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SRNA3AdvancedPatho2 > Acute Neuropathologies > Flashcards

Acute Neuropathologies Flashcards

1
Q

Brain Tumors: What is it ?

A

Space-occupying lesions – cause ↑ ICP.

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2
Q

Can be life-threatening.

A

Both benign & malignant tumors

Unless accessible and removable

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3
Q

The largest category of primary malignant tumors.

A

Gliomas

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4
Q

Brain tumors classified based on

A

Cell derivation & location of tumor

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5
Q

Brain Tumors

Tumors can also arise from

A

meninges or pituitary

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6
Q

Primary malignant tumors rarely

A

metastasize outside CNS

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7
Q

Secondary brain tumors

A

Metastasized from breast or lung

Effects are similar to primary tumors

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8
Q

Brain Tumors

Primary malignant tumors (PID)

A
  • Poorly defined margins
  • Invasive, have irregular projections into adjacent tissue (T1)
  • Inflammation develops around the tumor (T2)
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9
Q

Difficult to totally remove

A

Primary Malignant tumors

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10
Q

Brain Tumors Supratentorial mostly in

A

Adults; more frequently in cerebral hemispheres

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11
Q

Brain tumors: Infratentorial: mostly in

A

Children; more frequently in brainstem / cerebellum

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12
Q

Brain Tumors Signs and symptoms : determines focal signs
 Usually no systemic signs of malignancy
 Will cause death before they cause general effects

A

 Site of tumor

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13
Q

Often first sign of brain tumors

A

Seizures

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14
Q

Brain tumors Signs and symptoms HVILPB

A 
HA (↑ ICP);
vomiting
lethargy 
Irritability
Personality and
Behavioral changes; possible unilateral facial paralysis or 
   visual problems
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15
Q

What are the treatment of Brain tumors?

A

Treatment – may cause damage to normal CNS tissue
Surgery if accessible
Chemotherapy and radiation (many are radio resistant)

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16
Q

Glomus Tumors of Head and Neck

“Paragangliomas” –Form where?

A

form within neuroendocrine tissue lying along carotid artery, C.N. IX+ and middle ear

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17
Q

Paragangliomas” – What determines signs/symptoms:

A

Location of tumor

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18
Q

Glomus Tumors of Head and Neck

“Paragangliomas” Middle ear tumor (UCA)

A

 Unilateral pulsatile tinnitus
 Conductive hearing loss
 Aural fullness

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19
Q

Glomus Tumors of Head and Neck : “Paragangliomas”

C.N. tumor symptoms

A

 Facial paralysis

 Dysphonia/Dysarthria

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20
Q

Glomus Tumors of Head and Neck can

A

Secrete hormones

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21
Q

Glomus Tumors of Head and Neck can Norepi –

 Serotonin – mimics carcinoid syndrome

A

mimics Pheochromocytoma

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22
Q

Glomus Tumors of Head and Neck ->  CCK –

A

causes post-op. ileus

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23
Q

Glomus Tumors of Head & Neck Serotonin –

A 
mimics carcinoid syndrome
Bronchoconstriction
 HA
 Flushing
 HTN
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24
Q

Possible Anesthesia Complications Brain tumors Pre-op (if C.N. (VAL)

A

9, 10, 12 affected):
 Airway obstruction
 Vocal cord paralysis
 Laryngeal distortion

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25
Q

Possible Anesthesia Complications Brain tumors Intra-op

A

(if norepi or histamine released during surgery)

 Profound Hyper or Hypotension

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26
Q

Possible Anesthesia Complications Post-op

A

(if C.N. or vessel damage)
 ↑ risk aspiration with impaired gastric emptying
 Venous air embolism
 Massive blood loss

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27
Q

Vascular disorders Ischemia (TIA) or Infarct (CVA) 2o to:

A

 Occlusion

 Aneurysm with resultant ↑ICP

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28
Q

TIA and CVA Extent of damage & manifestations depend on

A

artery involved

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29
Q

TIA and CVA Ischemia can be

A

Focal or Global

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30
Q

Temporary ischemia caused by:

PASVL

A 
 Partial occlusion of an artery
 Atherosclerosis
 Small embolus
 Vascular spasm
 Local loss of autoregulation
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31
Q

