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Exam 3 - Neuro Flashcards

1
Q

What is CBF per weight of brain tissue?
mL/min?
% of CO?

A

50 mL/100 g
750 mL/min
15% of CO

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2
Q

Combined volume of brain tissue, CSF, and intracranial blood?

A

1200-1500 mL

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3
Q

Normal ICP?

A

5-15 mmHg

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4
Q

This fold seperates the two hemispheres?

A

Falx cerebri

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5
Q

This fold seperates the supratentorial and infratentorial spaces?

A

Tentorium cerebelli

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6
Q

Herniation of hemispheric against the falx cerebri?

A

Subfalcine herniation

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7
Q

Herniation of supratentorial contents against the tentorium cerebelli?

A

Transtenorial herniation

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8
Q

What is uncal herniation?

A

Subtype of transtentorial herniation
The uncus herniates over the tentorium cerebelli

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9
Q

Label each type of herniation?

A
  1. Subfalcine
  2. Transtentorial
  3. Tonsillar
  4. Transcalvarial
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10
Q

What are the 3 reasons tumors increase ICP?

A
  1. Directly d/t their size
  2. Indirectly by causing edema
  3. Obstructing CSF outflow (3rd ventricle tumors)
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11
Q

How does propofol decrease ICP?

A

Cerebral vasoconstrictor, decreases CMRO2 and CBF

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12
Q

What is MS?
Risk factors?

A

Progressive, autoimmune demyelination of central nerve fibers
Female, 1st degree relative, EBV, smoking, having other AI disorders

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13
Q

Treatments for MS?

A

No cure
Corticosteroids, immune modulators, IVIG

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14
Q

When should you order LFTs preop for MS patients?

A

If they are on dantrolene or azathioprine - causes liver impairment

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15
Q

What are intraop anesthetic concerns for MS patients?

A
  • Temp management is cruccial (body swings trigger exacerbations)
  • Avoid succinylcholine - increased K+ d/t upregulation of nACh receptors
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16
Q

Why do MG patients have increased risk for aspiration and respiratory insufficency?

A

Bulbar involvement causes laryngeal/pharyngeal weakness

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17
Q

Anesthetic concerns for MG patients?

A
  • Reduce paralytic dosage to avoid prolonged weakness
  • AChesterase inhibitors (pyridostigmine) will increase succs and ester LA
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18
Q

What is Eaton-Lambert syndrome?

A
  • Antibodies against presynaptic VG Ca++ channels
  • Leads to decreased ACh release at the NMJ
  • Heavily associated small cell lung carcinoma
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19
Q

Symptoms and treatments for E-L syndrome?

A

Sx: limb-girdle weakness, dysautonomia, oculobulbar palsy
Tx: 3-4 diaminopyridine (K+ channel blocker), azathioprine, AChesterase inhibitors

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20
Q

What would you avoid giving to a patient with E-L syndrome?

A

Non-depolarizing NMB
Extreme caution with dosing of paralytics

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21
Q

Cause of muscular dystrophy?

A

Muscle fiber degeneration d/t breakdown dystrophin-glycoprotein complex

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22
Q

Most common and severe from of MD?

A

Duchenne
Only occurs in boys, have decreased lifespan

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23
Q

What lab finding is increased in MD?

A

Creatine kinase d/t muscle wasting

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24
Q

What severe anesthetic complication can occur with MD patients?

A

Hypermetabolic syndrome- similar to MH, triggered by succ and VA
Can cause rhabdo, hyperkalemia, VFib, and cardiac arrest

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25
Q

What is the best anesthetic and paralytic for MD patients?

A

Low dose roc and TIVA

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26
Q

What is myotonia?

A

Prolonged contraction after muscle stimulation

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27
Q

What is myotonic dystrophy?

A

Muscle wasting - esp in face, masseter, hand, and pretibal muscles

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28
Q

What is myotonia congentia?

A

milder form, involves only skeletal muscles

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29
Q

What is central core disease?

A

Core muscle cells lack mithochondrial enzymes → proximal muscle weakness and scoliosis

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30
Q

Triggers for myotonic dystrophies?
Treatments?

A
  • Stress and cold temps
  • No cure - quinine, procanamide, steroids
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31
Q

Anesthetic concerns for myotonic dystrophies?

A
  • Increased aspiration risk from GI hypomotility
  • Keep warm to avoid flare ups
  • Avoid succ - fasiculations trigger myotonia
32
Q

What are the three major dementia syndromes and their occurence?

