25 Mar Neuro Disease Assessment (Exam 3) Flashcards
What is the normal range for intracranial pressure (ICP)?
5-15 mmHg
What is cerebral perfusion pressure (CPP) influenced by?
Arterial blood carbon dioxide levels, brain oxygen levels, and intracranial pathologies
What is the Monroe-Kelly hypothesis?
An increase in one intracranial compartment must be offset by a decrease in another to avoid ICP increase
List the herniation syndromes discussed.
- Subfalcine herniation
- Transtentorial herniation
- Uncal herniation
- Cerebellar tonsillar herniation
What can cause increased intracranial pressure?
- Tumors
- Hematomas
- Infections
What methods are used to decrease ICP?
- Elevating the head of the bed
- Ventilation to reduce PA CO2
- Using external ventricular drains (EVDs)
What are hyperosmotic drugs like mannitol used for?
To increase serum osmolality and reduce ICP
What is multiple sclerosis?
A progressive autoimmune demyelination of central nervous system fibers
What is myasthenia gravis?
An autoimmune disease where antibodies are generated against nicotinic acetylcholine receptors, causing muscle weakness
What is Eaton-Lambert syndrome?
A syndrome involving antibodies against voltage-gated calcium channels, causing muscle weakness
What are the common treatments for hydrocephalus?
- Diuretics
- Surgical interventions like VP shunts
What types of strokes are there?
- Ischemic
- Hemorrhagic
What is the Spetzler-Martin AVM grading system used for?
To assess arteriovenous malformations based on size and venous drainage patterns
What are the symptoms of Chiari malformation?
Headaches, neck pain, balance issues, and possibly syringomyelia
What is tuberous sclerosis (AKA Bourneville Disease)?
A genetic condition with benign tumors in various body regions
What anesthesia considerations are important for patients with von Hippel-Lindau disease?
Managing exaggerated hypertension and avoiding neuraxial anesthesia
What is the Glasgow Coma Scale used for?
To categorize the severity of traumatic brain injury
What are anti-epileptic drugs used for?
To manage seizures by decreasing neuronal excitability
Fill in the blank: Cerebral perfusion pressure (CPP) is calculated as _______.
MAP - ICP
True or False: Hydrocephalus can be treated with serial lumbar punctures.
True
What is the treatment for cerebral aneurysms?
- Coiling
- Stenting
- Bypassing aneurysms
What is the impact of increased PA CO2 on cerebral vessels?
It leads to cerebral vessel dilation and increased cerebral blood flow
What are the effects of transtentorial herniation?
Compresses the brainstem, causing altered mental status and respiratory compromise
What are the symptoms of Parkinson’s disease?
- Tremors
- Rigidity
- Akinesia
What is the role of corticosteroids in managing increased ICP?
To increase blood-brain barrier integrity and reduce intracranial swelling
What is the primary treatment for ischemic strokes?
Thrombolytics and revascularization within 90 minutes
What is the main reason for increased intracranial pressure (ICP)?
Increased ICP can occur due to:
* Tumors
* Intracranial hematomas
* Obstruction of cerebrospinal fluid (CSF) flow
* Infectious processes
What is the primary function of the intracranial vault?
The intracranial vault is compartmentalized to protect the brain by containing increases in ICP regionally.
What is the function of the faux Cerebri?
The faux Cerebri is a fold of dura that separates the two cerebral hemispheres.
What is transnatorial herniation?
Transnatorial herniation occurs when supratentorial contents push down against the tentorium cerebelli, potentially compressing the brainstem.
What are the symptoms of uncus herniation?
Symptoms of uncus herniation include:
* Ipsilateral ocular motor nerve dysfunction
* Pupillary dilation
* Ptosis
* Lateral deviation of the affected eye
What is the outcome of cerebellar tonsil herniation?
Cerebellar tonsil herniation can lead to medullary dysfunction, cardio instability, and death.
How can tumors increase ICP directly?
Tumors can increase ICP directly by occupying space and increasing volume.
What is one way that tumors can increase ICP indirectly?
