Fundamentals of neuroimaging
- Recognize common spine fractures and dislocations.
- Differentiate on computerized images between blood, air, fat, CSF, and bone.
- Distinguish the typical imaging characteristics of epidural hematoma, acute subdural hematoma, chronic subdural hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage.
- Define cerebral perfusion pressure, and explain how it is used in the management of patients with elevated intracranial pressure.
- Describe how blood gases, fluids, and electrolyte balance influence intracranial pressure.
- Describe the clinical manifestations of acute brain herniation, including transtentorial, uncal, and subfalcine herniation syndromes.
Diagnosis and management of ischemic cerebrovascular disease
- Distinguish the symptoms and signs of anterior and posterior circulation ischemia.
- Differentiate the radiographic presentations of the different types of ischemic stroke: embolic, hemodynamic, and lacunar.
- Describe the roles and indications of the following treatment options in ischemic disease: medical management, risk factor modification, and surgical therapy.
Diagnosis and management of nontraumatic neck and back problems
- Define radiculopathy, myelopathy, and cauda equina syndrome.
- Describe the general management of cervical disc herniation, lumbar disc herniation, lumbar instability, and low back pain.
- List the most common examples of extradural, intradural-extramedullary, and intramedullary spine tumors.
Diagnosis and management of peripheral nerve injury and entrapment
- Describe the differences in the management of sharp lacerating injuries, blunt lacerating injuries, gunshot wounds, stretch injuries, compression injuries, and avulsion injuries to peripheral nerves.
- Describe the signs and symptoms of carpal tunnel syndrome and ulnar neuropathy, and outline the surgical indications.
Diagnosis and management of hydrocephalus and spinal dysraphism
- List common symptoms and signs of acute hydrocephalus in children.
- List common symptoms and signs of normal pressure hydrocephalus in adults.
- Define communicating and noncommunicating hydrocephalus and describe the differences in their treatments.
- List two examples each of open and closed spinal dysraphism.
- Describe the principles of management of myelomeningocele.
Diagnosis and management of surgically treatable pain problems, movement disorders, and epilepsy
- Describe the classic presentations of trigeminal neuralgia, failed back surgery syndrome, complex regional pain 2. syndrome 1, and complex regional pain syndrome-
- Describe the differences in indications for spinal cord stimulation versus spinal infusion pump.
- List at least one different surgical treatment each for Parkinson disease, dystonia, spasticity, and hemifacial spasm.
- Define the different types of seizures (simple, partial, etc.).
- Describe the differences between temporal lobectomy, lesionectomy, and disconnective surgery for seizure disorders.
The neurological examination
- Evaluate patient’s mental status and speech.
- Examine the cranial nerves.
- Examine central and peripheral sensory function.
- Examine motor function.
- Examine cranial and peripheral reflexes.
- Examine cerebellar function and gait.
Diagnosis and management of head trauma
- Assign the Glasgow Coma Score.
- Initiate management of elevated intracranial pressure in head trauma.
- Define concussion, brain contusion, and diffuse axonal injury, and initiate management of each.
- Distinguish anatomically and radiographically acute subdural and epidural hematoma, and describe the surgical indications for each.
- Describe the initial management of penetrating high and low velocity head trauma.
- Describe the management of chronic subdural hematoma.
Diagnosis and management of brain tumor and abscess
- Know the relative incidence and location of the major types of primary and secondary brain tumors.
- Describe the general clinical presentations of brain tumors in the following locations: cerebral hemisphere, cerebellum, brainstem, pituitary, and cerebellopontine angle.
- List the advantages and limitations of the following diagnostic tools used in the evaluation of brain tumors: CT, MRI, MR spectroscopy, and angiography.
- Describe the surgical indications for the most common benign and malignant tumors in the locations listed in #2.
- Describe the indications for and the differences between radiotherapy and radiosurgery in the treatment of malignant brain tumors.
- List the major differences between the diagnosis and management of brain tumor and abscess.
- List the most common etiologies of cerebral abscess.
Diagnosis and management of headache
- Distinguish the radiographic presentation of the major causes of intracranial hemorrhage: hypertensive intracerebral hemorrhage, amyloid intracerebral hemorrhage subarachnoid hemorrhage, arteriovenous malformation hemorrhage, tumor hemorrhage, and coagulopathy hemorrhage.
- Apply the following diagnostic tools in evaluation of acute headache (CT, MRI, angiogram, and lumbar puncture).
- Describe the broad treatment strategies (surgery, radiosurgery, interventional radiology, as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations.
- Differentiate the symptomatology of migraine, cluster, tension, and sinusitis headache.
- Describe the rapid assessment of a patient with spinal trauma.
- Recognize the common spine fractures on X-ray.
- Initiate acute management of spinal cord injury, including immobilization, steroids, and systemic measures.
- Define the unstable spine.
- Present a case to your preceptor, including relevant history, neurological examination, imaging findings, and treatment plan.
Participation on the wards
- Ask neurosurgical staff (residents, attendings, etc.) questions as appropriate to enhance learning opportunities both in and out of the OR.
- Demonstrate professionalism in the operating room; do not be disruptive, but feel free to participate, including asking questions, reviewing images, pathology, intraoperative findings, etc.
- Demonstrate level of interest by scrubbing in on cases at the discretion of the resident and attending.
- Attend all scheduled conferences.
- Feel free to participate and ask questions.
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