Surgery 3B - Neurosurgery Flashcards
(153 cards)
1
Q
Uncal Herniation
A
Opposite lower extremity weakness
2
Q
Upward herniation
A
Posterior fossa pathology
3
Q
Tonsillar herniation
A
Cardiorespiratory impairment
4
Q
Central Transtentorial herniation
A
Pinpoint pupils
5
Q
Subfalcine herniation
A
Opposite upper/lower ext weakness
6
Q
Skull X ray
A
Rapid and almost universally available
7
Q
CT Scan
A
Access vascular pathology of brain and spine
8
Q
Cranial MRI
A
Superior Brain/Spinal tissue resolution
9
Q
Cerebral Angiography
A
Evaluates hemorrhagic stroke/trauma
10
Q
EMG-NCV
A
Peripheral nerve integrity
11
Q
Catheter inserted into frontal horn of lateral ventricle, also used for CSF drainage
A
EVD
12
Q
Normal ICP range
A
110-120 mmH2O (5-10 mmHg)
13
Q
Increased ICP
A
> 200 mmH2O (15 mmHg)
14
Q
Volume of blood
A
120 mL
15
Q
Volume of CSF
A
120 mL
16
Q
Cushing Triad
A
Sys HPN,
Bradycardia
Resp irregularities
17
Q
Example of primary (impact damage) brain injury
A
Cortical contusions
Diffuse white matter lesions
Laceration
18
Q
Thalamic bleed
A
Hemiplegia/hemiparesis
19
Q
Pontine bleed
A
Total paralysis
20
Q
Cerebellar bleed
A
Repeated vomiting
Conjugate stare
21
Q
Putaminal bleed
A
Face sags
Slurred speech
22
Q
Lobar bleed
A
Depends on area affected
23
Q
Bivex lentiform shape on CT
A
Epidural hematoma
24
Q
Respects cranial sutures line
A
Epidural hematoma
25
Bright crescent shape by CT
Acute subdural hematoma
26
Hypodense crescent shape by CT
Chronic subdural hematoma
27
Spherical hyperdense intra-axial shape by CT
?
28
Abnormally dilated arteries and veins w/o intervening capillary bed
AVM
29
Most common primary intra-axial CNS neoplasm in adults
Astrocytoma
30
Metastatic tumors of the brain least likely extra-cranial source is
Melanoma
| More likely lungs, breast, colon, kidney
31
Calcifications and hemorrhage on CT or MRI suggest diagnosis of
Oligo-dendro-glioma
32
Most common intra-dural, intra-medullary spinal tumor
Ependymoma
33
Loss of motor control and proprioception ipsilaterally
Brown Sequard
34
Upper extemities worse than lower extremities weakness
Central cord syndrome
35
Total loss of sensory, motor, nociception and proprioception bilaterally
Functional cord transection
36
Loss of bilateral proprioception and thermoception
Posterior cord syndrome
37
Best dx imaging for trauma
CT w/contrast
38
Communicating type of hydrocephalus are as follows except
- meningitis
- arachnoiditis
- subarachnoid hemorrhage
- aqueductal stenosis
- none
Aqueductal stenosis
39
CSF production /day
500cc/day
40
Masses higher up in the hemisphere can pass the cingulate gyrus causing what type of herniation
Subfalcine herniation
| Opposite upper/lower ext weakness
41
Primary source of energy in the brain
Glucose
42
True of brain abscess
Manifest as cerebritis early
Ring enhancing lesion on CT contrast
Congenital cyanotic heart dse is a risk factor
43
Composted of cystic vascular spaces lined by single layer of endothelial cells
Cavernous malformation
44
Increased ICP can be 2' to ff except
- Sagittal Sinus thrombosis
- Hypoventilation
- Hypocarbia
- Hypercarbia
Hypo-carbia
45
Cerebral blood flow
50ml/100g of brain/min
46
50 m, sudden severe headache w/assocaited nuchal rigidity. Afebrile and heache refractory to analgesics.
Brain abscess
47
Most common cause of communicating hydrocephalus
Meningitis (ex TB infection)
48
MCC Lateral ventricle tumor
subependymal giant cell astrocytoma
49
Lucid interval after falling, consider
Epidural hematoma
50
Diagnostic procedure in Epidural hematoma (lucid interval)
CT scan w/o contrast
51
Battle sign
Discoloration over the mastoid
52
Intra-dural extra-medullary spinal cord tumors
Schwannoma
Meningioma
(NOT astro)
53
MCC spontaneous intra-cerebral hematoma in 1st two decades of life
AVM
54
MC spinal cord tumor in intra-dural, extramedullary region w/predilection in thoracic region
Schwannoma ?
| Astrocytoma ?
