Problem Based Neurosurgery

Contents......Page 10
Disclaimer......Page 6
Dedication......Page 8
Preface......Page 14
Problem 1-1: How to get the patient to tell you what is wrong. (The smart way of taking a succinct complete history of any illness)......Page 16
Problem 1-2: How to elicit neurological signs effectively, demonstrate them with confidence and make a lasting impression. (The smart way of performing neurological physical examination 1)......Page 27
1-2-1 Higher mental functions examination (HMF):......Page 28
1-3-2 What are the special features and functions of each nerve?......Page 38
Problem 1-4: How to examine the third, fourth and sixth cranial nerves efficiently, with confidence and make a lasting impression. (The smart way of performing neurological physical examination 3)......Page 47
1-4-1 How to examine the third nerve?......Page 50
1-5-1 Where does the fifth nerve originate?......Page 60
1-5-2 How to localise fifth nerve lesion?......Page 64
1-5-3 How to examine the fifth nerve?......Page 65
1-5-4 Where does the seventh nerve originate?......Page 66
1-5-5 How to examine the seventh nerve?......Page 68
1-5-6 How to localise facial nerve lesions?......Page 71
1-6-1 Where does the eighth nerve originate?......Page 72
1-6-2 How to examine the eighth nerve?......Page 73
1-6-3 How to test vestibular functions (balance)?......Page 76
1-6-5 How to examine the ninth cranial nerve?......Page 79
1-6-6 Where does the tenth nerve originate?......Page 80
1-6-7 How to examine the tenth cranial nerve?......Page 82
1-7-1 Where does the 11th nerve originate?......Page 84
1-7-2 How to examine the 11th nerve?......Page 85
1-7-4 How to examine the 12th cranial nerve?......Page 86
Problem 1-8: How to examine the motor system efficiently, with confidence and make a lasting impression. (The smart way of performing neurological physical examination 7)......Page 88
1-8-1 How to assess muscle tone?......Page 89
1-8-2 How to localise a motor lesion along motor pathways?......Page 90
1-8-3 How to assess muscle power?......Page 92
1-8-4 How to elicit the reflexes?......Page 99
1-8-5 How to interpret reflex findings?......Page 106
Problem 1-9: How to examine the sensory system, coordination and gait efficiently and make a lasting impression. (The smart way of performing neurological physical examination 8)......Page 111
1-9-2 How to examine the spinothalamic sensory pathways?......Page 113
1-9-3 How to assess integrity of posterior columns?......Page 115
1-9-4 How to examine cortical sensation?......Page 117
1-9-5 How to assess coordination?......Page 118
References......Page 122
2-1-1: How can I read a plain CT image of the brain?......Page 124
2-1-2 What are the uses of CT scan?......Page 127
2-1-3 What enhancement patterns are seen on CT?......Page 131
2-1-5 What are the disadvantages of CT?......Page 133
Problem 2-2: Magnetic resonance imaging (MRI): How to interpret MRI-based images?......Page 135
2-2-2 What are the different MRI sequences?......Page 136
2-2-3 What are the uses of MRI?......Page 142
2-2-4 What lesions enhance on MRI scan?......Page 146
2-2-5 What are the advantages of MRI?......Page 147
2-2-6 What are the disadvantages of MRI?......Page 148
2-3-1 How can I perform and interpret CSF examination?......Page 149
2-3-2 How L/P is performed?......Page 150
2-3-3 What should CSF analysis include?......Page 151
2-4-1 How can I interpret an EEG?......Page 152
2-4-2 How is EEG generated?......Page 153
2-5-1 How can I interpret results of nerve conduction studies (NCS)?......Page 154
2-5-4 What is F-wave study?......Page 156
References......Page 157
PCS3-1-1:......Page 160
3-1-3 What is the rationale of head injury management?......Page 161
3-1-4 When would you refer a patient to hospital after a head injury?......Page 162
3-1-5 When can a person be sent home after minor head injury?......Page 165
3-1-7 When does a CT become indicated?......Page 166
3-1-10 Who should be admitted to hospital after head injury?......Page 167
3-1-11 What is concussion and contusion?......Page 168
3-1-12 How to manage a patient with traumatic cranial haematomas?......Page 169
3-1-13 How to manage dural fistulae and CSF leaks?......Page 171
3-1-14 Categorisation of head injury severity......Page 172