Tumors can cause cerebral edema, leading to increased pressure in the cranial vault.
What is an external ventricular drain (EVD)?
An EVD is a device used to relieve intracranial pressure by draining cerebrospinal fluid.
What is the initial non-invasive method to decrease ICP?
Elevating the head of the bed.
What role do corticosteroids play in managing ICP?
Corticosteroids increase the integrity of the blood-brain barrier and decrease intracranial swelling.
What is multiple sclerosis (MS)?
Multiple sclerosis is a progressive autoimmune demyelination of central nervous fibers.
What age range is commonly associated with the onset of multiple sclerosis?
The onset of multiple sclerosis typically occurs between 20 to 40 years of age.
What factors can trigger an exacerbation of multiple sclerosis symptoms?
Triggers for exacerbation can include:
* Stress
* Temperature swings
* Postpartum period
What are common symptoms experienced by patients with multiple sclerosis?
Common symptoms include:
* Motor weakness
* Sensory disorders
* Visual impairments
* Autonomic instability
True or False: All patients with multiple sclerosis experience the same severity of symptoms.
False
What is the purpose of a ventriculostomy?
A ventriculostomy is performed to relieve increased intracranial pressure by draining cerebrospinal fluid.
Fill in the blank: Increased intracranial pressure can be caused by _______.
tumors, hematomas, or infection
What is the significance of the Centurion cerebelli?
The Centurion cerebelli separates supratentorial and infratentorial spaces.
What can happen if an external ventricular drain (EVD) is ineffective?
If ineffective, the patient may require a surgical procedure called a VP shunt.
What is delayed hydrocephalus?
Delayed hydrocephalus is a condition where fluid buildup occurs weeks after initial treatment.
What are the main symptoms of Multiple Sclerosis?
Motor weakness, sensory disorders, visual impairments, autonomic instability
Autonomic instability can include heart rate changes and postural hypotension.
What is the current treatment approach for Multiple Sclerosis?
Corticosteroids, immunomodulators, targeted antibodies, IVIG
IVIG stands for intravenous immunoglobulins.
What assessments are needed for pre-anesthetic consideration in Multiple Sclerosis patients?
Assess existing deficits, pulmonary function testing, general labs (BMP, CBC), liver function testing, glucose levels, electrolytes
Liver function testing is crucial due to the heavy liver load from certain medications.
Why is temperature management critical in Multiple Sclerosis patients during surgery?
Temperature swings can exacerbate the disease process
Maintaining normothermia is essential to avoid triggering exacerbations.
What anesthetic options are acceptable for patients with Multiple Sclerosis?
Regional anesthesia, peripheral nerve blocks
Avoid succinylcholine due to the risk of hyperkalemia.
What is Myasthenia Gravis?
An autoimmune disease with antibodies against nicotinic acetylcholine receptors
It causes muscle weakness, particularly in cranial nerves.
What are common triggers for exacerbations in Myasthenia Gravis?
Stress, pain, insomnia, infection, surgery
These factors can worsen muscle weakness.
What is the primary treatment for Myasthenia Gravis?
Acetylcholinesterase inhibitors (e.g., pyridostigmine)
Pyridostigmine increases circulating acetylcholine levels.
What is Eaton Lambert Syndrome and its association with cancer?
A syndrome with antibodies against voltage-gated calcium channels, highly associated with small cell lung carcinoma
Over 60% of patients with Eaton Lambert have this type of lung cancer.
What are the primary symptoms of Eaton Lambert Syndrome?
Progressive weakness, dysautonomia, ocular involvement
Similar symptoms to Myasthenia Gravis but with a different underlying mechanism.
What is Muscular Dystrophy?
A disorder of muscle fiber degeneration caused by the breakdown of the dystrophin glycoprotein complex
Duchenne muscular dystrophy is the most common and severe form.
What are common symptoms of Duchenne Muscular Dystrophy?
Progressive muscle wasting, kyphoscoliosis, respiratory weakness
Average lifespan is about 20-25 years, primarily due to cardiopulmonary complications.
What key anesthetic considerations are necessary for patients with Muscular Dystrophy?
