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Egyptian Board Neurosurgery study materials
Egyptian Board Neurosurgery study resources

Egyptian Board Neurosurgery: Neurotrauma (Head and Spinal Injury)

Egyptian Board Neurosurgery · Work through your exam, one topic at a time.

All guide sections

Neurotrauma (Head and Spinal Injury)

Trauma questions are management algorithms: what happens first, what you must avoid, and which operation changes outcome.

Head injury

  • ATLS sequence: airway with inline cervical control, ventilation to PaCO2 35 to 40, circulation. A single systolic reading below 100 mmHg markedly worsens outcome, so target systolic at least 110 in adults.
  • CT indications: GCS under 13 at any time, GCS 13 to 15 with vomiting, amnesia, seizure or anticoagulation, focal deficit, or skull fracture.
  • Severe injury, GCS 8 or less: intubate and place an ICP monitor if CT is abnormal or if age over 40 plus hypotension is present.
  • Treat ICP above 22 mmHg. First tier: head up 30 degrees, sedation, normocapnia, osmotherapy with mannitol 0.25 to 1 g/kg or hypertonic saline. Second tier: CSF drainage, brief hyperventilation, neuromuscular blockade. Third tier: decompressive craniectomy.
  • Seven days of phenytoin or levetiracetam prevents early post-traumatic seizures. Steroids are contraindicated because they increase mortality.
  • Reverse anticoagulation with prothrombin complex concentrate and vitamin K; idarucizumab for dabigatran.

Operative thresholds

  • Extradural haematoma over 30 cm3, or any with GCS fall, anisocoria or shift over 5 mm. A lucid interval is classic.
  • Acute subdural over 10 mm, or over 5 mm with shift over 5 mm, or a GCS drop of 2 points.
  • Depressed fracture greater than 1 cm or with dural breach; lower the threshold for posterior fossa lesions.

Spine

  • ASIA: A complete, B sensory incomplete, C motor incomplete with most muscles below grade 3, D grade 3 or more, E normal.
  • Spinal shock is the flaccid areflexic phase; neurogenic shock is hypotension with bradycardia from lost sympathetic tone.
  • TLICS combines morphology, posterior ligamentous complex and neurology; cord injury or ligamentous disruption pushes toward surgery.
  • High-dose methylprednisolone is no longer recommended for acute cord injury.

Worked example

A 25-year-old with GCS 6, a right fixed pupil and a biconvex hyperdense temporal lesion: intubate, control ventilation, give osmotherapy, and take him to theatre for craniotomy and evacuation while correcting coagulopathy. Not lumbar puncture, not steroids.

Traps

  • Allowing a single hypotensive episode in a head-injured patient.
  • Missing a cervical fracture in ankylosing spondylitis.
  • Relying on plain films to clear the spine in an obtunded patient.