

management 2 and treatment 2 of patients with suspected pituitary apoplexy

management: MRI or CT
urgent replacement of steroid + hormones

29

locate this tumor: loss of upper gaze + sunset eyes

pineal gland tumor

30

locate this tumor: mother complains that her child has truncal ataxia and has been stumbling around

posterior fossa tumor (cerebellar symptoms)