Baseline labs including pulmonary function testing and CK levels, pre-op EKG, echocardiogram, caution with neuromuscular blockers
Monitoring is essential to avoid over-dosing on paralytics.
True or False: Patients with Myasthenia Gravis are at risk for prolonged muscle weakness from neuromuscular blockers.
True
Careful dosing is required to avoid exacerbating their condition.
Fill in the blank: The drug _______ is used to increase circulating acetylcholine in Myasthenia Gravis patients.
[pyridostigmine]
What is the significance of IVIG in treating autoimmune diseases like Myasthenia Gravis?
It provides healthy antibodies to replace dysfunctional autoimmune antibodies
However, it is very expensive and has a risk of blood-borne infections.
What is hyper metabolic syndrome and how does it relate to muscular dystrophy?
A syndrome similar to malignant hyperthermia, presenting with muscle symptoms
It is not generally as deadly as malignant hyperthermia.
What is hyper metabolic syndrome?
A syndrome similar to malignant hyperthermia, presenting with fever, tachycardia, and can progress to severe complications like V fib and cardiac arrest
Triggered by certain anesthetics, it requires careful management to avoid exacerbation.
What should be avoided in patients with hyper metabolic syndrome?
Volatile anesthetics and succinylcholine
These agents can exacerbate muscle membrane instability.
What is myotonic dystrophy?
The most common form of myotonia, characterized by prolonged muscle contractions post-stimulation
Onset is typically in early adulthood, affecting various muscle groups and potentially leading to aspiration risks.
What are the symptoms of myotonic dystrophy?
Muscle wasting, especially in the face, hands, and respiratory muscles
It can also affect the cardiac conduction system, with about 20% of patients having mitral valve prolapse.
What is the treatment for myotonic dystrophy?
Managed with quinine, propanolol for arrhythmias, and steroids
There is no cure for myotonic dystrophies.
What are the three major dementia syndromes?
- Alzheimer’s (70% of cases)
- Vascular dementia (25%)
- Parkinson’s dementia (5%)
These syndromes require careful assessment of cognitive dysfunction and may involve advanced directives for medical decision-making.
What is the primary treatment for Parkinson’s disease?
Levodopa, which converts to dopamine and crosses the blood-brain barrier
Other treatments may include anticholinergics and deep brain stimulators.
What are the common symptoms of Parkinson’s disease?
- Tremors
- Rigidity
- Akinesia
Patients often exhibit a ‘pill rolling’ maneuver with their hands and may experience cognitive decline.
What is the preferred anesthesia type for dementia patients?
Regional anesthesia
This is to minimize opioid requirements and reduce complications in older populations.
What are the common symptoms of brain tumors related to increased intracranial pressure?
- Headaches
- Confusion
- Mobility impairment
- Autonomic dysfunction
Vomiting can also occur, further increasing intracranial pressure.
What type of brain tumor is an astrocytoma?
A tumor of astrocytes, which are the most common glial cells in the central nervous system
Astrocytomas can vary in aggressiveness and prognosis.
What is a common benign brain tumor?
Meningioma
Usually has a good prognosis if surgically resected.
What is the management for patients with brain tumors undergoing surgery?
Monitor glucose and electrolytes, assess neurological status, and administer stress doses of steroids
Patients are often on anti-seizure medications due to the risk of seizures.
What is the role of deep brain stimulators in Parkinson’s disease?
To stimulate dopaminergic fibers and increase dopamine release
It may require disabling during surgery to avoid interaction with cautery.
What are the potential risks for patients with Parkinson’s disease during anesthesia?
Aspiration risk and respiratory compromise
Special attention should be given to their pulmonary status and medication interactions.
Fill in the blank: Myotonic dystrophy can lead to an increased risk of _______.
aspiration
Due to muscle weakness affecting respiratory and swallowing functions.
True or False: All myotonic disorders are triggered by stress and extremes of temperature.
True
Particularly cold temperatures can exacerbate symptoms.
What is the significance of a patient’s advanced directives in surgical decisions?
