Here is another blog for those who want to crack Neurosurgery entrance exams for MCh and DrNB. Here I will tell you in a step-by-step manner how you can go about your neurosurgery entrance exam preparation. "How to crack Neurosurgery entrance" will be discussed under the following headings:

What are the various examinations conducted for Neurosurgery Entrance?

The examinations for Neurosurgery which you can appear after your MS General Surgery are:

• NEET SS Neurosurgery (MCh/ DrNB)
• NIMHANS Neurosurgery (MCh)
• AIIMS Neurosurgery (MCh)
• PGI Chandigarh Neurosurgery (MCh)
• JIPMER Neurosurgery (MCh)

What Online Course to join for MCh/ DrNB Neurosurgery Entrance?

Usually people find it difficult to read Neurosurgery from books by themselves, because most of them have not had a practical exposure, thus grasping and remembering Neuroanatomical and Neurosurgical facts can be a daunting task. Check out this Conceptual Neurosurgery course for Neurosurgery Entrance Preparation which I will be teaching for Surgtest (App Link). Below are the salient features and contact details:

✅ Live and online classes  

✅ Video Recordings of all sessions

✅ Notes/slides prepared personally by the faculty 

✅ Topic-based conceptual classes: Answer any variation of questions asked on a topic! 

Download the 𝗰𝗼𝘂𝗿𝘀𝗲 𝗯𝗿𝗼𝗰𝗵𝘂𝗿𝗲 here to know the details and topic wise schedule: 

https://drive.google.com/file/d/1VJyzBf1wUcbgWTfJ3iS-sxOlan8MsjjD/view?usp=sharing

Whatsapp chat helpline - +91 7395939989 

Email - info@surgtest.com

What are the theory books to prepare for MCh/ DrNB Neurosurgery Entrance?

Following are the theory books from which majority of the questions are framed:

• Snell's Neuroanatomy - Must Read

Either of These

• Greenberg's Review of Neurosurgery 

                Or

• Ramamurthy and Tandon's Manual of Neurosurgery

Greenberg is prefered more because it is high yield even for Neurosurgery residents but it is difficult to grasp and remember. It is so exhaustive that you can be almost sure that you won't miss anything.

Ramamurthy and Tandon Manual ("Manual", Not the Ramamurthy Textbook) is better in terms that it clears your concepts of Neurosurgery, it is written in simple language, written by authors who are Senior faculties in AIIMS and in other institutes of national importance and you can finish reading it in 2-3 months time.

What are the MCQ books to prepare for MCh/ DrNB Neurosurgery Entrance?

Amongst most of the MCQ books available in the market, no single book is satisfactory yet, you can check out these books for MCQs.

• Nimhans Pg Medical Entrance Test 12ed 2017
• CBS: DM/Mch Neurology and Neurosurgery: Entrance Examination: 3rd Edition
• Objective Study of Neurosurgery by Jaiswal
• Review of Neurosurgery by by Prakash khetan

How much time is required to prepare for MCh/ DrNB Neurosurgery Entrance?

In ideal conditions 1-1.5 years is necessary to grasp all neurosurgery concepts, finish a textbook and practice MCQs if you are reading along with your General Surgery Residency. 

If after finishing your general surgery residency, you are able to give your dedicated attention, the time required can be shorter. 

How many daily hours of study are required to prepare for MCh/ DrNB Neurosurgery Entrance?

As any other competitive entrance in country like India, atleast 5-6 hours of dedicated study time on daily basis is required to crack the entrance exam.

What books to read for Neuroanatomy for MCh/ DrNB Neurosurgery Entrance?

Best book for reading Neuroanatomy is undoubtedly Snell's Neuroanatomy. All diagrams and MCQs given in the book are important.

What are the important topics for the preparation of  MCh/ DrNB Neurosurgery Entrance?

Following topics or areas are very important in terms of bulk of questions asked:

• Neuroanatomy
  
• Neurotrauma
  
• Neuroncology 
• Infections of brain
  
• Neuropthalmology 

How is Neurosurgery as a branch?

I have listed down the pros and cons of joining Neurosurgery below so that you can make up your mind for starting your Neurosurgery preparation. Always remember at the end- Most important factor to decide is asking yourself - "What kind of work I will love to do for the rest of my life?"

