Neurosurgery

Definition Subarachnoid haemorrhage (SAH) is bleeding in the subarachnoid space between the arachnoid and pia mater meningeal layers. Aetiology SAH can be a life-threatening emergency and it is estimated that 10-15% of patients die before they reach hospital. SAH can be divided into traumatic or spontaneous Traumatic (tSAH): most common cause of SAH. Usually in setting of a head injury (e.g. fall, assault, road traffic collision) Spontaneous: commonly due to rupture of a cerebral aneurysm (aSAH) Traumatic Trauma is the most common cause of SAH. There is usually evidence of trauma in the clinical history (e.g. road traffic accident). An isolated SAH in

Overview Several classic syndromes that have characteristic clinical features based on the area of the spinal cord that is affected. Neurological signs and symptoms can usually be located to the spinal cord based on the presentation of bilateral motor and sensory signs without head or face involvement. In some situations, a specific set of clinical features can develop due to the area within the spinal cord that is affected. These are known as the spinal cord syndromes. We discuss some of the more common ones below. Anatomy The spinal cord is part of the central nervous system (CNS) and forms the main

Overview Radiculopathy refers to symptoms or impairments related to the involvement of a spinal nerve root. The spinal nerve roots serve as the main communication between the central nervous system (i.e. the spinal cord) and the peripheral nerves. When a spinal nerve root is affected, it is known as radiculopathy. Radiculopathies may be single or multiple. When multiple nerve roots are affected it is known as polyradiculopathy. The symptoms of radiculopathy are usually characteristic because each root supplies a specific area of cutaneous tissue, known as the dermatome, and a functional group of muscles, known as a myotome. Therefore, patients typically

Definition An extradural haematoma (EDH) is a collection of blood in the extradural space, above the dura mater. Extradural haematoma (EDH), also known as epidural haematoma, refers to a collection of blood in the extradural space between dura and skull. It is most often due to trauma and commonly associated with a skull fracture (75-95% of cases). Aetiology EDH is most commonly due to trauma from a direct head injury. EDH is often life-threatening and patients may require emergency neurosurgery depending on the patient’s neurological status and size of the lesion. It is worth noting that the majority of patients with an

Definition Subdural haematoma is a collection of blood in the subdural space. Subdural haematoma (SDH) refers to a collection of blood in the subdural space. This is situated underneath the dura and above the arachnoid mater meningeal layers. There are several classifications of SDH: Acute (ASDH): bleeding occurring in the last 1-3 days. Chronic (CSDH): blood that has usually been present for > 3 weeks. Subacute: bleeding that occurs between 4 days and 2-3 weeks. Acute on chronic: chronic haematoma that may expand secondary to recurrent bleeding. Aetiology The most common cause of CSDH is trauma. The most common cause of CSDH is trauma in

Overview Cauda equina syndrome is due to compression of the collection of nerves distal to the terminal part of the spinal cord known as the cauda equina. The cauda equina, which is Latin for ‘horses tail’, refers to the collection of spinal nerves that lie within the subarachnoid space distal to the last part of the spinal cord known as the conus medullaris. Compression of the cauda equina leads to a syndrome characterised by lower limb weakness, bladder and bowel dysfunction, and abnormal perianal sensation. It is considered a neurosurgical emergency. While not a true spinal cord lesion, cauda equina syndrome is usually

Overview Brain tumour is a generic and broad term for a wide range of pathologies. A brain tumour is a broad term for an intracranial tumour, or mass, affecting structures such as the meninges, brain, glands, neurovascular structures and/or bone. Other words that may be used to describe an intracranial tumour include a mass, growth, space-occupying lesion (SOL) or central nervous system (CNS) lesion. The term ‘brain tumour’ itself is very generic and should generally be avoided as the management and prognostication for each type differ considerably. Where possible, it is important to use precise terminology. The clinical presentation, management, and prognostication

Definition Subdural haematoma is a collection of blood in the subdural space. Subdural haematoma (SDH) refers to a collection of blood in the subdural space. This is situated underneath the dura and above the arachnoid mater meningeal layers. There are several classifications of SDH: Acute (ASDH): bleeding occurring in the last 1-3 days. Chronic (CSDH). blood that has usually been present for > 3 weeks. Subacute: bleeding that occurs between 4 days and 2-3 weeks Acute on chronic: chronic haematoma that may expand secondary to recurrent bleeding Aetiology The most common cause of ASDH is trauma. ASDH is often a life-threatening emergency and historically