May occur singly or in series

A

TIA

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32
Q

Difficult to diagnose

A

TIA

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33
Q

TIA manifest as (weakness)

A

Intermittent short episodes of impaired function ex. muscle weakness in arm or leg

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34
Q

TIA signs TFV

A

 Visual disturbances
 Facial numbness / paresthesias
 Transient aphasia, confusion or dizziness

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35
Q

CVA Infarction caused by:

A

 Occlusion or Aneurysm of cerebral blood vessel

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36
Q

Irreversible damage

A

5 Minutes of ischemia
 Central area of necrosis develops; all function lost
 Surrounding inflammation later heals.

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37
Q

Test used to determine whether a stroke is ischemic or hemorrhagic.

A

Non-contrast CT

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38
Q

CT reliably detects

A

intracranial bleeding, but is insensitive to ischemic changes during first few hours of a stroke.

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39
Q

% of CVA hemorrhagic

A

Approx. 20% of CVAs are hemorrhagic.

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40
Q

Hemorrhagic strokes are

A

4x more likely to result in death.

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41
Q

Test to determine cause

A

MRA useful in determining cause

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42
Q

Risk factors for CVA

4S DEHAIOH

A 
Systemic HTN
Systemic lupus
Smoking
Sedentary lifestyle
Diabetes
Erythematosus
Hyperlipidemia
Alcohol abuse,
Increasing age
Obstructive sleep apnea
Heart disease
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43
Q

This combination can lead to stroke->

A

Combination of oral contraceptives & cigarette

smoking

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44
Q

CVA and congenital

A

Congenital malformation of blood vessels

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45
Q

Signs and symptoms of CVA

Depend on

A

location & size of artery involved (Collateral circulation may diminish size of affected area)

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46
Q

IN CVA, Weakness signs and symptoms

A

 Lack of voluntary movement or sensation on opposite side of body
 Initially flaccid paralysis
 Spastic paralysis develops weeks later

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47
Q

NIH Stroke Scale

A

 Developed by the National Institutes of Health

 Designed to assist with rapid diagnosis in an emergency situation

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48
Q

CVA Treatments:

Rehabilitation

A

 Surgery
 Medical - Thrombolytics for clot
 Glucocorticoids
 Supportive treatment

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49
Q

IV TPA – must be initiated within

A

3 hours from the onset of symptoms

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50
Q

CVA rehab

A

Occupational and physical therapy; speech-language

pathologists

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51
Q

 Treat underlying problem to prevent recurrence

A

CVA

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52
Q

What is an aneurysm?is

A

Localized weakness in wall of an artery

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53
Q

Cerebral aneurysms frequently

A

multiple.

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54
Q

Cerebral aneurysm Usually in

A

subarachnoid space, or at points of bifurcation on circle of Willis “Berry” aneurysms

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55
Q

Aneurysm aggravated by

A

Often aggravated by HTN

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56
Q

Aneurysm is initially ____and _______

Slow bleed cause_______

A

Initially small and asymptomatic

Slow bleed causes vascular headache

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57
Q

Aneurysm rupture

A

Rupture = fatal ↑ICP and death

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58
Q

Aneurysms Signs and symptoms of subarachnoid hemorrhage (LSND)

A

 Loss of vision or visual disturbances
 Sudden severe HA & photophobia
 Nuchal rigidity due to meningeal irritation
 Decreased level of consciousness

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59
Q

ECG changes often seen following subarachnoid

hemorrhage:

A

 ST-segment depression, and inverted T waves.

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60
Q

Aneurysm Treatment

A

Treatment
 Surgical treatment before rupture
 Antihypertensives

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61
Q

Moyamoya Japanese word – means

A

“puff of smoke” – refers to angiographic findings.

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62
Q

Moyamoya is progressie

 TIAs/ischemia seen in children; Hemorrhage in adults

A

Progressive stenosis of intracranial vessels with 2o

development of anastomotic capillaries.

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63
Q

Moyamoya genetic

A

Familial tendency

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64
Q

Intracranial aneurysms occur with

A

increased frequency

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65
Q

Medical Treatment of Moyamoya

A

Vasodilators

Anticoagulants

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66
Q

Surgical Treatment of Mayamoya

A

Anastomosis STA to MCA

Prognosis Poor

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67
Q

Moyamoya – (Anesthesia Considerations)

FIA

A

Intra-arterial catheterization for rapid BP assessment should be placed prior to induction.
Avoid hyperventilation to reduce risk of cerebral
vascoconstriction.
Facilitate rapid emergence from anesthesia for neurologic
function assessment.

