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Y2 Neurology > Cerebral Perfusion & ICP > Flashcards

Cerebral Perfusion & ICP Flashcards

1
Q

what does GCS stand for?

A

glasgow coma score

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2
Q

what are the three components of the GCS ?`

A

best eye response
best verbal response
best motor response

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3
Q

under which GCS is someone in a coma?

A

<8

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4
Q

on a CT scan how can you tell that a brain is swollen?

A

can’t see ventricles or they have a reduced size

can’t see sulci

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5
Q

what does brain swelling result in ?

A

increased intracranial pressure

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6
Q

what four pathophysiological processes result in brain swelling ?

A
  1. haemorrhage
  2. disruption of the BBB which increases extra cellular fluid
  3. membrane failure which results in an increase of Ca
  4. influx of inflammatory mediators
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7
Q

what is vasogenic oedema ?

A

when there is an increase in extra cellular fluid

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8
Q

what is cytotoxic oedema ?

A

when there is an increase of Ca ions and causes swelling of cells

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9
Q

state two secondary effects of raised intracranial pressure ?

A
  1. herniation syndromes

2. decreased cerebral perfusion

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10
Q

does decreases cerebral perfusion result in a higher or lower GCS ?

A

lower GCS

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11
Q

is there is fixed volume in adults and babies ?

A

in adults there is a fixed volume but in babies their sutures haven’t fuse yet so they don’t have a fixed volume

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12
Q

what three components make the fixed volume of the intracranial space?

A

brain
CSF
blood

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13
Q

what is the equation used to measure the volume of the intracranial space?

A

Monro-Kellie Doctrine

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14
Q

how can the intracranial space compensate for an increase of pressure ?

A

increase venous output

increase output of CSF to subarachnoid space

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15
Q

how is cerebral perfusion pressure calculated ?

A

mean arterial pressure - intracranial pressure = CPP

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16
Q

what should normal CPP be?

A

80mmHg

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17
Q

what should normal MAP be?

A

90mmHg

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18
Q

what should normal ICP be?

A

5-15mmHg

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19
Q

does the brain have a high or low metabolic requirement?

A

high requirement

20
Q

can the brain use anaerobic respiration ?

A

no

21
Q

what are the four components that regulate cerebral blood flow?

A

auto regulation
cerebral metabolism
CO2 and O2
neurohumoral factors

22
Q

what is auto regulation ?

A

auto regulation is a myogenic mechanism when the smooth muscle constricts

23
Q

when does auto regulation occur ?

A

when there is an increase in the wall tension

24
Q

does the vessel diameter increase or decrease with increasing cerebral perfusion pressure?

A

decrease

25
Q

what nucleus do the optic tract pass through before entering the optic radiation ?

A

lateral geniculate nucleus

26
Q

what nucleus do the optic fibres pass through for the light reflex?

A

pretectal nucleus

27
Q

what nucleus does the oculomotor nerve pass through to the ciliary ganglia ?

A

Edinger Westphal nucleus

28
Q

what nerve causes constriction of the pupil?

A

oculomotor

29
Q

what causes a fixed dilated pupil?

A

when there is an increased intracranial pressure and the brain herniates through the tenterium cerebelli and compresses the oculomotor nerve and prevents contraction of the sphincter pupillae

30
Q

name three hernias that can occur in the brain ?

A

Subfalcine herniation
medial motor cortex

Uncal herniation
IIIrd CN, ipsilateral corticospinal tracts

Foramen magnum herniation
brain stem centres

31
Q

what is it called when the

  • pulse decreases
  • resp. rate decreases
  • diastolic decreases
A

cushings response

32
Q

why does the pulse and resp. rate decrease with increased intracranial pressure ?

A

the cardiac centres and resp centres are being compressed

33
Q

does an increase in CO2 partial pressure increase or decrease cerebral blood flow?

A

increase

34
Q

does an decrease in O2 partial pressure increase or decrease cerebral blood flow?

A

increase

35
Q

what is the normal CO2 partial pressure ?

A

35-45mmHg

36
Q

what is the normal O2 partial pressure ?

A

80-100mmHg

37
Q

when there is increased blood flow what occurs?

A

cerebral vasodilation and oedema

increased ICP

38
Q

does increased cerebral pressure result in increased or decreased cerebral blood flow ?

A

decreased blood flow

39
Q

what is hyperventilation ?

A

very slow deep breathes

40
Q

does hyperventilation help with increased intracranial pressure ?

A

yes

- will decrease CO2 in blood and hence will reduce vasodilation

41
Q

what drug is given to drain out the brain and reduce the intracranial pressure ?

A

mannitol

42
Q

what type of drug is mannitol ?

A

diuretic

43
Q

what instrument can be used to measure the intracranial pressure ?

A

ICP bolt

44
Q

if the increased intracranial pressure doesn’t respond to medical treatment, what can be done ?

A

craniotomy and evacuation of clot

external ventricular drainage

decompressive craniectomy

45
Q

what post ICP management may need to be done for a patient ?

A
  • neuropsychology
  • physio
  • social work
  • post traumatic counselling

Y2 Neurology (52 decks)

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