Guides medical decision-making and intervention preferences
Especially important for dementia patients who may not provide informed consent.
What is a common risk associated with autonomic dysfunction?
Risk and manifestation on EKG, postural tachycardia, labile heart rates, labile blood pressures
What should be monitored before a craniotomy?
Fresh labs, EKG, CT, and MRI trends
What is the purpose of administering mannitol preoperatively?
To reduce intracranial volume and pressure on the brain
What are the two main types of strokes?
- Ischemic strokes
- Hemorrhagic strokes
What percentage of strokes are ischemic?
88%
What is the leading cause of death and disability worldwide?
Stroke
What are the major arteries supplying blood to the brain?
- Internal carotid arteries
- Vertebral arteries
What is the Circle of Willis?
A structure that provides collateral circulation to multiple areas of the brain
What are the neurological deficits associated with anterior cerebral artery occlusion?
Contralateral leg weakness
What symptoms are associated with middle cerebral artery occlusion?
- Contralateral hemiparesis
- Aphasia
- Contralateral visual deficits
What is a transient ischemic attack (TIA)?
A focal neurological deficit that resolves generally within 24 hours
What is the first step if a stroke is suspected?
Obtain a non-contrast CT
What does the prognosis of an ischemic stroke depend on?
The time of treatment from the onset of symptoms
What is the TOAST classification used for?
Classifying different types of ischemic strokes based on the originating factor
What is the first-line treatment for ischemic stroke?
Oral aspirin
What is the time frame for administering TPA for ischemic stroke?
3 to 4.5 hours post onset
What is revascularization in the context of stroke treatment?
A procedure performed to remove a clot using interventional radiology
What is required for patients undergoing surgery after starting a new anticoagulant?
Elective cases must be canceled for three months
What is a hemorrhagic stroke?
Bleeding inside the intracranial vault that impairs brain perfusion
What are the subtypes of hemorrhagic strokes?
- Intracerebral hemorrhage
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hematoma
- Intraventricular hemorrhage
What is the most reliable predictor of outcomes in hemorrhagic stroke?
Blood volume in the hemorrhage and change in level of consciousness
What does conservative treatment for hemorrhagic stroke include?
- Reducing intracranial pressure
- Controlling blood pressure
- Seizure precautions
- Careful monitoring
What are common symptoms of cerebral aneurysms?
- Photophobia
- Confusion
- Hemiparesis
- Coma
What are the risk factors for cerebral aneurysms?
- Hypertension
- Smoking
- Female gender
- Cocaine use
How can a cerebral aneurysm be diagnosed?
- CT
- MRI
- Lumbar puncture for CSF analysis
What is photophobia?
Sensitivity to light
What is hemiparesis?
Weakness on one side of the body
What are some risk factors for aneurysms?
- Hypertension
- Smoking
- Female gender
- Cocaine use
How is an aneurysm diagnosed?
- CT scan
- MRI
- Lumbar puncture for CSF analysis
What is the recommended timeframe for intervention after an aneurysm rupture?
Within 72 hours
What medications are patients with an aneurysm generally placed on?
Steroids
What is Triple H therapy for subarachnoid hemorrhage vasospasm?
- Hypertension
- Hypervolemia
- Hemodilution
What is the initial treatment in Triple H therapy?
Hypertension
What is the Hunt and Hess classification used for?
To gauge the mortality of patients with aneurysms
What are AVMs?
Arteriovenous malformations, direct arterial to venous connections
How are AVMs typically diagnosed?
- Angiograms
- MRIs
What are the treatment options for AVMs?
- Radiation
- Embolization
- Surgical resection
What is Chiari malformation?
Congenital displacement of the cerebellum downward through the foramen magnum
What is the only real treatment for Chiari malformation?
Surgical decompression
What are the key anesthesia considerations for tuberous sclerosis?
- Airway compromise
- Cardiac involvement
- Kidney involvement
What is hydrocephalus?
Accumulation of cerebrospinal fluid leading to increased intracranial pressure
What are the preferred diuretics for treating hydrocephalus?