• Easy to get jobs both in metro cities and tier B cities
• Good remuneration (One of the top most)
• Challenging in terms of hours and techniques involved
• Has a variety of procedures including Neuroncology, Brain Trauma Surgery, Endoscopic Surgery, Neurovascular Surgery, Spine surgery, Peripheral Nerve Surgery
• Evolving fast with many new breakthroughs
• Can also do individual practice and do basic procedures
• High in demand
• High stress
• High patient load
• High complications and mortality rates

When to start preparation for MCh/ DrNB Neurosurgery Entrance?

Make up your mind in 1st year of General Surgery residency itself on what branch you want to join and start preparing or atleast orienting yourselves to that specific branch in terms of both theoretical and practical knowledge. 

Start reading formally when you start to get more time for reading books from 2nd year of your residency.

Is there any Facebook or Whatsapp group for  guidance and preparation of MCh/ DrNB Neurosurgery Entrance?

For further guidance, I will be available at following groups on Facebook and Whatsapp.

Facebook NEET SS Neurosurgery Preparation

• https://www.facebook.com/groups/neurosurgeryneetss

Whatsapp Surgtest Neurosurgery Group

• https://chat.whatsapp.com/LkCw0Ao6jMaDlZ2polF70z

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5/07/2021 07:54:00 PM

Contents

• How much free time do you have as a neurosurgeon?
• How is the load of patients in Neurosurgery?
• How much time does it take to be a Neurosurgeon?

---

7/22/2020 11:18:00 PM

Contents

1. Case Report
2. Introduction
3. Signs and symptoms
4. Pathophysiology
5. Diagnosis
6. Treatment
7. Hypertensive Pontine Hemorrhage Video

Case Report

• 52yr old male
• k/c/o HTN not on regular medication
• Presented with sudden onset loss of consciousness

On Examination

• GCS - E1VetM1
• Pupils -B/L 1mm NRTL (Pin-Point Pupils)
• Planters B/L mute

CT Scan

Hypertensive Pontine Hemorrhage

Hypertensive Pontine Hemorrhage: Introduction

• Seen in long standing poorly-controlled chronic hypertension. 
• It carries a very poor prognosis.
• Pontine hemorrhage accounts for 5-10% of all hemorrhagic strokes (Jang et al 2011)

Signs and symptoms

• "classic" pontine hematoma syndrome characterized by coma, quadriparesis, and eventual demise (Kushner et al 1985)
• Clinical features of Pontine Hematoma are (Deng and Gaillard et al.)
• • Loss of consciousness (most common)
  • long tract signs including tetraparesis
  • cranial nerve palsies
  • seizures
  • Cheyne-Stokes respiration
• CST does not play an essential role in recovery of independent walking and vestibulospinal tracts may not crucially affect recovery of independent walking in patients with pontine hemorrhage. In contrast, and intact CRP (corticoreticular pathway) or changes of the CRP integrity appear to be related to the recovery of gait function (Yeo et al 2020)

Pathophysiology

Hypertensive Pontine Hemorrhage

• Due to rupture of penetrating arteries from the basilar artery extending into the pons 
• These arteries are prone to lipohyalinosis as a result of poorly-controlled hypertension 
• This makes the vessel wall prone to rupture. 
• Larger paramedian perforators are more commonly the culprit vessels

Other Causes of Pontine Hemorrhage

Other causes of pontine hemorrhage include

• Cavernoma
• AV Malformation
• Tumour bleed
• Transtentorial herniation (Duret Hemorrhage)

Diagnosis

NCCT Brain is the investigation of choice. It shows:

• Acute intraparenchymal hemorrhage within the pons
• The hematoma frequently ruptures into the 4th ventricle 

Treatment

• Poor prognosis
• Large bleeds are almost universally fatal. 
• Open surgical evacuation of the clot is usually not performed
• In smaller hemorrhages, medical management and treatment of hydrocephalus with extraventricular drains may be life saving, 
• Mortality ranges between 30% and 90% (Jang et al 2011)
• Outcome depends on the volume of the bleed and initial GCS

Hypertensive Pontine Hemorrhage Video

Hypertensive Pontine Hemorrhage Video

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6/12/2020 06:01:00 PM

1. Neurogenic bladder refers to dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition . 

2. Non Neurogenic bladder refers to dysfunction of the urinary bladder due to dynamic disturbance of genitourinary system. 

