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Principles 3 > Exam 1 Neuro 2 > Flashcards

Exam 1 Neuro 2 Flashcards

1
Q

How much CSF is there any given time?

A

150mL

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2
Q

What is the normal CSF pressure when horizontal?

A

~ 10 mmHg

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3
Q

What lines all the ventricles?

A

Choroid Plexus

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4
Q

What excretes CSF?

A

Ependymal cells (E- excrete)

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5
Q

What absorbs CSF into cerebral veins?

A

Arachnoid villi (A= absorb)

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6
Q

What prevents CSF backflow?

A

One-way valves in the arachnoid villi

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7
Q

What is the flow of CSF?

A

Formation of fluid in choroid plexus of lateral ventricles
→ excreted by ependymal cells
→ into third ventricle through Foramen of Monro
→ along Aqueduct of Sylvius into fourth ventricle
→ through Foramen of Luschka & Magendie into Cisterna Magna
→ through SA space absorbed by arachnoid villi
- (Excrete → 3rd ventricle → Monro → Sylvius 4th ventricle → Luscha → Magna → Subarachnoid → Absorb)

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8
Q

What is Pseudotumor Cerebri & in whom can it be commonly seen?

A
  • CSF build up/obstruction.
  • May be seen in obese women of reproductive age
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9
Q
  • What is normal ICP?
A

7-15 mmHg

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10
Q

What ICP is pathological or critical?

A

> 20 mmHg

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11
Q

What is the Gold standard for ICP measurement?

A

Intraventricular monitor

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12
Q

At what pressure is brain herniation possible?

A

> 20 mmHg

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13
Q

What is the formula for CPP?

A

CPP= MAP – ICP

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14
Q

The ___ ICP, the ___ the CPP?

A

Higher & lower

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15
Q

What is a normal CPP?

A

60 -80 mmHg

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16
Q

What is the critical ischemia CPP threshold?

A

30 – 40 mmHg

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17
Q

When in an intracranial pathologic state, managing the ___ is most critical?

A

ICP

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18
Q

When in hemodynamic instability/shock, managing the ___ is most critical?

A

MAP

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19
Q

How can increased CBF cause increased ICP?

A
  • Hypoxia,
  • hypercarbia,
  • increased CMRO₂ cause increased CBF
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20
Q

Where would a CSF flow obstruction be?

A

Between 3rd & 4th ventricle (aqueduct stenosis)

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21
Q

What are some increased ICP symptoms?

A

HA, N/V, blurred vision, somnolence, papilledema (swollen eyeballs), midline shift, hydrocephaly, edema

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22
Q

What are Cushing’s triad symptoms?

A
  • Widened pulse pressure,
  • irregular respirations,
  • bradycardia
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23
Q

How can a ventilated patient’s ICP be quickly reduced & how long does it last?

A
  • Hyperventilate to PaCO2 of 30 – 35 mmHg.
  • Effects last 6 – 12 hrs
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24
Q

How does a PaCO2 & EtCO2 compare?

A

The PaCO₂ is usually ~ 5 mmHg higher than EtCO₂

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25
CO2 is a potent?
Cerebral vasodilator
26
What is the usual dose of Mannitol & onset?
- 0.5-1 gr/kg - onset 30mins
27
Why are corticosteroids given for cranial tumors & when is the best time to start them?
- Decrease swelling. - Start 48hrs prior to Sx
28
What are the best anesthetics for someone with increased ICP?
- Barbiturates (Robinhood effect), - propofol infusion (decreases ICP by decreasing CMRO2)
29
What is parenchymal volume?
Functional brain tissue
30
What are 2 ways to decrease cerebral blood volume?
Hyperventilation & barbiturates
31
How long is CBF affected by mild hyperventilation?
6 – 12hrs
32
Why can Lasix be good for cranial surgery patients?
It slows down the rebound effect of neurons and glia swelling up
33
What is the downside to Dextran solutions?
Direct interference with platelets & Factor 8
34
Is there a benefit to hypothermia in neurosurgery?
Not really
35
What is the recommended glucose level for someone that had a TBI?
150 – 200mg/dL
36
Which ICP monitoring device is placed into the parenchyma?
Intraparenchymal bolt
37
What does cerebral oximetry measure?
Blood of the cerebral cortex
38
What is a normal cerebral oximetry?
~70% (+/- 20%)
39
SSEP’s check what pathway?
Dorsal column of the spinal cord
40
Where are SSEP signals received?
Cerebral sensory cortex
41
What kind of decrease is significant with SSEP & MEP?
50% decrease in amplitude
42
What is triple H therapy and for what is it used?
- Hypertension (20-30 mmHg > baseline), - hypervolemia, - hemodilution. - To prevent vasospasms
43
What medications can treat vasospasm?
- CCB, - statins, - Magnesium, - antifibrinolytics, - Cilostazol
44
What is believed to cause vasospasms?
Breakdown products of Hgb & NO
45
What region is targeted with a deep brain stimulator?
Subthalamic region
46
What drugs (2) are avoided in DBS placement & why?
- Benzos (interfere w/ signals), - Remifentanil (may suppress tremors)
47
What drugs (2) are appropriate for DBS placement?
Propofol & Precedex qtts
48
What drugs (6)are avoided in stereotactic ablations?
- Benzos, - ketamine, - methohexital, - etomidate, - alfentanil, - meperidine
49
What medication is held the morning of stereotactic neurosurgery?
Levadopa d/t muscle rigidity & potential difficult IV start
50
What is the target CPP for a neurotrauma adult?
70 mmHg
51
What is the triad of hydrocephalus?
- Dementia, - gait changes, - incontinence
52
What are some S/S of hydrocephalus with elevated ICP?
- N/V, - altered LOC, - papilledema, - bradycardia, - HTN, - altered breathing pattern
53
Where is the obstruction in non-communicating hydrocephalus?
Aqueduct of Sylvius between 3rd & 4th ventricle
54
What part of a VP shunt surgery is very stimulating?
Tunneling of the catheter into the abdomen
55
What is the most common intracranial tumor?
Glioblastoma (most aggressive)
56
Which intracranial tumor has a high chance of VAE?
Meningioma d/t being near the sagittal sinus
57
What type of pituitary tumors are there?
- Microadenoma (functional) & - Macroadenoma (Nonfunctional tumor)
58
What hormones can be seen with microadenomas?
- Prolactin, - adrenocorticotropic hormone (ACTH), - growth hormone
59
What nerve & artery are at risk in a transsphenoidal hypophysectomy?
Optic nerve & carotid artery
60
What cranial nerve is affected by acoustic neuroma?
CN 8
61
Mnemonic for cranial nerve function?
Some Say Marry Money, But My Brother Says Big Brains Matter Most
62
Mnemonic for cranial nerve names?
Only One Of The Two Athletes Felt Very Good, Victorious, And Healthy
63
What part of neurosurgery can evoke the trigeminal cardiac reflex?
Retraction of the dura over the parietal lobe area

Principles 3 (3 decks)

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