Important knowledge

⚡️Astrocytoma is the most common type of brain tumour in children -Metastasis (secondary) brain tumor is the most common malignant tumor in brain (75%) in adult (معدلة)

⚡️Ealdrly with OPI ( ocification of posterior longitudinal ligament) suspected to develop central cord syndrome

Whiplash injury (flexion hyper extension) Responsible for central cord syndrome

⚡️ اخر منطقه يروح بيها ال sensation بال spinal injury هيه ال anal area فاذا موجود بيها sensation معناها ال incomplete injury

⚡️ most common site for vertibral injury is lower cervical & upper lumbar ( between fixed & mobile one as thoracic is fixed & cervical and lumbar is mobile)

⚡️Mannitol given for 15 to 20 min per dose because if given for more than 20min will cause rebound phenomena

Burr hole

Management EDH = always craniotomy SDH = Acute = Craniotomy SDH = Chronic = Burr Hole SAH = Traumatic = conservative SAH = Ruptured Aneurysm = Surgery

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⚡️ 90% of Epidural hematoma associated with skull fracture but in children fracture is rarely assotiated

Very important

⚡️Triad of transtentorial herniation on neurological examination ( emergency) 1) decrease level of conscious 2) ipsilateral dilated pupil 3) contralateral hemiparesis

#neurosurgery 🧠

⚡️Tumor marker for follow up of patients with teratoma after surgery - AFP - B-HCG - CA 125

⚡️Urinary catecholamine metabolites -homovanillic acid (HVA) -vanillylmandelic acid (VMA) Posative in 90% of the patients with neuroblastoma Ddx / phaeochromocytoma

Thyroglossal Duct Cyst presentation 1) concurrent or prior infection. 2) draining sinus 3) foul taste in the mouth

⚡️Ddx of suprahyiod midline neck mass - Thyroglossal Duct Cyst(mostly at or below hyiod) - submentaldermoid cysts - submental lymph nodes

puckering of the skin

‘blue dot’ sign Sign of Testicular appendahges torsion Same picture of Testicular torsion but less sever pain & age between 7-10 y ( Testicular torsion most common before 3Y & after 15 Y)