55
Unequal weakness of all ext more profound in lower and some form of sacral sparring
Central cord
56
MCC congenital hydrocephalus
Aqueductal stenosis
57
Subdural hematomas are located b/t
Dura and arachnoid
58
Epidural hematomas are located b/t
Bone and dura
59
MCC of subarachnoid hemorrhage in general
Intracerebral hemorrhage
60
MC intra-cranial tumor (adult)
Metastasis
61
Pediatric pt. w/gain unsteadiness and intention tremors
Medulloblastoma
62
Glucose consumption in the brain
60 mg/min
63
Pathologic condition where excessive CSF is collected in the cranial cavity
Hydrocephalus
64
68 F w/bleed
Extends to pain
No verbal output
Opens eye to pain
GCS 5
65
Hx of mauling
Obeys
Confused
Opens eye spontaneously
GCS 14
66
```
5 M
Hx of fall
Withdraws to pain
Inappropriate words
Opens eye to pain
```
GCS 9
67
```
18 M
Hx bike accident
Flexes to pain
Moans
No eye opening
```
GCS 6
68
Pt w/stroke
localizes
Confused
Opens eye to pain
GCS 11
69
Cerebral blood flow
50cc/kg/min
70
Coma
< 20 mg glucose
71
Brain blood volume
120 mL
72
Cerebral O2 consumption
45-50cc/min
73
Glucose consumption
25% of body/60mg/min
74
Ant cerebral artery stroke
Contralateral limb weakness
75
Middle cerebral artery stroke
Aphasia expected
76
Post cerebral artery stroke
Homonymous hemianopsia
77
PICA stroke
Nystagmus and ataxia are prominent
78
Pontine stroke
Total paralysis
79
Brain abscess w/TOF
Fronto-parietal abscess
80
Chronic otitis media
Temporal abscess
81
Recurrent frontal sinusitis
Frontal abscess
82
Odontogenic source
Basifrontal abscess
83
Chronic mastoiditis
Cerebellar abscess
84
Usually appears in majority of brain tumor patients, exacerbated by changes of posture, usually predominates in early morning upon waking up
Headache
85
Dandy walker malformation
Posterior fossa cyst
86
Communicating hydrocephalus type
Post-meningitis hydrocephalus
87
Non-communicating hydrocephalus example
Aqueductal stenosis
88
Vascular malformation w/nidus arterial feeder and draining vein
AVM
89
Vascular malformation containing several sinusoidal vascular spaces
Cavernous malformation
90
Possible complication of ethmoidal sinusitis via contiguous route
Frontal lobe abscess
91
Pt w/TOF might develop a hematogenous route of cerebral abscess
Fronto-patietal convexity abscess
92
Chronic otitis media predisposes to
Temporal or cerebellar abscess
93
Extradural spinal turmor
Metastatic
94
Example of Intradural extramedullary spinal tumor
Meningioma
95
Metastasis
Extra-dural extra-medullary spine tumor
96
Ependymoma
Intra-dural intra-medullary spine tumor
97
Schwannoma
Intra-dural extra-medullary spine tumor
98
Hyperdense crescent shape on CT
Acute subdural hematoma
99
Hypodense crescent shape on CT
Chronic subdural hematoma
100
Cerebellar bleed
hydrocephalus
101
Pontine bleed
Hemiparesis w/poor outcome
102
Lobar bleed
Focal deficits based on location
103
Thalamic bleed
contralateral hemi-sensory loss
104
Basal ganglia bleed
contralateral weakness
105
Aneurysm
Neck and sac
106
Cavernous malformation
Not seen in angiography w/mass-like sinusoidal vessels
107
Venous malformation
No arterial supply
108
Capillary telangiectasia
Benign and low incidence of bleeding, see in autopsy
109
AVM
Needs embolization, Sx, radiation or combination
110
Cerebral hemispheres (telencephalon)
cerebral cortex
basal ganglia
hippocampus
111
frontal lobes
```
Executive fxn
Decision making
Speech
Restrain of emotion
Origin of CST
```
112
Parietal lobes
Sensory cortex
| Bounded by occipital lobe posteriorly
113
Temporal lobes
Amygdala
| Lowe optic radiation (Meyer's loops)
114
T/F
Hippocampus = memory
Amygdala = emotion
Lower optic radiation = visual pathways
All True
115
Brainstem
Midbrain
Pons
Medulla
