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Posterior fossa malformations Chiari malformations involve cerebellar herniation through the foramen magnum: /uni25CF Normal: up to 5 /uni00A0 mm of cerebellar tonsillar descent through the foramen magnum. /uni25CF Chiari I: >5 /uni00A0 mm of tonsillar desce...

Presentation Most tumours present with one or more features belonging - to three cardinal categories: these are seizure, raised ICP and focal neurological deficit. Pituitary adenomas may also present with endocrine disturbance. Rachel Cowden was, in 1963, the fi...

RAISED INTRACRANIAL PRESSURE The importance of intracranial pressure (ICP) management in the context of head injury has been discussed elsewhere (see Chapter 28 ). Likewise ICP is key to presentation and management across the spectrum of cranial neurosurger...

Risks of craniotomy The risks associated with craniotomy are important to appre - ciate in discussing operations with patients and family , and in evaluating patients who deteriorate postoperatively . Specific risks depend on the anatomy of each approach. T he...

Spina bifida occulta A congenital absence of a spinous process, without exposure of meninges or neural tissue, but presenting a characteristic shallow hair-covered hollow at the base of the spine. This is common and rarely clinically significant. syndrome, whi...

Subdural empyema Subdural empyema refers to an infected fluid collection in the subdural space. This may develop as a result of sinusitis, mastoiditis or meningitis, and can complicate trauma or surgery . Figure 48.12 shows a subdural empyema associated with o...

Surgical/interventional management Aneurysms may be removed from the circulation surgically by craniotomy and ‘clipping’ or by endovascular embolisation, also known as ‘coiling’ ( Figure 48.16 ). Sometimes mesh stents may also be used to help secure the metal ...

Treatment of hydrocephalus Acute obstructive hydrocephalus is an emergency because of the risk of rapid progression to coma and death, sometimes with very sudden deterioration, a ‘hydrocephalic attack’. It may be relieved by addressing the underlying patholog...

Tuberculosis Tuberculosis (TB) infection of the central nervous system (CNS) represents haematogenous spread from primary pulmonary foci. A high index of suspicion is required, especially when population or individual risk factors are present. TB can result i...

VASCULAR NEUROSURGERY Subarachnoid haemorrhage ‘Spontaneous’ SAH is usually the result of bleeding from a - ruptured aneurysm (approximately 80% of SAH) or an arterio - - venous malformation (A VM). Most ruptured aneurysms are located in the circle of Willi...

Vestibular schwannoma These are nerve sheath tumours arising in the cerebellopontine - angle ( Figure 48.27 ) that present with hearing loss, tinnitus - and balance problems. Facial numbness and weakness are less common, while large tumours may present with fe...

Acute angle closure This usually occurs in older, often hypermetropic, patients. The prevalence is much higher in some Asian populations. The cornea becomes hazy , the pupil oval, dilated and non-reacting, the vision poor and the eye feels hard. In severe case...

Adults Malignant melanoma is the most common primary malignant tumour of the eye and originates in the pigmented cells of the choroid ( Figure 49.14 ), ciliary body or iris. It can present with a reduction in vision, a vitreous haemorrhage or by the chance fi...

Blunt injuries to the eye and orbit The floor of the orbit is its weakest wall and in blunt trauma, such as a blow from a fist, it is often fractured without fractures of the other walls. This is called a blow-out fracture. Clinical - signs are enophthalmos, b...

Blunt ocular injuries Blunt injuries to the eye can give rise to several problems, which include the following: /uni25CF Iritis . Inflammation; treated with topical steroids. /uni25CF Hyphaema (blood in the anterior chamber) ( Figure 49.20 ). Rest and sedation,...

Burns Radiation burns Corneal injury may occur after exposure to ultraviolet radia - tion, for example after arc welding or excessive sunlight (snow blindness) and sun lamps. Such burns cause intense gritty burning pain and photophobia as a result of keratiti...

Conjunctivitis Symptoms are grittiness, redness and discharge. Causes are infective, chemical, allergic or traumatic. In the newborn it can be serious; gonococcal and chlamydial infection must be excluded. Bacterial conjunctivitis is purulent, usually self- li...

DIFFERENTIAL DIAGNOSIS OF THE ACUTE RED EYE This is important in the management of minor ocular complaints and the recognition of conditions that require expert attention. Possible causes of the acute red eye include: /uni25CF subconjunctival haemorrhage; /...