- Furosemide
- Acetazolamide
What is the surgical treatment for chronic hydrocephalus?
Insertion of a VP shunt
What defines a traumatic brain injury (TBI)?
Injury to the brain from external force, classified as penetrating or non-penetrating
What scale is used to categorize the severity of TBI?
Glasgow Coma Scale
What is a primary injury in TBI?
Injury occurring at the time of insult
What are secondary injuries in TBI?
- Neuroinflammation
- Cerebral edema
- Hypoxia
- Electrolyte imbalances
What is the first step in managing a severe TBI in the ER?
Obtain a CT scan
What is the significance of a lumbar puncture in diagnosing aneurysms?
Presence of blood in CSF can indicate an aneurysm
What is the role of interventional radiology in aneurysm treatment?
Coiling or stenting of the aneurysm
What is the significance of vasospasm post subarachnoid hemorrhage?
It occurs due to inflammatory mediators released after the hemorrhage
What is the Spetzler-Martin AVM grading system?
Grades AVMs based on size, surrounding brain tissue, and venous drainage patterns
What are the four types of Chiari malformation?
- Type I: Downward displacement of cerebellum
- Type II: Arnold Chiari with myelomeningocele
- Type III: Rare, occipital encephalocele
- Type IV: Not compatible with life
What are the common symptoms of Chiari malformation?
- Headaches
- Visual disturbances
- Ataxia
What is the anesthesia consideration for patients with neurofibromatosis?
Avoid neuraxial anesthesia due to higher likelihood of spinal tumors
What should be assessed in patients undergoing anesthesia?
Morbidity, degree of injury, imaging, severity of damage, baseline labs, neuro exam
Important to understand the patient’s overall condition and potential complications.
What is the preferred type of venous access for emergency surgery?
Essential venous catheter
An a-line may also be necessary for monitoring.
What type of blood may be given if there isn’t time for typing?
Uncrossmatched blood
This is often critical in emergency situations.
Why should an NG tube or OG tube be avoided in trauma cases?
Risk of nasal skull fracture
Insertion could exacerbate injuries.
What is the primary focus during surgery for traumatic brain injuries?
Correcting intraoperative issues
Continuous monitoring and adjustments may be necessary.
What are common causes of seizures?
- Hypoglycemia
- Hyponatremia
- Hyperthermia
- Intoxication
These conditions can lead to transient seizure activity.
What defines epilepsy?
Recurrent seizures due to congenital or acquired factors
Differentiates from single-event seizures.
What should be assessed preoperatively in patients with seizure disorders?
Source of seizures, control with medications
Important for planning anesthesia and surgery.
What is the role of anti-epileptic drugs?
Decrease neuronal excitability and enhance inhibition
Helps in managing seizure disorders.
What may patients on enzyme-inducing drugs require?
Higher doses of hepatically cleared medications
Due to increased metabolism of these drugs.
What should be ready when intubating a patient having a seizure?
RSI and suction
Preparedness is crucial for airway management.
Fill in the blank: Seizures are a transient, _______ discharge of neurons in the brain.
proximal synchronous
This definition helps in understanding seizure mechanisms.
True or False: All patients with seizures should have their anti-seizure medications reviewed preoperatively.
True
Ensures proper management during anesthesia.
What factors modulate cerebral blood flow (CBF)?
- Cerebral metabolic rate
- Cerebral perfusion pressure (CPP)
- Arterial blood carbon dioxide (PaCO2)
- Arterial blood oxygen (PaO2)
- Various drugs and intracranial pathologies
What is the normal range for intracranial pressure (ICP)?
5-15 mmHg
What does the Monro-Kellie hypothesis state?
Any increase in one component of intracranial volume must be offset by a decrease in another component to prevent an elevated ICP
What happens when compensatory mechanisms fail due to increased ICP?
Cerebral ischemia occurs
What are the two main types of herniation syndromes?
- Subfalcine Herniation
- Transtentorial Herniation
What is a common cause of increased ICP related to tumors?
- Direct size of tumors
- Indirectly causing edema
- Obstructing CSF flow
What are methods to decrease ICP?
