Neurological Surgery
Core concepts
Know the management of traumatic brain injury, intracranial hemorrhage, hydrocephalus, and spinal emergencies. Understand the Glasgow Coma Scale, pupillary exam, and signs of herniation. Intracranial pressure management includes head elevation, sedation, osmotherapy, and decompressive surgery when indicated.
Key topics
- Epidural versus subdural hematoma: lucid interval and lens-shaped versus crescent-shaped imaging descriptions.
- Aneurysmal subarachnoid hemorrhage: sudden thunderclap headache, CT then lumbar puncture if needed, and early securing of the aneurysm.
- Spinal cord compression: urgent imaging and steroids in selected malignant cases.
- Hydrocephalus: shunt versus endoscopic third ventriculostomy.
Traps
- Missing a herniation syndrome in a deteriorating patient.
- Confusing epidural and subdural presentations.
- Delaying aneurysm treatment after subarachnoid hemorrhage.
- Forgetting that anticoagulation worsens outcomes in intracranial hemorrhage.
Worked example
A head-injured patient with a brief lucid interval then decline and a fixed dilated pupil: epidural hematoma with impending herniation - urgent neurosurgical decompression. Rule of thumb: a blown pupil is a surgical clock, not a radiology question.
Study strategy
Pair each hemorrhage type with its typical history and imaging description. Practice GCS scoring and herniation recognition.