 

Micturition Pathway

3. detrusor muscle of the bladder is innervated by parasympathetic neurons located in the S2-S4  column

 

5/19/2020 01:08:00 AM

The CT comma sign is a characteristic sign seen in head trauma. 
It is the presence of concurrent epidural and subdural hematomas, 
which gives the characteristic appearance of this sign as a "comma" shape.           

70/M 

Chief Complaints: Numbness Lt Arm, 1 Episode of Partial seizure,Lt grip weakness since today morning. 

H/o Fall 3 days back. 

K/C/O HTN/DM/Post CABG 1994 with implanted defibrillator device (CRTD)/ Post Mechanical Thrombectomy for Rt MCA territory Infarct (March2020) on Ecospirin and T. APIXABAN(last dose today). 

Kn chronic  smoker and alcoholic. 

O/E 

E4V5M6

Pupils B/L 2mm RTL . 

Power Lt side 4/5. 

Left Hand grip 70%.

Since the patient was having multiple comorbidities with deranged coagulation and the GCS was 15, it was decided to manage the patient conservatively. Ecospirin and APIXABAN were stopped after consulting with a cardiologist and neurologist. 

#neuroradiology#neuroscience

#neurosurgeon #brainmri #braincat 

Reference

https://radiopaedia.org/articles/ct-comma-sign-head

5/08/2020 10:28:00 AM

 


1. MR spectroscopy provides a measure of brain chemistry.
2. The most common nuclei that are used are 
• 1H (proton)
• 23Na (sodium)
• 31P (phosphorus). 
• Proton spectroscopy is easier to perform and provides much higher signal-to-noise than either sodium or phosphorus.
3. MRS can be performed within 10-15 minutes and can be added on to conventional MR imaging protocols. 
4. It can be used to serially monitor biochemical changes in tumors, stroke, epilepsy, metabolic disorders, infections, and neurodegenerative diseases. 
5. They require interpretation and should always be correlated with the MR images before making a final diagnosis.

5/05/2020 01:23:00 AM

 Video Link:Neurosurgery written board crash course - hypothalamus 




 

1. hypothalamus as the name suggests is directly underneath the thalamus and it's directly above the pituitary 
2. borders of the hypothalamus can be drawn by a triangle 
• line between the anterior commissure and a posterior commissure and it's called the ACPC line
• line between the anterior commissure and the optic chiasm roughly boarded by the lamina terminalis 
• line between the chiasm and the posterior commissure 

5/02/2020 09:39:00 PM

What are the pain sensitive intracranial structures?

Brain itself is pain insensitive. 

The following intracranial structures are pain-sensitive:

1. Meningeal arteries
2. Proximal portions of the cerebral arteries
3. Dura at the base of the brain
4. Venous sinuses
5. Cranial nerves 5, 7, 9, and 10, and cervical nerves 1, 2, and 3

What are the mechanisms causing headaches?

• Distortion or traction of Dura, Venous Sinuses or Blood vessels: 

• Drainage of CSF in erect posture causes headache, secondary to traction on the venous sinuses when the brain sinks toward the tentorium as it loses CSF flotation
• Intracranial mass distorts the dura or the arteries at the base of the brain 
• Distortion due to raised ICP 

• Distension of a vessel

• Distension of extracranial and occasionally intracranial arteries is thought to be the cause of pain in migraine (activate the trigeminal nerve terminals in the vessel wall)

• Inflammation

• Inflammation in the subarachnoid space can result in headache. Inflammation can be caused by infection, hemorrhage, or chemical irritation
• Inflammation of vessel wall by autoimmune process. eg Giant cell arteritis

• Referral of Pain

• Lesions above the tentorium - referred pain in trigeminal nerve distribution (the forehead or behind the eye) - because the dura in this region is supplied by the trigeminal nerve
• Lesions in the posterior fossa - 
• referred pain in the ear and the back of the head - because this part of the dura is supplied by cranial nerves 9 and 10 and the upper three cervical roots
• refer pain to orbit -  termination of orbital (ophthalmic division) pain nerve fibers in the lowest part of the spinal nucleus of the trigeminal nerve, which also receive termination of the upper cervical pain afferent nerve fibers 
• referred pain to ear - Irritation of cranial nerves 7, 9, and 10 - because the ear has cutaneous supply from each of these nerves as well as cranial nerve 5.

