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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
Q

CO2 is a potent?

A

Cerebral vasodilator

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26
Q

What is the usual dose of Mannitol & onset?

A
  • 0.5-1 gr/kg
  • onset 30mins
27
Q

Why are corticosteroids given for cranial tumors & when is the best time to start them?

A
  • Decrease swelling.
  • Start 48hrs prior to Sx
28
Q

What are the best anesthetics for someone with increased ICP?

A
  • Barbiturates (Robinhood effect),
  • propofol infusion (decreases ICP by decreasing CMRO2)
29
Q

What is parenchymal volume?

A

Functional brain tissue

30
Q

What are 2 ways to decrease cerebral blood volume?

A

Hyperventilation & barbiturates

31
Q

How long is CBF affected by mild hyperventilation?

A

6 – 12hrs

32
Q

Why can Lasix be good for cranial surgery patients?

A

It slows down the rebound effect of neurons and glia swelling up

33
Q

What is the downside to Dextran solutions?

A

Direct interference with platelets & Factor 8

34
Q

Is there a benefit to hypothermia in neurosurgery?

A

Not really

35
Q

What is the recommended glucose level for someone that had a TBI?

A

150 – 200mg/dL

36
Q

Which ICP monitoring device is placed into the parenchyma?

A

Intraparenchymal bolt

37
Q

What does cerebral oximetry measure?

A

Blood of the cerebral cortex

38
Q

What is a normal cerebral oximetry?

A

~70% (+/- 20%)

39
Q

SSEP’s check what pathway?

A

Dorsal column of the spinal cord

40
Q

Where are SSEP signals received?

A

Cerebral sensory cortex

41
Q

What kind of decrease is significant with SSEP & MEP?

A

50% decrease in amplitude

42
Q

What is triple H therapy and for what is it used?

A
  • Hypertension (20-30 mmHg > baseline),
  • hypervolemia,
  • hemodilution.
  • To prevent vasospasms
43
Q

What medications can treat vasospasm?

A
  • CCB,
  • statins,
  • Magnesium,
  • antifibrinolytics,
  • Cilostazol
44
Q

What is believed to cause vasospasms?

A

Breakdown products of Hgb & NO

45
Q

What region is targeted with a deep brain stimulator?

A

Subthalamic region

46
Q

What drugs (2) are avoided in DBS placement & why?

A
  • Benzos (interfere w/ signals),
  • Remifentanil (may suppress tremors)
47
Q

What drugs (2) are appropriate for DBS placement?

A

Propofol & Precedex qtts

48
Q

What drugs (6)are avoided in stereotactic ablations?

A
  • Benzos,
  • ketamine,
  • methohexital,
  • etomidate,
  • alfentanil,
  • meperidine
49
Q

What medication is held the morning of stereotactic neurosurgery?

A

Levadopa d/t muscle rigidity & potential difficult IV start

50
Q

What is the target CPP for a neurotrauma adult?

A

70 mmHg

51
Q

What is the triad of hydrocephalus?

A
  • Dementia,
  • gait changes,
  • incontinence
52
Q

What are some S/S of hydrocephalus with elevated ICP?

A
  • N/V,
  • altered LOC,
  • papilledema,
  • bradycardia,
  • HTN,
  • altered breathing pattern
53
Q

Where is the obstruction in non-communicating hydrocephalus?

A

Aqueduct of Sylvius between 3rd & 4th ventricle

54
Q

What part of a VP shunt surgery is very stimulating?

A

Tunneling of the catheter into the abdomen

55
Q

What is the most common intracranial tumor?

A

Glioblastoma (most aggressive)

56
Q

Which intracranial tumor has a high chance of VAE?

A

Meningioma d/t being near the sagittal sinus

57
Q

What type of pituitary tumors are there?

A
  • Microadenoma (functional) &
  • Macroadenoma (Nonfunctional tumor)
58
Q

What hormones can be seen with microadenomas?

A
  • Prolactin,
  • adrenocorticotropic hormone (ACTH),
  • growth hormone
59
Q

What nerve & artery are at risk in a transsphenoidal hypophysectomy?

A

Optic nerve & carotid artery

60
Q

What cranial nerve is affected by acoustic neuroma?

A

CN 8

61
Q

Mnemonic for cranial nerve function?

A

Some Say Marry Money, But My Brother Says Big Brains Matter Most

62
Q

Mnemonic for cranial nerve names?

A

Only One Of The Two Athletes Felt Very Good, Victorious, And Healthy

63
Q

What part of neurosurgery can evoke the trigeminal cardiac reflex?

A

Retraction of the dura over the parietal lobe area

Principles 3 (3 decks)

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