Surgery EOR: Neuro
Terms in this set (60)
Glasgow Coma Scale (GCS)
What does unilateral, dilated nonreactive pupils suggest?
Focal mass lesion with ipsilateral herniation and compression of CNIII
What do bilateral fixed and dilated pupils suggest?
Diffusely increased ICP
4 signs of a basilar skull fx?
Periorbital ecchymoses (raccoon eyes)
Postauricular ecchymoses (battle's sign)
Otorrhea/rhinorrhea (CSF leak)
What is the initial radiographic neuroimaging in trauma?
Head CT scan without contrast
T/L spine AP and lateral
What is a subarachnoid hemorrhage (SAH)?
Bleeding in to the subarachnoid space
What are 3 main causes of bleeding in to the subarachnoid space? Which is MC?
Trauma - MC
Ruptured berry aneurysm
What kind of aneurysm causes 75% of nontraumatic cases of subarachnoid hemorrhage?
Ruptured saccular (berry) aneurysm - has a mortality rate of 50% . MC age is 5th-6th decade of life. M=F
What is the MC location of a berry aneurysm?
Anterior communicating artery
Risk factors for aneurysm?
Heavy alcohol use
What other diseases are aneurysms associated with?
Polycystic kidney disease
Coarctation of the aorta
Connective tissue disease (Marfans)
What is a arterio-venous malformation (AVM)?
Congenital abnormality of the vasculature with connections between the arterial and venous circulations without interposed capillary network
Clinical features of carotid artery disease?
TIA (deficits last <24 hours)
RIND - reversible ischemic neuro deficit (lasts 24-72 hours)
What is amaurosis fugax?
Temporary monocular blindness ("curtain coming down") - seen with microemboli to retina
Diagnostic test of choice for carotid artery disease? What is the gold standard?
Carotid US/Doppler - TOC
A-gram - gold standard
Surgical tx of carotid artery stenosis?
Carotid EndArterectomy (CEA) - removal of diseased intima and media of the carotid artery, often performed with a shunt in place
What are indications for tx for carotid artery disease in an asymptomatic patient?
Clinical features of SAH?
Severe, generalized headache. "Worse HA of my life"
Seizure like activity
Elevated BP - body trying to compensate to perfuse brain
Meningeal irritation (AMS, nuchal rigidity)
Fever up to 102
Work up for SAH?
Noncontrast Head CT - first test
Angiogram - follow up test to look for aneurysms/AVM
Medical tx for SAH?
Prevention of elevated arterial or intracranial pressures that might lead to rerupture
Strict bed rest
Stool softeners to prevent straining
Keeping BP in an optimal range
Surgical tx for SAH?
Clipping or wrapping aneurysms <--TOC
Removal or embolization of an AVM by intra-arterial catheter
What is Intracerebral hemorrhage (ICH)?
Bleeding into the brain parenchyma. AKA hemorrhagic stroke
Causes of ICH?
HTN/atherosclerosis - MC cause
Bleeding into a tumor
Where do most ICH occur?
Basal ganglia - the putamen is structure MC affected
Clinical presentation of ICH?
Contralateral hemiplegia and hemisensory deficits
Lateral gaze preference
How is hemorrhagic stroke treated?
Supportive care - management of hypertension and antiedema therapy (mannitol and steroids), intracranial pressure monitoring
Endovascular repair and surgical clipping for select patients
What is a subarachnoid hematoma?
Blood below the arachnoid membrane and above the pia mater. Caused by head trauma
Tx for subarachnoid hematoma?
Anticonvulsants and observation
What is a Subdural hematoma?
Blood collection under the dura
What causes a subdural hematoma?
Tearing of "bridging" veins that pass through the space between the cortical surface and the dural venous sinuses or injury to the brain surface with resultant bleeding from cortical vessels
What are three types of subdural hematomas?
Acute - sx within 48 hours of injury
Subacute - sx within 3-14 days
Chronic - sx after 2 weeks
What is the tx of epidural and subdural hematomas?
Mass effect (pressure) must be reduced - craniotomy with clot evacuation is usually required
What are classic findings on a head CT scan with a subdural hematoma?
Curved, crescent shaped hematoma
What is an epidural hematoma?
Collection of blood between the skull and dura
What causes epidural hematoma?
Bone fragments that lacerate the meningeal arteries from a skull fx
Which artery is associated with epidural hematomas?
Middle meningeal artery
What is the MC sign of a epidural hematoma?
>50% have ipsilateral blown pupil
What is the classic history with an epidural hematoma?
LOC followed by a "lucid interval" followed by neurologic deterioration
What are classic CT scan findings with an epidural hematoma?
Lenticular (lens) shaped hematoma
Surgical tx for epidural hematoma?
What are indications for surgery for an epidural hematoma?
Any symptomatic epidural hematoma
What is a cerebral contusion?
Hemorrhagic contusion of brain parenchyma
What are coup and contrecoup injuries?
Coup - injury at the site of impact
Contrecoup - injury at the site opposite the point of impact
What is a depressed skull fracture?
Fx in which one or more fragments of the skull are forced below the inner table of the skull
What are indications for surgery for a skull fx?
Contaminated wound requiring cleaning and debridement
Impingement on cortex
What are tx options for open skull fxs?
Seizure prophylaxis (phenytoin)
What are two types of spinal injury?
Complete - no-motor/sensory function below level of injury
Incomplete - residual function
What is "spinal shock"
Loss of all reflexes and motor function, hypotension, bradycardia
Initial studies/interventions for spinal injury?
Complete cervical xrays
What is anterior cord syndrome?
Affects corticospinal and lateral spinothalamic tracts. There is:
Loss of pain/temp sensation
What is central cord syndrome?
Preservation of some lower extremity motor function and sensory ability
Upper extremity weakness
What is posterior cord syndrome?
Loss of proprioception and vibration sense distally
Preserved pain/temp sensation
What is Brown-Sequard Syndrome?
Hemisection of cord leading to ipsilateral muscle weakness and touch/proprioception loss with contralateral pain/temp loss
What are clinical features of brain tumors?
What are the MC intracranial tumors?
What are causes of a spinal epidural abscess? What is MC cause?
Hematogenous spread from skin infections - MC
What are clinical features of a spinal epidural abscess?
Severe pain over affected area with flexion/extension of spine
Weakness can develop ultimately leading to paraplegia
Furuncle can develop
MC organism that causes spinal epidural abscess?
Diagnostic test of choice for spinal epidural abscess? What test is contraindicated?
LP is contraindicated
Tx for spinal epidural abscess?
Surgical drainage and appropriate antibiotic coverage