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Neuro Pathology > Clinical Aspects of Cerebral Perfusion and ICP > Flashcards

Clinical Aspects of Cerebral Perfusion and ICP Flashcards

1
Q

What does GCS stand for?

A

Glasgow coma scale

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2
Q

What does the GCS look at?

A

Eye response
Verbal response
Motor response

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3
Q

What is the scoring of the GCS?

A 
Best eye response
- open spontaneously - 4
- open to verbal command - 3
- open to pain - 2
- does not open eyes - 1
Best verbal response
- orientated - 5 
- confused speech - 4
- inappropriate words - 3
- incomprehensible sounds - 2
- no speech - 1
Best motor response
- obeys commands - 6
- localises to pain - 5
- Normal flexion to pain - 4
- abnormal flexion to pain - 3
- Extension to pain - 2
- no movement
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4
Q

What is the total score of the GCS?

A

15

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5
Q

What is the eye response of the GCS marked out of?

A

4

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6
Q

What is the verbal response of the GCS marked out of?

A

5

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7
Q

What is the motor response of the GCS marked out of?

A

6

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8
Q

What does disruption of the BBB lead to?

A

Increased ECF (vasogenic oedema)
Membrane failure
- influx of Ca - cellular swelling (cytotoxic oedema)
Influx of inflammatory mediators

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9
Q

What does BBB stand for?

A

Blood brain barrier

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10
Q

What are the secondary effects of raised ICP?

A

Anatomical - herniation syndromes

Cellular - decreased cerebral perfusion

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11
Q

What % of CO does the adult brain receive?

A

15%

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12
Q

Does the brain have a high O2 consumption?

A

Yes

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13
Q

What regulates cerebral blood flow?

A

Autoregulation (myogenic)
Cerebral metabolism
CO2 and O2
Neurohumoral factors

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14
Q

Examples of herniation syndromes

A

Subfalcine herniation
Uncal herniation
Foramen magnum herniation

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15
Q

What does a subfalcine herniation affect?

A

Medial motor cortex

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16
Q

What does uncal herniation affect?

A

IIIrd CN

Ipsilateral corticospinal tracts

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17
Q

What does a foramen magnum herniation affect?

A

Brain stem centres

18
Q

On intubation, what does the anesthetist briefly do to help the patient control his ICP?

A

Hyperventilate them

19
Q

What is normal PaO2?

A

80 - 100mmHg

20
Q

What is normal PaCO2?

A

35 - 45mmHg

21
Q

What interventions can neurosurgeons use to reduce ICP?

A

Craniotomy and evacuation of clot
External ventricular drainage
Decompressive craniotomy

22
Q

What does the Munro-Kellie Doctrine consist of?

A

Fixed volume; Brain/CSF/Blood

V(CSF) + V(blood) + V(brain) + V(other) = V(intracranial space) = constant

23
Q

What is the normal MAP?

A

90mmHg

24
Q

What is the normal ICP?

A

5 - 15 mmHg

25
Q

What does the CPP =?

A

MAP - ICP

26
Q

What does MAP =?

A

Diastolic BP + 1/3 pulse pressure

27
Q

What is the normal CPP value?

A

80mmHg

28
Q

What medical management can be used in ITU to reduce ICP?

A 
Head position - 30 degrees head up 
Nothing to impede venous drainage
CO2 maintained in a low normal range
Intermittent boluses of mannitol when ICP raised
Fully sedated and paralysed
29
Q

What can ICP be eventually controlled by after everything else?

A

Deep sedation with thopentone

30
Q

Treatment of neuroepileptic malignant syndrome

A

Bromocriptine (dopamine agonist)

31
Q

When assessing the GCS, what must be done?

A

The BEST response from both sides

32
Q

Pneumonic to remember the features of wernickes encephalopathy

A 
CAN OPEN 
Confusion 
Ataxia 
Nystagmus 
Opthalmoplegia 
Peripheral neuropathy
33
Q

Cause of wernickes encephalopathy

A

Thiamine (Vit B12) deficiency

34
Q

Who is wernickes encephalopathy commonly seen in?

A

Alcoholics

35
Q

Causes of wernickes encephalopathy

A

Alcoholics
Persistent vomiting
Stomach cancer
Dietary deficiency

36
Q

Classic triad of wernickes

A
  1. Opthlamoplegia/nystagmus
  2. Ataxia
  3. Confusion
37
Q

Features of wernickes

A 
Opthalmoplegia 
Nystagmus
Ataxia 
Confusion - altered GCS
Peripheral sensory neuropathy
38
Q

Investigations of wernickes encephalopathy

A

Decreased red cell transketolase

MRI

39
Q

Treatment of wernickes

A

Urgent replacement of thiamine

40
Q

What may develop if don’t treat wernickes?

A

Korasskofs syndrome

41
Q

Features of korasskofs

A

Confabulation

Amnesia (anterograde and retrograde)

42
Q

Definition of confabulation

A

Make up stories in compensation for lost memories

Neuro Pathology (21 decks)

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