General Surgery Rotation

General Surgery: Neurology (PEARLS)

The General Surgery End of Rotation Blueprint Neurology section includes seven topics and represents 5% of your General Surgery EOR exam

Change in speech Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions

  • This damage is typically caused by a postoperative cerebral vascular accident (stroke), or head trauma; however, these are not the only possible causes.

Dysarthria is a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system

Change in vision Perioperative vision loss is very rare, occurring at a frequency of 0.002% after nonocular surgeries and 0.2% after cardiac and spine surgeries

  • Increased prevalence after cardiac, spine, head and neck, and some orthopedic procedures
  • The most common cause of postoperative ocular injury is corneal abrasion, which may or may not be associated with visual loss
  • The most common causes of permanent POVL are central retinal artery occlusionischemic optic neuropathy, and cerebral vision loss
Epidural hematoma Traumatic head injury, conscious in ER followed by unconsciousness

Epidural hematomas are caused by damage to the middle meningeal artery as it passes through the foramen spinosum of the sphenoid bone.

Motor and sensory loss Spinal Cord Injuries

Anterior cord syndrome:

  • Loss of pain and temperature below the level with preserved joint position/vibration sense

Central cord syndrome:

  • Loss of pain and temperature sensation at the level of the lesion, where the spinothalamic fibers cross the cord, with other modalities preserved (dissociated sensory loss)

Complete cord transection:

  • Rostral zone of spared sensory levels (reduced sensation caudally, no sensation in levels below injury); urinary retention and bladder distention

Brown-Sequard syndrome (hemisection of the cord):

  • Loss of joint position sense and vibration sense on the same side as lesion and pain and temperature on the opposite side a few levels below the lesion
  • Lesion of half-ipsilateral cervical cord lesion
  • Contralateral sensory findings: pain and temperature loss

Distal sensory polyneuropathy

  • Stocking-glove sensory loss is a term used to describe sensory loss affecting the distal lower and upper extremities that is most commonly seen in length-dependent axonal neuropathies

Axonal neuropathies are most frequently due to:

Other causes of sensory neuronopathy include:

Subarachnoid hemorrhage "Worst headache of my life"

Subarachnoid hemorrhage typically occurs due to ruptured berry aneurysms and presents with the "worst headache" of a person's life.

Subdural hematoma An elderly patient with a history of multiple falls who is now presenting with neurological symptoms – indicative of a chronic subdural hematoma.
Vascular disorders (carotid disease) Carotid stenosis < 70% is best managed with antiplatelet therapy (aspirin), whereas stenosis > 70% is best managed with carotid endarterectomy.
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