- Elevation of the head
- Hyperventilation
- CSF drainage
- Hyperosmotic drugs
- Diuretics
- Corticosteroids
- Cerebral vasoconstricting anesthetics
- Surgical decompression
What is the typical age of onset for Multiple Sclerosis (MS)?
20-40 years
What are common symptoms of Multiple Sclerosis?
- Motor weakness
- Sensory disorders
- Visual impairment
- Autonomic instability
What are preanesthetic considerations for patients with Multiple Sclerosis?
- Assess existing deficits
- Pulmonary function tests if respiratory compromise
- Monitor glucose and electrolytes
- Temperature management
What triggers exacerbations in Myasthenia Gravis (MG)?
- Pain
- Insomnia
- Infection
- Surgery
What is the primary treatment for Myasthenia Gravis?
- Ach-E inhibitors (Pyridostigmine)
- Immunosuppressive agents
- Steroids
- Plasmapheresis
- IVIG
What are the effects of Eaton-Lambert Syndrome?
- Progressive limb-girdle weakness
- Dysautonomia
- Oculobulbar palsy
What is the most common and severe form of Muscular Dystrophy?
Duchenne Muscular Dystrophy
What are pre-anesthetic considerations for patients with Muscular Dystrophy?
- CBC, BMP, PFTs
- Pre-op EKG, echocardiogram
- Caution with ND-NMBs
What is myotonia?
Prolonged contraction after muscle stimulation
What are common symptoms of Dementia?
- Cognitive dysfunction
- Potential aspiration risk
What are the three major dementia syndromes?
- Alzheimer’s
- Vascular dementia
- Parkinson’s
What are common symptoms of brain tumors?
- Increased ICP
- Papilledema
- Headache
- AMS
- Mobility impairment
- Vomiting
- Autonomic dysfunction
- Seizures
What is the prognosis for Meningiomas?
Good prognosis with surgical resection
What are pre-anesthesia considerations for patients with brain tumors?
- Review history & physical
- Inquiry about previous therapies
- Continue steroids
- Monitor glucose levels
What is a common complication associated with prolonged respiratory compromise in Myasthenia Gravis?
Need for post-op respiratory support
Fill in the blank: The combined volume of brain tissue, CSF, and intracranial blood is ______ mL.
1200-1500
True or False: Hyperosmotic drugs decrease serum osmolarity to decrease ICP.
False
What is radiation damage associated with?
Lethargy and AMS
AMS refers to altered mental status.
What neurological effects can chemotherapy have?
Neurological effects including cognitive changes and peripheral neuropathy
Patients may experience symptoms like memory issues and nerve pain.
Why are patients often on steroids?
To minimize cerebral edema.
What must be monitored while continuing steroids?
Glucose levels.
What are common medications used for patients with supratentorial lesions?
Anticonvulsants.
What may autonomic dysfunction manifest as?
EKG changes, labile heart rate, and blood pressure.
What diagnostic tests are commonly performed?
CBC, BMP (glucose), EKG, CT/MRI.
What is mannitol used for?
To reduce intracranial volume and pressure.
What does CVA stand for?
Cerebral Vascular Accident.
What is the leading cause of death and disability worldwide?
Stroke.
What are the two main types of strokes?
- Ischemia (88% of cases)
- Hemorrhage (12% of cases).
What supplies blood to the brain?
- Internal carotid arteries
- Vertebral arteries.
What is the Circle of Willis?
A structure that provides collateral circulation to multiple areas of the brain.
What causes an ischemic stroke?
Occlusion of a vessel that perfuses a region of the brain, causing brain cell necrosis.
What characterizes a transient ischemic attack (TIA)?
Sudden focal vascular neurologic deficit that resolves within 24 hours.
What percentage of patients who experience a TIA will subsequently suffer a stroke?
1/3.
What is needed to distinguish ischemic stroke from intracerebral hemorrhage?
A STAT non-contrast CT.
What factors affect ischemic stroke prognosis?
Time from onset to thrombolytic intervention (<90 min).
List the TOAST classification groups for ischemic stroke causes.
