Q1) When does neural tube start to form? When does the the rostral neuropore close? When does the caudal neuropore close?
Cannot be exact with the dates but these events occur around:
Neural tube forms: about 22 dayRostral neuropore close: about day 25Caudal neuropore close: about day 27
TW Sadler. Longmanʼs medical embryology. Ninth edition. Lippincott Williams and Wilkins, Phili, 2004 p 90
Q2) How do you manage patients with hypertension secondary to intracerebral haemtoma?
There does not appear to be consensus on this. Decreasing blood pressure likely to decrese risk of rehaemorrhage and vasogenic oedema but there is a risk of causing ischaemia.
According to Warburton Indications for management of hypertension in ICH (Liz A Warburton. managmento facute ischaemic stroke. In Textbook of neuroanaesthesia and critrical care. In: Basil Matta, David Menon, John Turner. GMM, London 2000, p 357):
hypertensive encephalopathyaortic dissectioncardiac failureacute renal failureBlood pressure readings exceeds limits of autoregulation : i.e systolic BP > 220 diastolic
It is also not clear how rapidly or cautiously the blood pressure should be brought down. Whether it be over minutes or over days.
American heart association guidelines from (1999) (reviewd in Torbey MT. Bood pressure management. In: Handbook of Neurocritical care. Humana PressTotowa, 2004, 234):
- if SBP is > 230 mmHg or DBP >140 mmHg on two readings 5 mins apart, institute
- if SBP is from 180-230 mmHg on two readings 20 mins apart, institute intravenous
labetalol, ermolol, enalaprilat, Nicardipine
- If SBP is <180 mmHg and DNP <105 mmHg, defer antihypertensive therapy- If ICP monitoring is available, CPP shouild be kept at >70 mmHg
Labetalol, esmolol and enalapril do not have effect on ICP. Nitroglycerine and sodium nitroprusside cause vasodilatation and cause increase in CBF and ICP; these effects can decreased by slowly infusing these drugs ( Allen SJ, Parmley CL, Cardiovascular therapy. In: Handbook of neuroanaesthesia. 4th edition. Eds.: Newfield P, Cottrell JE. Lippincott Williams & Wilkins, Philadelphia, 2007 pp377
The control of BP in patients with ICH is controversial. It is useful to discuss this topic with your neuro-intensivist. Do you follow any protocol in your unit?
Q3) What is the iv loading dose of Sodium valproate in adults?
Target serum concentration > 100microgram/ml
Venkataraman V et al. Epilepsy Res, 1999 June; 35(2):147-53Limdi Na et al. Epilepsia 2007; 48(3): 478-83
Q4) Can a patient sense touch, If the spinal posterior column is affected?
Yes. Tactile sensation is carried by the anterlateral pathway. It is the discriminatory tactile sensation that is carried in posterior column. So if the posterior column is affected the patient can feel touch but cannot discriminate between single or paired stimuli; unable recognize numbers traced on the skin
Q5) How would you treat a pure chance fracture?
Chance fracture is mainly osseous. Patient can be treated conservatively or operatively. Conservative treatment will entail the patient wearing an extension brace. Operative treatment would entail bisegmental pedicle screw fixation without (posterolateral) fusion; However, the the metal work would need to be removed after 8-12 months (after the bone has healed) to allow regain the range of motion.
(I would go for the conservative treatment; avoiding 2 operations, expenses, risk of operative complications)
Bartolome Marre. Thoracolumbar and lumbar spine fracture. In: AOLSpine manual clinical applications(Vol 2). Eds.: Aebi M, Arlet V, Webb JK. Thieme, Stuttgart 2007, pp178-179
Q1) When does neural tube start to form? When does the the rostral neuropore close? When does the caudal neuropore close?Cannot be exact with the dates but these events occur around:Neural tube forms: about 22 dayRostral neuropore close: about day 25Caudal neuropore close: about day 27TW Sadler. Longmanʼs medical embryology. Ninth edition. Lippincott Williams and Wilkins, Phili, 2004
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