25 Neurosurgery MCQs Answers

Answer: c, d, e

Injuries to the spinal cord can be either complete, resulting in total loss of function below the level of the injury or incomplete which may be manifest in the Brown-Sequard syndrome. This syndrome is manifested by ipsilateral loss of motor function and position-vibratory sensation with contralateral loss of pain and temperature sensation below the level of the injury. Anatomically, this presentation is explained by hemisection of the cord. In addition to the neurologic deficit, acute spinal cord injury is accompanied by many systemic responses. Blood pressure is generally low if the cord injury is above the T-5 level. Such an injury effectively denervates the sympathetic nervous system, which leads to increased venous capacitance and decreased venous return. The resulting hypotension is controlled by the administration of intravenous fluids.

The goals of treatment of a spinal injury are to correct spinal alignment, to protect undamaged neural tissue, to restore function to irreversibly damaged neural tissue, and ultimately to achieve permanent spinal stability. Reduction and immobilization of any fracture or dislocation must receive top priority to meet these objectives. Cervical spine malalignment can almost always be reduced by skeletal traction. Traction may be applied using skull tongs or halo apparatus. Both are seated percutaneously through the outer table of the skull while the patient is kept supine and immobilized. The indications for early operation on patients with spinal cord injury include the inability to close the fracture or dislocation satisfactorily by closed methods, neurologic deterioration in a patient with initially incomplete cord lesion, and severe compression of the spinal cord by an intraspinal mass shown on myelography or MRI. Either the anterior or posterior approach may be used, depending on the nature of the spine injury and the degree of instability. If cord function is preserved immediately after injury, additional function usually returns if the cord and spine are protected from secondary injury. Patients with complete injuries rarely recover function below the level of the lesion.

Category: Surgery MCQs