- Large artery atherosclerosis
- Small vessel occlusion
- Cardioaortic embolic
- Other etiology
- Undetermined etiology.
What is the recommended initial treatment for ischemic stroke?
PO Aspirin.
What must be initiated within 3-4.5 hours post-onset for ischemic stroke?
IV or intra-arterial tissue plasminogen activator (TPA).
What is revascularization in the context of ischemic stroke treatment?
A procedure in interventional radiology to administer thrombolytics or perform thrombectomy.
What are the two most reliable predictors of outcome in hemorrhagic CVA?
- Blood volume
- Change in level of consciousness (LOC).
What are the subtypes of hemorrhagic strokes based on blood location?
- Intraparenchymal hemorrhage
- Epidural hematoma
- Subdural hematoma
- Subarachnoid hemorrhage
- Intraventricular hemorrhage.
What is the conservative treatment for hemorrhagic stroke?
Reduction of ICP, blood pressure control, seizure precautions, and monitoring.
What does surgical treatment for hemorrhagic stroke involve?
Evacuation of the hematoma.
What should be assessed pre-operatively in cerebrovascular disease?
History, deficits, imaging, treatments, and co-existing diseases.
What imaging techniques are used for cerebrovascular disease assessment?
- Carotid U/S
- CT/MRI head & neck
- Echocardiogram.
What is the risk for vasospasm post-subarachnoid hemorrhage (SAH)?
3-15 days.
What triggers vasospasm after SAH?
Free hemoglobin (hgb) reduces nitric oxide availability and increases endothelin 1.
What is Triple H therapy?
Hypertension, Hypervolemia, Hemodilution.
What are congenital brain abnormalities?
Defects in the development or structure of the CNS.
What is Chiari Malformation?
Congenital displacement of the cerebellum.
What are the types of Neurofibromatosis?
- Type 1 (most common)
- Type 2
- Schwannomatosis (rare).
What is hydrocephalus?
Excessive CSF accumulation causing increased ICP.
What are the main treatments for hydrocephalus?
- Diuretics (furosemide, acetazolamide)
- Serial lumbar punctures
- Surgical treatment (VP shunt, ETV).
What is the Glasco-Coma Scale used for?
Categorizing the severity of traumatic brain injury (TBI).
What is the primary injury in TBI?
Injury occurring at the time of the insult.
What are secondary injuries in TBI?
- Neuroinflammation
- Cerebral edema
- Hypoxia
- Anemia
- Electrolyte imbalances
- Neurogenic shock.
What must be done for severe TBI patients?
Intubation and mild hyperventilation to control ICP.
What is a seizure?
Transient, paroxysmal, synchronous discharge of neurons in the brain.
What is epilepsy?
Recurrent seizures due to congenital or acquired factors.
What is the role of antiepileptic drugs?
Decrease neuronal excitability and enhance inhibition.
What should be reviewed pre-anesthesia for seizure patients?
Source of seizures and control level.
What is the main concern regarding patients on enzyme-inducing medications?
They require higher doses of hepatically-cleared medications.
What is the primary risk factor for Parkinson’s Disease?
Advanced age.
What is the triad of symptoms for Parkinson’s Disease?
- Skeletal muscle tremor
- Rigidity
- Akinesia.
What are common treatments for Parkinson’s Disease?
- Levodopa
- Anticholinergics
- MAOIs
- Deep brain stimulator.
What is the major risk factor for cerebral aneurysms?
Hypertension.
What are the symptoms of cerebral aneurysms?
- Headache
- Photophobia
- Confusion
- Hemiparesis
- Coma.
What is the recommended intervention time for cerebral aneurysms after rupture?
Within 72 hours for best outcomes.
What is an arteriovenous malformation (AVM)?
An arterial to venous connection without intervening capillaries.
What are the treatment options for AVMs?
- Radiation
- Angio-guided embolization
- Surgical resection.
What is Tuberous Sclerosis also known as?
Bourneville Disease.
What does Tuberous Sclerosis cause?
Benign hamartomas, angiofibromas, and other malformations.