116
Cerebellum arises from dorsal aspect of the brainstem
integrates somatosensory, vestibular and motor info for coordination and timing of movement
117
Pineal tumor big enough to press on the posterior midbrain compromising CSF passage thru aqueduct
Lateral ventricles enlarge
118
Paired spinal nerves exit the spinal cord
7 cervical vertebral bodies
119
L2-L4 spinal nerves intersect in the lumbrosacral plexus and divide to form the main nerve branches to the leg
Common peroneal
Tibial
Femoral
120
CT
Acute hematoma appear white or hyperdense
| INvasive procedure for plain cranial CT scan
121
T/F
MRI = excellent imaging of soft tissue in head and spine
Transarterial catheter-based angiography remains gold STD for vascular pathology of brain and spine
Acute nerve injury after 28 days is ideal timing for EMG NCV
TRUE
122
Pressure volume curve of ICP
Arbitrary point volume and pressure are directly proportional
123
Brain death
Confirmed absence of CBF
| EEG documentation necessary
124
Multiple injured vehicular accident patient who is unconscious
presumed to have spine injury
lateral cervical xray done by turning pt laterally like a log
treated acc to ABC for multiple injured persons
125
Peripheral nerve injuries
Neuroproxia
Axonotmesis
Neurotmesis
Neuroproxia - temporary failure of nerve fxn
Axonotmesis - disruption of axons and myelin. Endoneurium intact
Neurotmesis - disruption of axons and endoneural tubes
126
Erh's palsy
C5 C6 components of brachial plexus
| Glemohumeral dislocation
127
Klumple's palsy
Injury to C8 T1 components of brachial plexus
| Claw hand deformity
128
Cerebrovascular dse
DM, cholesterol, BP, smoking = risk factors
| Basal ganglia is most common site of IC hemorrhage
129
Acute epidural hematoma
Biconvex hyperdense lesion
130
Brain tumors
Meningiomas are beign and rarely malignant
131
GCS
Stimuli at nailbed or supraorbital
low score = lower sensorium
3 = poorest prognosis
132
Acute epidural hematoma
Lucid interval
High assoc ofskull patient
Not always Sx
133
Lumbar puncture after ruptured cerebral aneurysm
spinal fluid primarily dominant RBC
134
Corticospinal tract fibers at the right half of midbrain passed thru the
right posterior limb of int capsule
135
Motor cortex is
Covered by parietal bones
| Pre-central gyrus
136
Corticospinal tract
UMN
includes anterior hron cells of the cervical spine
Modulates the spinal arch
137
CST at thoracic cord level if from the right motor cortex
located at the left posterior quadrant
138
Pain and temp from left big toes at the thoracic cord
Right anterior quadrant
139
Occipital lobe L infaction
R hemianopsia
140
CN attached to brainstem
occulomotor
141
Spinal cord
- starts at F magnum
- Anchored in spinal cancal by nervous structure dentate
- Ends at approx lower level of L1
True
142
Spine
7 Cervical Vertebrae
8 Cervical Roots
One coccygeal nerve root/side
143
L2-L4
Lumbrosacral plexus
Mixed Nerves
Common peroneal, tibeal, femoral
144
Spinal cord division
Ant - pain, temp, motor
| Post - position and vibratory
145
X ray of cervical spine
cross table for unconscious pt
146
CT
detects Acute hemorrhage
xray radiation
generally used w/contrast for pt w/metal in orbit or pacemaker (not able to use MRI)
147
Electromyography and Nerve conduction
NC records velocity and amplitude of nerve action potential
148
Invasive IC pressure monitoring
external ventricular drain
intra-parencymal fiberoptic pressure transducer
brain tissue oxygen sensors
149
Intracranial pressure/volume curve
maintain pressure in early stage
150
Recurrent frontal sinusitis
Frontal abscess
151
Temporal abscess
Chronic otitis media
152
Odontogenic source
Basifrontal abscess
153
Mastoiditis
Cerebellar abscess