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68
Q

BP control of Moyamoya

A

Dopamine and ephedrine control hypotension with less

adverse effects on cerebral vasculature than vasoconstrictor drugs

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69
Q

Infections - meningitis

A

Different age groups are susceptible to different causative
organisms.
May be 2o to other infections

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70
Q

Children and young adults Meningitis

A

Neisseria Meningitis or meningococci
Frequently carried in nasopharynx of asymptomatic carriers
Spread by respiratory droplets

71
Q

Neonates Meningitis

A

Escherichia coli most common causative organism

Usually in conjunction with a neural tube defect, premature rupture of the amniotic membranes, difficult delivery

72
Q

Young children Meningitis
Most often due to
 More often in the

A

H. influenzae

autumn or winter

73
Q

Older adults and Meningitis

A

 Streptococcus pneumoniae – major caus

74
Q

Signs and symptoms of Meningitis

SSBNP

A 
 Sudden onset
 Severe HA
 Nuchal rigidity
 Back pain
 Photophobia
75
Q

Sign with Meningitis

A

 Kernig sign

 Brudzinski sign

76
Q

Symptoms of Meningitis

A

Vomiting
Irritability
Lethargy, fever, and chills with leukocytosis
Progressing to stupor or seizures

77
Q

Meningitis Diagnostic tests

A

 Lumbar puncture to examine CSF

 Identify causative organism

78
Q

Treatment of Meningitis

AGRV

A

 Aggressive antimicrobial therapy
 Glucocorticoids
 Reduction of cerebral inflammation & edema
 Vaccines available for some types of meningitis

79
Q

Infections - Brain Abscess

LUF

A

Localized infection
Usually necrosis of brain tissue and a surrounding area of
edema
Frequently in frontal or temporal lobes

80
Q

Brain Abscess spread?

A

May spread from organisms in ear, throat, lung, sinuses
May result from septic emboli, acute bacterial
endocarditis, site of injury or surgery

81
Q

Treatment of brain abscess

A

Surgical drainage and antimicrobial therapy

82
Q

Infections – Viral Encephalitis

A

Infection of the parenchymal or connective tx. of Brain/SC Inflammation & Necrosis develop
Results in some permanent damage

83
Q

Viral Encephalitis infection  Early signs

A

Severe HA, stiff neck, lethargy, fever, vomiting, seizures

84
Q

Infection may include

A

meninges

85
Q

Western equine encephalitis

A

 Arboviral infection spread by mosquitoes
 More frequent in summer
 Common in children

86
Q

St. Louis encephalitis

A

Affects older persons more seriously than young

87
Q

West Nile fever

A

 Caused by a flavivirus

 Spread by mosquitoes

88
Q

Encephalitis Herpes simplex encephalitis

A

 Occurs occasionally
 Spread from herpes simplex I
 Extensive necrosis and hemorrhage in the brain

89
Q

Tetanus

Caused by _________

A

Caused by Clostridium tetani

90
Q

Botulism caused by

A

Caused by Clostridium botulinum

91
Q

WIth botulism exotoxin

A

blocks acetylcholine @NMJ causing FLACCID Paralysis, respiratory failure

92
Q

With Tetanus exotoxin

A

Exotoxin blocks inhibitory glycine & GABA @NMJ
Spastic paralysis
Respiratory failure

93
Q

Rabies

A

Viral, transmitted by bite of a rabid animal, or

transplant of contaminated tissues

94
Q

Virus travels along peripheral nerves to CNS causing

A

 HA, fever, nervous hyperirritability, sensitivity to

touch, seizures

95
Q

Virus also travels to salivary glands.