3-1-15 What are the indications of monitoring ICP?......Page 175
3-1-17 How to treat raised ICP?......Page 176
PCS3-2-1:......Page 178
3-2-2 What is the incidence and early management of spinal injuries?......Page 179
3-2-3 What are the types of spinal cord injuries?......Page 180
3-2-5 How to evaluate the spine radiologically?......Page 181
3-2-6 How to manage patients with suspected cervical spinal injury after radiological evaluation?......Page 184
3-2-9 When will emergency surgery be required?......Page 185
3-2-11 What is Brown Squard Syndrome (BSS)?......Page 186
3-2-12 What is central cord syndrome (CCS)?......Page 187
3-2-14 What are the different types of C-spine fractures?......Page 188
3-2-16 What are the mechanisms of spinal injuries?......Page 197
References......Page 198
4-1-2 What is the differential diagnosis of sudden (acute) headache?......Page 200
4-1-3 What are the signs associated with SAH?......Page 201
4-1-4 What is the epidemiology of SAH?......Page 202
4-1-6 What causes SAH?......Page 203
4-1-7 What is the natural history of SAH?......Page 205
4-1-8 What is the management of a patient suspected of having SAH?......Page 206
4-1-9 What investigations a SAH-suspected patient should have? What is the interpretation? How to confirm SAH?......Page 207
4-1-10 How to manage a patient with confirmed SAH?......Page 214
4-1-11 What is the prognosis after aneurysmal SAH?......Page 221
PCS4-2-1:......Page 224
4-2-3 What is CVA (cerebrovascular accidents: strokes, infarcts, TIAs)?......Page 225
4-2-4 What are the risk factors for cerebral infarct?......Page 226
4-2-5 How to manage spontaneous intracerebral haematoma (SICH)?......Page 227
4-2-6 How to manage spontaneous arterial dissection?......Page 229
4-2-7 How to manage cerebral venous sinus thrombosis (CVST)?......Page 232
PCS4-3-2:......Page 235
4-3-4 How are seizures classified?......Page 236
4-3-5 How do AEDs work and what are the principles of AED therapy?......Page 237
4-3-8 How to investigate a patient presenting with seizures?......Page 238
4-3-9 What are the indications for surgery in epilepsy?......Page 240
4-3-10 How effective is epilepsy surgery?......Page 241
4-3-11 What other therapeutic options are available apart from resective surgery for epilepsy?......Page 242
References......Page 243
PCS5-1-1:......Page 248
PCS5-1-2:......Page 250
5-1-4 What are the characteristic features of raised ICP?......Page 251
5-1-5 What are the causes of raised ICP?......Page 252
5-1-6 Epidemiology of primary malignant brain tumours:......Page 253
5-1-7 What are the different types of primary malignant brain tumours?......Page 256
5-1-8 What are the other neuroimaging techniques used in brain tumours?......Page 268
5-1-9 How to manage gliomas?......Page 270
PCS5-2-1:......Page 273
5-2-2 What is the differential of a single intrinsic cerebral lesion?......Page 275
5-2-3 What is the epidemiology and presentation of brain metastases?......Page 276
5-2-4 How to manage brain metastases?......Page 278
PCS5-3-1:......Page 280
5-3-3 What are the causes and sources of CNS infections?......Page 282
5-3-4 What types of CNS infections occur?......Page 283
5-3-5 What are the causes and epidemiology of bacterial meningitis?......Page 286
5-3-6 What are the symptoms and signs of meningitis?......Page 287
5-3-7 How to investigate a patient with suspected meningitis?......Page 288
5-3-8 How to treat bacterial meningitis?......Page 290
5-3-9 What is the prognosis of meningitis?......Page 291
5-3-10 How to manage subdural empyema?......Page 292
5-3-11 How to manage encephalitis?......Page 294
PCS5-4-1:......Page 296
PCS5-4-2:......Page 297
5-4-3 How to classify hydrocephalus (differential diagnosis)?......Page 298
5-4-4 How to diagnose normal pressure hydrocephalus?......Page 301
5-4-5 How to treat normal pressure hydrocephalus?......Page 303
5-4-6 What is congenital hydrocephalus and Chiari malformations?......Page 304
5-4-7 What is colloid cyst and how to manage it?......Page 307
5-4-8 How does hydrocephalus exert its effects?......Page 312
5-4-10 How to manage hydrocephalus?......Page 315
5-4-11 What are the types of shunts?......Page 317
References......Page 318
PCS6-1-1:......Page 322
PCS6-1-2:......Page 323