What are the types of Headaches?

For the purpose of history taking, headaches can be divided into two types:

• Primary- no identifiable cause on examination or investigation and diagnosis is based on  recognizing a pattern, e.g.
• Migraine
• Cluster headache
• Tension-type headache
• Secondary - definite identifiable cause on examination or investigation, e.g. 
• Brain tumors
• Meningitis
• Sub-arachnoid hemorrhage 
• 90% - primary headaches, less than 10% are secondary headaches (Rasmussen 1991)

What are the headache "Red Flags"?

• Worst Headache ever
• New onset Headache
• Onset after age of 50 yrs
• Change in pattern of headache
• Worsening headache
• Sudden onset during exertion, sneezing, coughing
• Headache with postural variation
• Headache in setting of malignancy or HIV
• Headache associated with Neurological symptoms or signs
• Associated with systemic symptoms - fever, weight loss and chronic cough

What history to take in a patient presenting with Headache?

Duration

Exact duration as reported by patient

NEW onset headache or something that has been there since before and has worsened now

Onset ( sudden/ gradual )

Acute onset, severe, first and worst headache, the common possibilities are sub-arachnoid hemorrhage, vascular dissection, pituitary apoplexy

Gradual onset – migraine(mins to days), SDH, GCA(days to months)

Severity

verbal rating scale from 0 to 10

Character

Pulsatile or throbbing or hammering (Raised ICP Headaches/ Migraine)

Dull featureless pain (Tension type headache)

Boring sharp- cluster HA

Time of occurrence

Raised ICP headaches - More in morning, May waken the patient at an early hour

Frequency

Increase in frequency - red flag

Distribution

Frontal or Holocranial - Raised ICP

Band like - tension headaache

Aggravating factors

Exertion, coughing, sneezing, stooping, and straining at stool

Changes in posture (increases in supine - ↑ICP , increases in upright – low CSF pressure headache)

Relieving factors

Improvement on lying flat - low pressure headache

Associated features

Blurring of Vision - Papilloedema

Diplopia, the commonest cause of which is abducens nerve paresis

Nausea & vomiting – migraine, ↑ICP

Neck stiffness – meningeal process

Changes in consciousness

Focal neurological symptoms

References

• Ravishankar K. The art of history-taking in a headache patient. Ann Indian Acad Neurol. 2012;15(Suppl 1):S7–S14. doi:10.4103/0972-2327.99989
• Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population – a prevalence study. J Clin Epidemiol. 1991;44:1147–57
• https://www.dartmouth.edu/~dons/part_2/chapter_18.html

12/24/2019 10:06:00 PM

Anatomy of Basal Ganglia - Axial View

Structures generally included in the basal ganglia are the caudate, putamen, and globus pallidus in the cerebrum, the substantia nigra in the midbrain, and the subthalamic nucleus in the diencephalon.

Basal ganglia's primary function is likely to control and regulate activities of the motor and premotor cortical areas so that voluntary movements can be performed smoothly.

Dysfunction results in a wide range of neurological conditions including disorders of behaviour control and movement.

Those of behaviour include Tourette syndrome, obsessive–compulsive disorder, and addiction.

Movement disorders include, most notably Parkinson's disease, which involves degeneration of the dopamine-producing cells in the substantia nigra, Huntington's disease, which primarily involves damage to the striatum, dystonia, and hemiballismus


 #neurosurgeon #neuro #neurosurgery #neurological #basalganglia #neuroscience #neurology #neurochirurgie #neuroradiology #BGBleed #caudate #caudatenucleus https://ift.tt/33tMQAo via WSF Instagram

10/17/2019 12:36:00 AM