A

 Difficulty swallowing
 Fear of fluids
 Respiratory failure – death

96
Q

Neuroborreliosis ( from Lyme disease)

Caused by

A

Borrelia burgdoferi

97
Q

Transmitted by ticks

A

Neuroborreliosis ( from Lyme disease)

98
Q

Neuroborreliosis Typical

A

“bull’s eye” lesion – sore throat, dry cough, fever, headache, cardiac arrhythmias, neurologic abnormalities

99
Q

Lyme disease need this therapy

A

 Antimicrobial therapy

100
Q

Poliomyelitis (infantile paralysis)

 Endemic in_______

A

 Polio virus

 Immunization available

101
Q

Polio is Endemic in

A

West and Central Africa

102
Q

Highly contagious

A

Poliomyelitis

103
Q

Transmission of polio

A

Direct contact or oral droplet

104
Q

What does polio do?

A

Attacks motor neurons of the spinal cord and medulla

105
Q

Polio signs and symptoms

A

Fever, headache, vomiting, stiff neck, pain, flaccid paralysis

106
Q 
Herpes zoster (shingles)
 Caused by
A

varicella-zoster virus

107
Q

Herpes zoster develop when ?

A

Years after varicella (chickenpox)

108
Q

Herpes zoster Usual affect on

A

cranial nerve or one dermatome

109
Q

HERPES Pain, paresthesia, vesicular rash

A

If antiviral drugs started within 48 hours of onset, pain is

significantly reduced.

110
Q

Lesions and pain persist for several weeks.

A

Herpes Zoster

Post-herpetic pain may persist for months to years in some cases.

111
Q

Vaccine available for those 60 years or older

A

Herpes Zoster

112
Q

Linked to viral infection in children treated with

A

Aspirin

113
Q

Reye syndrome

 Cause

A

not fully determined

114
Q

Reye syndrome is linked to

A

 Linked to viral infection in children treated with aspirin

115
Q

Reye Syndrome and fluid

A

Hepatomegaly with acute failure

Cerebral edema

116
Q

No immediate cure

A

Reye syndrome

117
Q

Infection-Related Syndromes - Guillain-Barre

A

Post-infection polyneuritis

118
Q

GBS is inflammatory

A

Inflammatory condition of PNS

119
Q

GBS Precise cause is

A

unknown, but usually follows viral infection

120
Q

Local inflammation with ______

A

accumulated lymphocytes, demyelination, axon destruction

121
Q

GBS Changes cause

A

impaired nerve conduction.

122
Q

Guillain-Barre Muscle weakness PATTERN

A

Ascending paralysis involves diaphragm

and respiratory muscles

123
Q

GBS respiratory

A

 C – Respiratory failure

124
Q

Guillain-Barre – Anesthesia Considerations functions altered

A

ANS and lower motor neuron

125
Q

Guillain-Barre – Anesthesia Considerations functions altered- CV

A

Compensatory cardiovascular responses absent,
with unpredictable changes in systemic BP.
– Intra-arterial catheter to monitor changes.

126
Q

GBS and NMB

A

Avoid succinylcholine - ↑risk of excessive K+ release
from denervated muscle.
–Non-depolarizing muscle relaxants w/ minimal
circulatory effects should be used:
ex. Cisatracurium or vecuronium

127
Q

Most common transmissible spongiform encephalopathy

A

CJD – Creutzfeldt-Jakob disease

128
Q

CJD is a Formation of

A

clustered vacuoles that become confluent in brain

129
Q

Rapidly progressive dementia with ataxia and myoclonus

A

CJD

130
Q

Prions – Anesthesia Precautions

______only body fluid shown to result in transmission

A

CSF

131
Q

LP with PRIONS

A

 Double glove
 Protective gown
 Protective glasses
 Label specimen “Infectious

132
Q

Head injury main issue

A

Can be severe and life-threatening
 Destruction of brain tissue
 Massive swelling

133
Q

Types of head Injuries:Concussion
 Result of
 Recovery

A

– (minimal brain trauma)mild blow to head or whiplash-type injury
–usually within 24 hours without permanent
damage

134
Q

Types of head Injuries:Contusion

A

–Bruised brain tissue, rupture of small blood vessels,
and edema
–Blunt blow to the head – possible residual damage

135
Q

Types of Head InjuriesClosed head injury

A

No Skull fx

Brain tissue injured, blood vessels may be ruptured

136
Q

Basilar fractures -occurs

A

at the base of skull

137
Q

What happens with a basilar fracture?

When might it occur?

