Surgery 3B - Neurosurgery Flashcards Preview

Pediatrics 3B > Surgery 3B - Neurosurgery > Flashcards

Flashcards in Surgery 3B - Neurosurgery Deck (153):
1

Uncal Herniation

Opposite lower extremity weakness

2

Upward herniation

Posterior fossa pathology

3

Tonsillar herniation

Cardiorespiratory impairment

4

Central Transtentorial herniation

Pinpoint pupils

5

Subfalcine herniation

Opposite upper/lower ext weakness

6

Skull X ray

Rapid and almost universally available

7

CT Scan

Access vascular pathology of brain and spine

8

Cranial MRI

Superior Brain/Spinal tissue resolution

9

Cerebral Angiography

Evaluates hemorrhagic stroke/trauma

10

EMG-NCV

Peripheral nerve integrity

11

Catheter inserted into frontal horn of lateral ventricle, also used for CSF drainage

EVD

12

Normal ICP range

110-120 mmH2O (5-10 mmHg)

13

Increased ICP

> 200 mmH2O (15 mmHg)

14

Volume of blood

120 mL

15

Volume of CSF

120 mL

16

Cushing Triad

Sys HPN,
Bradycardia
Resp irregularities

17

Example of primary (impact damage) brain injury

Cortical contusions
Diffuse white matter lesions
Laceration

18

Thalamic bleed

Hemiplegia/hemiparesis

19

Pontine bleed

Total paralysis

20

Cerebellar bleed

Repeated vomiting
Conjugate stare

21

Putaminal bleed

Face sags
Slurred speech

22

Lobar bleed

Depends on area affected

23

Bivex lentiform shape on CT

Epidural hematoma

24

Respects cranial sutures line

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