STATION 1

Hydrocephalus (a) Give three clinical features of hydrocephalus (3) (b) Give two common causes of communicating hydrocephalus

(2)

STATION 2

Spina Bifida (a) List signs suggestive of spina bifida occulta (3)

(b) List two other congenital anomalies associated with spina bifida (2)

STATION 1 & STATION 2

Station 1

• A) 1. Children with open fontanels – Bulging anterior fontanel

– Splayed sutures

– Distended scalp veins

– Craniofascial disproportion

– Macrocrania

2. Adults and older kids: headache that gets progressively worse

Vomit

Papiledema

Change in LOC

ophthalmoplegia

• B. Meningitis + SAH (d/t aneurysm rupture)

Station 2

A. Skin lesions in midline

– Dimple

– Sinus tract

– Hemangioma

– Tuft of hair

– Hyperpigmentation

• B. Chiari Malformation and Hydrocephalus

• Syringomylia

• Intellectual impairment

STATION 3

Trauma Resuscitation

A. Describe principles of resuscitation in primary survey of a polytrauma patient

(3)

B. List two factors associated with poor prognosis in a head injured patient

(2)

• A. According to ATLS principles:

B. 1. BP < 90mmHg

2. PO2 < 60mmHg

(gekry uit neursurg lesing 4de jaar)

Jana van Niekerk se:

> Abn pupils, No reflexes, low GCS

Primary Survey

Prim Clinical Survey: Airway, breathing, circulation, disability, exposure, fracture Primary radiological survey: C-spine (lateral, CXR, PXR)

STATION 4

• Severe Head Injury

(a) What are the clinical features of base of skull

fracture? (4)

(b) What is the diagnosis

on the CT scan shown below (1)

• A. Depends on if is anterior or middle cranial fossa # – Anterior fossa: racoon eyes, CSF rhinorrhea, subconjunctival hemorrhage (entire eye), asomnia

– Middle fossa: Battle sign, CSF otorrhea , Facial nerve palsy, heamotympanum

• B. Extradural haematoma

STATION 5

• Space Occupying Lesions

(a) Describe signs of raised intracranial pressure (3)

(b) Give two examples of primary brain tumours (2)

• A. 1. H/A – progressive as tumor SOL increases

• 2. Vomiting

• 3. 4. Seizures

• 4. Change in LOC – e.g. drowsiness

• 5. FND depending on the region involved

• 6. Papilledema

• B. 1. Astrocytoma

• 2. Meningioma

RANDOM IF ASK TO INTERPRET SCAN ALWAYS STATE FOLLOWING IN ANSWER:

1. Location

2. Density

3. Ring enhancement

4. Centre of lesion

5. Mass effect – midline shift or ventricle compression

Station 1

• 1) What is the diagnosis? (2)

• 2) What is the treatment

of choice for the above (1)

• 3) List 3 complications associated with your treatment above

(2)

• A. Communicating hydrocephalus

• B. VP shunt (ventricular peritoneal)

• C. 1.Infection (shunt, peritonitis, meningitis)

• 2. Blocking of shunt

• 3. Migration of shunt

• 4. Convulsions

• 5. Over drainage

Station 2

• 1) What is the diagnosis?

(2)

• 2) What will you do if this lesion ruptures?

(3)

• A. Spina Bifida Aperta - Myelomenigocele

• B. – Normal Neonatal Resus

– Cover with transparent non-adherent semi-permeable dressing • Gelanet

• Gauze

• Opsite

– Nurse Prone

– Keep nappy open – Px feces and urine getting into lesion

– Get urgent neurosurgery consult – must be repaired surgically within 36hr

– Antibiotics

– Multidisciplinary approach to Rx

Station 3 (No slide)

• 1) Define shock (2)

• 2) What clinical parameters will suggest adequate resuscitation (3)

• A. Shock – Circulatory failure resulting in inadequate organ perfusion.

– SBP <90mmHg

– Tachycardia

– Cold clammy extreminities

– Decreased capillary refill

– oligouria

• B.

– 1. Normalize BP and Urine Output

• Urine output > 0.5 ml/kg/hour

– 2. Central venous pressure SO2 >70%

– 3. Normalize pH, BE and Lactate

(antw uit Dr Shapiro se lesing)

Station 4

• 1) Interpret the scan below

(3)

• 2) What surgical treatment would you recommend?

(2)

• A. Intracerebral bleed with associated SDH (Burst Lobe)

• B. Craniotomy for drainage of hematoma??

Station 5

• 1) Describe the lesion on the

scan.

(2)

• 2) How do you think this patient presented?

