Neuro anesthesia quiz
Shobana Rajan, M.D.
Attending Anesthesiologist, Albany Medical Center,
Albany, NY
Shaheen Shaikh, M.D.
Assistant Professor of Anesthesiology, University of
Massachusetts Medical center, Worcester, MA.
This quiz is being published on behalf of the Education Committee
of the SNACC.
The authors have no financial interests to declare in this presentation.
“Questions from released In-Training Examinations are reprinted with
permission of The American Board of Anesthesiology, Inc., 4208 Six Forks
Road, Suite 1500, Raleigh, NC 27609-5765. The ABA does not attest to the
current veracity of the items presented.”
1. A 55 yr-old man has quadriplegia after undergoing
suboccipital craniotomy in the sitting position for the
treatment of acoustic neuroma. Which of the following is
the most likely cause?
A. Air embolism with the presence of probe patent foramen ovale
B. Compression of the cervical cord related to neck flexion
C. Jugular venous obstruction
D. Postoperative pneumocephalus
E. Sustained elevation of cerebral perfusion pressure
Please click on answer choices
go to Q 2
1. A 55 yr-old man has quadriplegia after undergoing
suboccipital craniotomy in the sitting position for the
treatment of acoustic neuroma. Which of the following is
the most likely cause?
A. Air embolism with the presence of probe patent foramen ovale
Venous air embolism is a known complication in the sitting position and can lead to disastrous
consequences including cardiac arrest. In the presence of patent foramen ovale, it can lead to
paradoxical air embolism and stroke,however isolated quadriplegia is uncommon.
Try again!!
Incorrect
1. A 55 yr-old man has quadriplegia after undergoing
suboccipital craniotomy in the sitting position for the
treatment of acoustic neuroma. Which of the following is
the most likely cause?
B. Compression of the cervical cord related to neck flexion
Cervical cord compression leading to quadriplegia is a rare complication of the sitting position. Focal pressure on the spinal cord
due to extreme flexion of the head on the neck is a postulated mechanism. Regional cord perfusion may also be decreased
especially when there is associated decrease in mean arterial pressure and could contribute to cord ischemia. Preventive measures
could include avoidance of extreme flexion of the neck and providing a space of at least one inch between the chin and the chest,
avoidance of excessive neck rotation particularly in elderly patients with cervical stenosis and maintenance of near normal mean
arterial pressure. Monitoring of short latency SSEPs have been advocated to monitor the sensory pathways during the procedure.
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Ref:Miller’s textbook of anesthesia:Ch 53: pg 2137
Morandi.X et al:Neurosurgery. 2004 Jun;54(6):1512-5;
Haisa.T et al: Neurosurgery. 1996 Apr;38(4):819-21; discussion 821-2
Correct answer
1. A 55 yr-old man has quadriplegia after undergoing
suboccipital craniotomy in the sitting position for the
treatment of acoustic neuroma. Which of the following is
the most likely cause?
C. Jugular venous obstruction
Jugular venous obstruction can lead to raised intracranial pressure but does
not produce quadriplegia by itself.
Try again!!
Incorrect
1. A 55 yr-old man has quadriplegia after undergoing
suboccipital craniotomy in the sitting position for the
treatment of acoustic neuroma. Which of the following is
the most likely cause?
D. Postoperative pneumocephalus
