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INTRODUCTION

Test Taking Tips

  • Make sure that you are familiar with the Glasgow Coma Score prior to the test.

  • Review the neurosurgery section in the trauma chapter, since most of the neurosurgical content is tied in with trauma scenarios.

What components are present in the cranium?

  • Brain tissue, cerebrospinal fluid (CSF), blood vessels and blood volume, pathologic volume (e.g., neoplasm, hematoma, abscess, etc.)

What may cause an increase in the brain tissue component (not including neoplasms)?

  • Edema, inflammatory, perineoplastic, vasogenic

What can be given to decrease swelling due to edema?

  • Mannitol, hypertonic saline

What can be given to decrease the brain tissue component if swelling is caused by inflammation or perineoplastic syndrome?

  • Steroids

What can be done to decrease the blood volume component?

  • Hyperventilation, diuretics, head elevation, remove venous obstruction

What can be done to decrease the CSF component?

  • Drainage (either external or internal such as a VP shunt), acetazolamide (temporary), steroids (temporary)

What can be done to decrease volume due to a mass lesion?

  • Evacuation or removal of the cause of the mass lesion

What is the Monro-Kelly doctrine?

  • The total volume of the cranial vault is fixed, and thus an increase in one component must be offset by a decrease in another component

True or False: CSF production rate is affected by intracranial pressure (ICP).

  • False. CSF production rate is constant and is not affected by “back pressure.”

What is the site of CSF production?

  • The arachnoid granulations

What is the name of the process that maintains cerebral blood flow at a constant rate despite changes in systemic blood pressure?

  • Autoregulation

Define cerebral perfusion pressure:

  • Mean arterial pressure (MAP) – ICP

Why do older people tend to be more tolerant of mass lesions?

  • They tend to have larger ventricles, which are more tolerant of compression than brain tissue

What is a raised ICP with no mass lesion termed?

  • Pseudotumor cerebri or idiopathic intracranial hypertension

What is increased ventricular volume without increased intracranial pressure called?

  • Normal pressure hydrocephalus

What is a failure of proper capillary formation termed?

  • Arteriovenous malformation (AVM)

What is the risk of hemorrhage associated with an AVM?

  • 4% per year

What percentage of AVM-associated hemorrhages is classified as severe?

  • 25%

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