Cerebral Perfusion + Adrenal Issues

Question 1

Vasogenic VS Cytotoxic

cerebral edema

Answer 1

Vasogenic: BBB is compromised
- Head injury, hematoma, hemorrhage, infection

Cytotoxic: increase in ICP => increase shift into ICF

Combo: head injury&raquo_space; hemorrhage&raquo_space; ischemia

Question 2

What is the calculation of CPP?

What are normal ranges?

Answer 2

CPP = MAP - ICP

CPP = 60-80 mmHg (need at least 50 mmHg) 
ICP = 5-15 mmHg; >20 mmHg = cerebral necrosis
MAP = 70-100 mm Hg

Question 3

What is the priority tx for cerebral edema?

Answer 3

Treating the UNDERLYING CAUSE

Question 4

What is CVA?

Answer 4

Cardiovascular attack aka STROKE

- A complete block of artery.

Question 5

Ischemic CVA

• Incidence; common location/deficits
• What is the tx? (3)

Answer 5

Thrombus/embolus deprives brain of blood.

• 80% of CVA
• Has TIA
• Commonly in middle cerebral artery (MCA) = DEFICITS IN UPPER LIMBS + FACE

TREATMENT

1. Thrombolytics (<3 hrs since onset of s/s)
2. Carotid endarterectomy (taking out clot from carotid artery)
3. Angioplasty

Question 6

Hemorrhagic CVA

• Incidence?
• Notable RFs?
• Notable S+S?
• Tx?

Answer 6

Blood vessel ruptures.

• Less common, but more fatal!
• RFs: Hemophilia, AVM, aneurysm
• Sudden onset of s/s (“worst headache of their life”)

Tx

1. FOCUS ON STABILIZING (optimize perfusion; surgical evacuation)
2. Osmotic diuretics (Mannitol) OR Hypertonic NS (3% NaCl)

Question 7

Transient Ischemic Attack (TIA)

Answer 7

Angina of the brain; “mini strokes” - when cerebral artery is temporarily blocked

• Risk of ischemic CVA
• Should be on stroke prevention

Question 8

Signs of stroke (CVA)

Answer 8

Face drooping
Arms - unable to raise both up
Speech is slurred/jumbled
Time - call 911 asap!

Question 9

Hemophilia

What is it a RF for?

Answer 9

A bleeding disorder that lacks coagulating factors.

- RF for hemorrhagic CVA

Question 10

Arteriovenous malformation (AVM)
- S/s; Tx

Answer 10

Congenital defect in structural formation of cerebral vessels in capillary network
- Increased risk of rupture (hemorrhage).

s/s

1. Ischemia (steals O2 from surrounding vessels)
2. Slow onset of neuro deficits

Tx:

• Surgical removal
• Radiation (gamma knife)
• Embolization

Question 11

Aneurysm

• What are s/s are dependent on?
• Types
• Ruptures
• Tx; what if a pt has a high risk for clotting?

Answer 11

A bulge/distended artery from weakened arterial walls (located dilation of BV).

S/s: depends on affected location

Types:

• Cerebral @subarachnoid space (80% in Circle of Willis)
• Aorta abdominal (AAA): older age = less elastin
• *LISTEN FOR BRUITS**
• Thoracic (chest)

Ruptures:
Cerebral = hemorrhagic CVA
Aorta = systemic bleed out (surgery, fluids ASAP!!)

Tx

1. Surgery (clipping; coiling)
2. Meds: THROMBUS PROPHYLAXIS
   - Antiplatlets (ASA, Clopidogrel) pre to post-3 m.
   * *unless high risk for clotting, then Heparin before antiplatelets**
3. MRI follow-up
4. Smoking cessation, tx other associated conditions

Question 12

Cardiac tamponade

• Notable S/S?
• Tx?

Answer 12

Coronary artery bursts causing fluid build-up in pericardium.

S/S:

• PULSUS PARADOXUS (SBP drops on inspiration)
• Hypotension

Tx

• *PERCARDIOCENTESIS (inserting needle into pericardium + withdrawing fluid)
• Stabilize

Question 13

Intracerebral hematoma

Answer 13

Within cerebral lobes

- Caused by anything hemorrhagic

Question 14

Epidural hematoma

Answer 14

B/w dura + skull

• Commonly d/t SKULL FRACTURE
• Very acute; life-threatening

Question 15

Subdural hematoma

Answer 15

B/w dura + subdural space
- Commonly d/t ACCEL/DECEL injuries = venous tearing

Acute: sudden onset; high m+m d/t high ICP
Subacute: slower onset; same danger
Chronic: very slow onset d/t brain atrophy = shrinking = venous tearing (HIGH RISK OF PT DYING AT HOME AFTER DISCHARGE)

Question 16

Pulsis paradoxus

Answer 16

A symptom of Cardiac tamponade where SBP decreases with inspiration.
(b/c when lungs fill, there is less space for the heart to pump)

Question 17

Mannitol & Isosorbide

• MOA?
• Tx?

Answer 17

Osmotic diuretics

1. Pulls H2O into circulation of renal tubules
2. Inhibits Renin release

Tx: cerebral edema + intraocular HTN (esp. hemorrhagic CVA)

Question 18

Adrenal synthesis + secretions

Answer 18

Cortex: Steroid hormones (cortisol, aldosterone, andorgens)
Medulla: catecholamines

Question 19

Describe the insufficiency of cortisol in athletes + s/s.

Answer 19

Repeated stress = repeated secretions of cortisol = depletion in cortisol stores

s/s:

• Salt cravings (less Na retained bc of lowered adrenal fx)
• Hyponatremia
• Fatigue
• Hypoglycemia (b/w meals; post-workout)

Question 20

Keto diet

• What risks are there?
• Risk for diabetic pts

Answer 20

High fat + proteins, no carbs.
- Results in increase in fat breakdown = increase in ketones produced = decrease in blood pH = ketoacidosis

Diabetic pts: Increases insulin resistance

Question 21

Pulmonary HTN

• Primary vs Secondary
• Tx?

Answer 21

When the pressure from BV to lungs is too high.

Primary (hereditary, ideopathic; i.e. low NO production)
Secondary: d/t existing disease

Tx: NIPRIDE
*Prevent secondary injury = COR PULMONALE (RS heart failure)

Question 22

Carotid endarterectomy

Answer 22

Tx for ischemic CVA in which a clot is directly removed from a carotid artery.

Question 23

Percardiocentesis

Answer 23

Tx for Cardiac Tamponade - inserts needle into pericardium + withdraw fluid