(3)

• A. Lesion located in midline anteriorly – frontal lobes

• Various densities – hyperdense (white) outline compared to hypodense (black) inner lesion

• Ring enhancement

• Mass effect – compression of ventricles

• B. Headache, vomiting,, seizures, change in LOC, papiledema

STATION 1 Patient had hydrocephalus due to meningitis. He had a VP shunt inserted.

Give 5 complications of VP shunt (5)

• A.

• 1.Infection (shunt, peritonitis, meningitis)

• 2. Blocking of shunt (obstruction)

• 3. Over drainage

• 4. Migration of shunt

• 5. Seizures (d/t gloisis)

STATION 1

1. What is the lesion?

2. What is the cause of the lesion?

3. Which vessels is the likely source?

4. A dilated pupil is in most cases ipsilateral to the lesion (True/False)

5. What is the definitive treatment?

5 Marks

• 1. Extra dural haematoma

• 2. Laceration of blood vessel (usu middle meningeal artery) following trauma

• 3. Middle meningeal artery

• 4. True

• 5. Craniotomy and drainage of haematoma.

STATION 2

1. What is the diagnosis?

2. List three causes

3. What is the most common definitive treatment option.

5 Marks

• 1. Hydrocephalus – communicating (sien prof se lesing vir similar prentjie)

• 2. – Meningitis

– SAH (d/t aneurysm rupture)

– Choroid plexus papiloma

– IVH

• 3. VP-shunt

STATION 3

1. What is the diagnosis?

2. List four clinical features.

5 Marks

• 1. Myelomeningocele (spina bifida aperta)

• 2.

• Neural elements protrude through vertebral defect

• Lined by meninges

• Associated with irreversible neurological deficit

Depends on spinal level

Includes weakness, flaccidity, spasticity, wasting, sensory level – in this child > LL signs

STATION 4

1. What is the diagnosis?

2. What is the most common complication if not treated?

3. List three indications for tracheal intubation.

5 Marks

• 1. Depressed Skull fracture (vault)

• 2. Infection

• 3. (Jana van Niekerk se opsommings) GCS ≤ 8

Poor oxygenation and ventilation

Severe work of breathing

Soft tissue swelling in neck

Massive facial #

Inhalation burns

STATION 5

1. List 5 clinical features of this lesion.

5 Marks

Headache

Vomiting

Seizures

Change in level of consciousness – e.g. drowsiness

FND – frontal lobes involved e.g. motor weakness

Describe scan: (extra vraag)

• Frontal lesion well circumscribed, crosses midline

• Ring enhancement

• Centre is hypodense and homogenous

• Mass effect – compression of ventricles

STATION 2

• NO SLIDE

• (a) What are the features of myelomeningocoele (2)

• (b) List 3 other congenital defects associated with spina bifida (3)

• Neural elements protrude through vertebral defect

• Lined by meninges

• Associated with irreversible neurological deficit

Depends on level of lesion

Includes weakness, flaccidity, spasticity, wasting, sensory level

• B:

– Chiari 2 malformation

– Hydrocephalus – 90% need a shunt!!

– Syringomyelia

– Intellectual impairment

STATION 3

NO SLIDE

• (a) What are the primary radiological survey/imaging required (3)

• (b) What fluid would you use for resuscitation and why? (2)

A: Primary Survey

• Prim Clinical Survey:

• Airway, breathing, circulation, disability, exposure, fracture

• Primary radiological survey:

• C-spine (lateral, CXR, PXR)

• B: Initial Fluid: Crystalloid – Ringers Lactate (2L) – good resus fluid (isotonic to plasma with similar electrolyte content) but short intravascular half life – Run fast, after this blood should ideally be available for further resus

– * if not can alternate between colloids (voluven) and crystalloid (RL)

STATION 4

• Patient was assaulted with a sharp object and sustained laceration with brain injury.

• (a) What is the diagnosis? (2)

• (b) How will you treat the patient?

(3)

• A. Skull fracture of vault (linear? Depressed?)

• B. ATLS priniciples – Airway: Px hypoxia

– Breathing: prevent hypoxia

– Circulation: Px hypotension

Clean wound + suture closed

Refer to Neurosurgery!!!

Station 5

Mr X, 56 years old, presented with seizures and progressive weakness on the left side of the body. Describe/interpret the scan (5)

• 1. Check date, pt name, scan orientation – check from outside to inside taking into account all structures. I will focus on the lesion:

• Located on the Right (frontal and parietal???)

• Not cross midline.

• No mass effect visible on this specific section.

• Tumor has various densities and not homogenous on enhancement

• Ring enhancement present???