6-1-3 What is the epidemiology of meningiomas?......Page 324
6-1-4 What are the causes of meningiomas?......Page 325
6-1-5 How do meningiomas look like and where are they located?......Page 327
6-1-6 What are the pathological classifications of meningiomas?......Page 330
6-1-7 How do meningiomas present?......Page 335
6-1-9 How to manage symptomatic meningiomas?......Page 336
PCS6-2-1:......Page 339
PCS6-2-2:......Page 341
6-2-3 What is the epidemiology of pituitary adenomas?......Page 342
6-2-4 How do pituitary adenomas present?......Page 343
6-2-5 How to investigate a patient with possible PA?......Page 344
6-2-6 What is the differential diagnosis of PA?......Page 347
References......Page 357
7-1-2 What causes unilateral sensory neural deafness?......Page 360
7-1-3 What is the epidemiology of VS?......Page 361
7-1-6 What investigations should a patient with unilateral hearing loss have? What is the interpretation of these tests?......Page 362
7-1-7 How to recognise VS, CPA meningioma and epidermoid of CPA?......Page 366
7-1-8 How to manage VS?......Page 368
7-2-2 What is the differential diagnosis of facial pain?......Page 371
7-2-3 How to manage a patient with facial pain?......Page 372
7-2-5 What is TN?......Page 376
7-2-7 What is the diagnostic criteria and natural history of TN?......Page 377
7-2-8 How to manage ITN?......Page 378
References......Page 380
PCS8-1-1:......Page 384
8-1-3 What is Parkinson’s disease (PD) and Parkinsonism?......Page 385
8-1-4 How to treat PD?......Page 386
8-1-5 What is the surgical treatment of PD?......Page 387
8-1-7 What is essential tremor (ET)?......Page 388
8-1-9 What is the surgical treatment of ET?......Page 389
8-1-10 What is rubral tremor (RT)?......Page 390
8-2-3 What causes dystonia?......Page 391
8-2-4 How to treat dystonia?......Page 392
References......Page 393
9-1-2 What is the differential diagnosis of bilateral leg weakness?......Page 396
PCS9-1-4:......Page 397
9-1-6 How does MSC present?......Page 400
9-1-8 How do metastases cause MSC?......Page 401
9-1-9 How to investigate suspected MSC?......Page 402
9-1-10 How to manage patients diagnosed with MSC?......Page 407
9-2-2 What is the differential diagnosis of cauda equina?......Page 411
9-2-3 How to investigate suspected cauda equina?......Page 412
9-2-6 What is the differential of paraparesis?......Page 413
9-2-8 How to manage intradural extramedullary spinal tumours?......Page 414
9-2-9 What are the different types of dural/intradual spinal tumours?......Page 416
PCS9-3-1:......Page 425
9-3-4 What investigations should this patient have?......Page 426
9-3-5 What are the types of spinal infections?......Page 428
9-3-8 How to manage discitis?......Page 429
PCS9-3-9:......Page 431
9-3-10 How to manage spinal epidural abscess?......Page 432
References......Page 433
PCS10-1-1:......Page 436
10-1-3 How to investigate cervical radiculopathy?......Page 437
10-1-5 What the differential diagnosis of cervical myelopathy?......Page 438
10-1-7 What is the pathophysiology of the cervical spondylosis?......Page 439
10-1-8 How does cervical nerve root compression present?......Page 441
10-1-9 What are the indications for surgery?......Page 442
PCS10-2-1:......Page 444
10-2-4 How to manage a patient with lumbar radiculopathy?......Page 445
10-2-5 What is the pathophysiology of lumbar disc prolapse?......Page 447
10-2-6 What are the types of disc prolapse?......Page 448
10-2-7 How does lumbar IVDP present and what are the signs?......Page 450
10-2-8 What are the root tension signs in lumbar spine?......Page 451
10-2-9 How to clinically identify which nerve roots are affected?......Page 452
10-2-10 What imaging can be performed in lumbar IVDP?......Page 453
10-2-11 What are the indications for surgery?......Page 454
10-2-12 What is the outcome and risks of lumbar IVDP surgery?......Page 455
10-2-13 How do red flags work in patients with LBP?......Page 456
PCS10-3-3:......Page 458
10-3-7 How to manage carpal tunnel syndrome (CTS)?......Page 459
10-3-8 How to diagnose CTS?......Page 460
10-3-9 How to manage cubital tunnel syndrome (UNC)?......Page 461
10-3-10 How to diagnose UNC?......Page 462
10-3-11 How to manage peripheral neuropathy (PN)?......Page 463
References......Page 464
Appendices......Page 466
Index......Page 488