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56 Cards in this Set
- Front
- Back
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What is the Monroe-Kellie Principle?
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cranium is a closed container, increase volume of one element= decrease volume of other element OR increase in pressure
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What are the 3 Compensatory Mechanisms?
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1. Movement of CSF out of the vault 2. Movement of venous blood out of the vault 3. Collapse of ventricular, cistern systems
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When do compensatory mechanisms fail?
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when volume increases beyond 30-50 ml
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What are 4 clinical signs of brain stem compression?
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1. Pupillary Mydriasis 2. LOC 3. Paralysis/Posturing 4. Respiratory Compromise
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What are the clinical signs of herniation?
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1. Brain Stem Compression signs 2. Loss of conjugate eye movements 3. Cushing Reflex
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Acute Cauda Equina Syndrome is "almost" always a result of _________________________.
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Acute Disc Herniation (L4/5) (L5/S1)
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Large Herniation + Small Canal =
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Acute Cauda Equina Syndrome
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What are some symptoms that a pt. might present w/Acute Caudal Equina Syndrome?
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acute back pain, urinary incontinence, saddle anestheisa, sexual dysfxn
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With Acute Cauda Equina Syndrome, disc tend to protrude ____________.
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Centrally
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What is the treatment for Acute Cauda Equina Syndrome?
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Surgical Decompression, immediately
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50% of all Intracerebral Hematomas are due to ________________ in ages 50-60 yo.
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Hypertension
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Anticoagulant therapy puts pts. At 8x more risk for ________________________.
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Intracerebral Hematoma
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A younger pt. has a stroke, you suspect what to be the cause??
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Street drugs ( cocaine is the most common, then amphetamines and PCP)
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What prescription drugs might cause a young person to suffer a stroke?
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1. Talwin 2. Dexatrim 3. Ritalin
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What is the management given for Intracerebral Hematomas?
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ABC, early intubation, Mannitol, Hyperventilation, ventriculostomy
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What cerebellar hemorrhages would qualify to go on to surgery?
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GCS <14; large hematoma >40 ml; diameter > 3 cm
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What is the Monroe-Kellie Principle?
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cranium is a closed container, increase volume of one element= decrease volume of other element OR increase in pressure
|
|
|
What are the 3 Compensatory Mechanisms?
|
1. Movement of CSF out of the vault 2. Movement of venous blood out of the vault 3. Collapse of ventricular, cistern systems
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When do compensatory mechanisms fail?
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when volume increases beyond 30-50 ml
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What are 4 clinical signs of brain stem compression?
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1. Pupillary Mydriasis 2. LOC 3. Paralysis/Posturing 4. Respiratory Compromise
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What are the clinical signs of herniation?
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1. Brain Stem Compression signs 2. Loss of conjugate eye movements 3. Cushing Reflex
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Acute Cauda Equina Syndrome is "almost" always a result of _________________________.
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Acute Disc Herniation (L4/5) (L5/S1)
|
|
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Large Herniation + Small Canal =
|
Acute Cauda Equina Syndrome
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What are some symptoms that a pt. might present w/Acute Caudal Equina Syndrome?
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acute back pain, urinary incontinence, saddle anestheisa, sexual dysfxn
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With Acute Cauda Equina Syndrome, disc tend to protrude ____________.
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Centrally
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What is the treatment for Acute Cauda Equina Syndrome?
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Surgical Decompression, immediately
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50% of all Intracerebral Hematomas are due to ________________ in ages 50-60 yo.
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Hypertension
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Anticoagulant therapy puts pts. At 8x more risk for ________________________.
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Intracerebral Hematoma
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A younger pt. has a stroke, you suspect what to be the cause??
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Street drugs ( cocaine is the most common, then amphetamines and PCP)
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What prescription drugs might cause a young person to suffer a stroke?
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1. Talwin 2. Dexatrim 3. Ritalin
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What is the management given for Intracerebral Hematomas?
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ABC, early intubation, Mannitol, Hyperventilation, ventriculostomy
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What cerebellar hemorrhages would qualify to go on to surgery?
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GCS <14; large hematoma >40 ml; diameter > 3 cm
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What makes up to 50% of all neoplastic cord compressions?
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Epidural Metastasis
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What are the most frequent primary tumors to spread to spine?
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Breast, lung, prostate, hematopoietic system (BLPH)
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What are 4 xray findings for Epidural Metastasis?
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Pedical Erosion, Collapse, Lytic Destrxn, focal osteopenia
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What is the best tx for Epidural Metastasis?
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Radiation! 1/3 to 1/2 are able to walk. Duration is <6months.
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What is the intial step for tx of Epidural Metastasis?
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Dexamethasone
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Venous tributaries from superior and inferior orbital veins drain to ______________________, which then drains to Sup & Inf. Petrosal sinuses.
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Cavernous Sinus Syndrome
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What are 3 symptoms assoc. w/Cavernous Sinus Syndrome?
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Opthalmoplegia, orbital congestion, proptosis
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What percent of pts w/RA have C spine problems?
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85% (and 25% of these have Atlantoaxial subluxation
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scissoring C1 on C2, pannus of granulation around the dens, and loosening of transverse lig on the atlas. What is this?
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Atlantoaxial Subluxation w/RA
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What is done to determine presence of antlantoaxial subluxation and what are the ranges?
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Lateral C-Spine. Normal distance=4 mm, if widening than due to a imcompetent transverse ligament. If > 9 mm= Myelopathy
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What is the treatment for Atlantoaxial Subluxation w/ RA?
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SURGERY C1/C2 wiring fusion (arthrodesis) when >6 mm + symptomatic or >8 mm even if asymp.
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What 4 things could cause Cavernous Sinus Thrombosis?
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1. Staph Aureus 2. Mucomycosis in diabetics 3. Orbital Cellulitis 4. paranasal sinuses
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What is a possible problem that could arise from receiving epidural steroid injxns?
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MRSA! Develop Spinal Epidural Absess
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Anterior Spinal Epidural Absesses are often seen with _____________________________.
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Vertebral Osteomyelitis
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Spinal Epidural Absesses tend to be _________________to the cord.
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82% are POSTERIOR
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What percent of shunt failures occur w/in the first year? Second year?
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40%; 50%
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Pt. comes in a few months after shunt surgery. What do you expect to be the problem?
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misdisplacement, disconnects, migration
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Your pt. has problems and you see that years earlier they had a shunt put in. What could cause it to have a problem now?
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fractured tubing, overdrainage, erosion
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What is the LARGEST cutaneous N in the body?
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Greater Occipital N
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Where does the Greater Occipital N arise from?
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primary ramus of 2nd cervical N
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Where does the Lesser Occipital N arise from?
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primary rami of 2nd AND 3rd cranial N
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What is the best way to diagnose Occipital Neuralgia?
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Neural Blockade---b/c it can diagnose and treat at the same time
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Where do you palpate the Occiptial A (to make sure you don't puncture)?
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at the Superior Nuchal Ridge
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Muscle spasms and pain are common in ______________________ and __________________with Cervical Radiculopathy.
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Trapezius and Intrascapular region
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