A

 Leakage of CSF through ears or nose is possible

 May occur when forehead hits windshield

138
Q

Contrecoup injury

A

Area of the brain contralateral to the site of direct damage is injured. As brain bounces off the skull

139
Q

Moya Moya

A

Puff smoked

140
Q

May be secondary to acceleration or deceleration injuries

A

Contrecoup injury

141
Q

Primary brain injuries is ____

what rupture?

A

 Direct injury of brain tissue

 Rupture or compression of cerebral blood vessels

142
Q

Secondary injuries

Result from additional effects of

A

cerebral edema, hemorrhage, hematoma, vasospasm, infection, ischemia

143
Q

**Epidural hematoma
Results from ruptured WHICH ARTERY ?

A

meningeal artery

144
Q

**Signs with EPIDURAL HEMATOMA: when does it show?

A

Signs usually arise within few hours of injury

145
Q

SIGNS and SYMPTOMS of EPIDURAL (BHM)

A

 Mydriasis
 Hemiparesis
 Bradycardia

146
Q

Subdural hematoma: Results from

Hematoma may be acute or subacute

A

Results from torn bridging veins between dura and arachnoid

-Acute or Subacute

147
Q

Subdural Signs arise

A

gradually over several days

148
Q

Signs and symptoms of Subdural HHL

A

 HA/Drowsiness
 Hemiparesis/Hemianopsia
 Language disturbances

149
Q

Head Injuries - Anesthesia

CPP? Avoid 2 things

A

 Optimize CPP – maintain above 70mmHg if possible
 Minimize cerebral ischemia
 Avoid drugs/techniques that could increase ICP
 Avoid hyperventilation to reduce risk of cerebral ischemia

150
Q

Fracture, dislocation of vertebrae causes:

A

Compression or tear of spinal cord

151
Q

May result from hyperextension or hyperflexion of neck

A

Cervical spine injuries

152
Q

injury to cord when force is applied to top of skull or to feet

A

Compression

153
Q

Complete transection of cord

A

Flaccid paralysis & loss of sensation at and below the level of injury

154
Q

Common with Complete transection of cord

A

Loss of temp. regulation and decreased systemic BP common

155
Q

Partial transection of cord

A

May allow recovery of some function

156
Q

Spinal Cord Injury: Spinal shock

A

Hypotension with absent ANS reflexes (@T & L-spine level)
Recovery dependent on amount of bleeding and surgical intervention

157
Q

Spinal shock lasts

A

Typically lasts 1 to 3 weeks in survivors

158
Q

Spinal SHOCK physiologic effects

A

Alveolar hypoventilation and ↓ability to clear bronchial
secretions (@C & Upper T-spine level)
↑risk of aspiration, pneumonia and PE

159
Q

Tetany what kind of paralysis

A

Spastic

160
Q

Botulism what kind of paralysis

A

Flaccid

161
Q

SCI Inflammation gradually subsides

 Damaged tissue removed by__________ what forms?

A

phagocytes

 Scar tissue forms

162
Q

SCI Reflex activity resumes

A

below level of injury.

No communication with higher levels or brain

163
Q

SCI what is lost?

A

 Control of reflexes below the level of damage is lost.

164
Q

**Spinal Cord Injury - Anesthesia

During airway mgmt, minimize

A

neck movements.

165
Q

**SCI and compensatory sympathetic NS

A

Absence of compensatory sympathetic NS can cause
profound hypotension with changes in body position,
blood loss or pos. airway pressure.

166
Q

SCI, If muscle relaxants necessary,

A

pancuronium or other non-depolarizing drugs can be used

167
Q

Carpal Tunnel Syndrome

A

Most common nerve entrapment

168
Q

Carpal tunnel syndrome

A

Compression of Median Nerve btwn. Ligament & bones

169
Q

Treatment of Carpal tunnel syndrome

A

Immobilization and/or cortisone injection

Surgical decompression

170
Q

Three times more frequent in women

A

Carpel tunnel

171
Q

From repetitive movements

A

Carpal tynosynovitis

172
Q

Symptoms with Carpel tunnel

A

Pain & paresthesias over thumb, index and middle fingers

173
Q

Cubital Tunnel Entrapment Syndrome

A

Compression of Ulnar N. passing through condylar groove

into cubital tunnel

174
Q

Surgical treatment by

A

decompression carries risk of injuring nerves blood supply which could worsen the condition

SRNA3AdvancedPatho2 (15 decks)

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