A

Alzheimers - 70%
Vascular dementia - 25%
Parkinsons - 5%

33
Q

GA choice for dementia patients?

A

TIVA with propofol

34
Q

Parkinsons patho?
Symptoms?
Treatments?

A
  • Unknown → degeneration of dopaminergic fibers of basal ganglia (dopamine suppresses overstimulation of extrapyramidal motor system)
  • Symptom triad: skeletal muscle tremor, rigidity, akinesia
  • Treatments: Levodopa (crosses BBB), anticholinergics, MAOIs (prevent dopamine breakdown), deep brain stimulator
35
Q

Parkinsons anesthesia concerns?

A
  • PO levodopa needs to be given preop to avoid extreme extrapyramidal effects (chest wall rigidity)
  • Avoid demerol if on an MAOI
  • Deep brain stimulators need to be turned off or the surgeon needs to use bipolar cautery
36
Q

What is the most common CNS glial cell?

A

Astrocytes

37
Q

What are the 4 types of astrocytomas?

A

Gliomas - least aggressive
Pilocytic astrocytomas - usually benign
Anaplastic astrocytomas
Glioblastoma multiforme - high mortality despite treatment

38
Q

This brain tumor arises from dura or arachnoid tissue and is usually benign?

A

Meningiomas

39
Q

This brain tumor is non-cancerous and can be cured with transphenoidal or open crainotomy?

A

Pituitary adenomas

40
Q

Tumor that involes vestibular component of CN VIII within the auditory canal?

A

Acoustic neuromas

41
Q

What is the leading cause of disabilty and death worldwide?

42
Q

Blood is supplies to the brain from the ____ and ____ arteries ?

A

internal carotid and vertebral

43
Q

What area may their be a stroke in if there is contralateral leg weakness?

A

anterior cerebral artery

44
Q

Strokes in this area present with contralateral hemipareises/hemisensory defect, aphasia, and contralateral visual field defect?

A

middle cerebral artery

45
Q

Features of a posterior cerebral artery stroke?

A

Contralateral visual field defect and hemiparesis

46
Q

Features of penetrating artery stroke?

A

Contralateral hemiparesis
and hemisensory deficits

47
Q

Basilar artery stroke symptoms?

A

Oculomotor deficits and/or ataxia with crossed sensory and motor deficits

48
Q

Vertebral artery stroke symptoms?

A

Lower cranial nerve deficits and /or ataxia with crossed sensory deficits

49
Q

TOAST classifications for ischemic stroke?

A
  1. Large artery atherosclerosis (stenosis)
  2. small vessel occlusion (laclunar stroke)
  3. cardioaortic embolic (a fib emboli)
  4. other etiology (hypercoaguable states)
  5. undetermined etiology
50
Q

Treatments for ischemic stroke?

A
  • Aspirin
  • TPA within 3-4.5h onset
  • Revascularization
51
Q

Hemorrhagic CVA treatment?

A

Conservative: reduce ICP, BP, seizure precautions, monitoring
Invasive: surgical evacuation

52
Q

What are the 2 most reliable predictors of outcome for hemorrhagic CVA?

A

blood volume and change in LOC

53
Q

How long should someone wait to have an elective cases after starting a new anticoagulant for thrombus?

54
Q

Patients on warfarin will need what perioperatively?

A

Short acting anticoags (heparin) to bridge the gap

55
Q

Causes of cerebral aneurysm rupture?

A

HTN, smoking, female, oral contraceptives, cocaine

56
Q

When should intervention be completed after a ruptured aneurysm?

A

Within 72 hours

57
Q

When is the highest risk for post SAH vasospasm?

A

3-15 days after a SAH

58
Q

What causes SAH vasospasm?

A

Free hgb triggers inflammatory mediators → reduces nitric oxide availibility and increases endothelin 1 → vasoconstriction

59
Q

Primary treatment to prevent Post SAH vasospasm?

A

Triple H therapy (hypertension, hypervolemia, hemodilution)

60
Q

More invasive treatment for SAH vasospasm?

A

Balloon dilation and direct injection of vasodilators

61
Q

What 2 grading scales are used for aneurysm prognosis?

A

Hunt and Hess Classification
World Federation of Neurological Surgeons Grading System (uses GCS and major deficit)

62
Q

What are AVM?

A

AV connections without capillaries
Creaties an area of high flow, low resistance shunting

63
Q

What is the scale for AVM grading?

A

Spetzier-Martin AVM Grading System

64
Q

What is a chiari malformation and the types?

A

Congenital displacement of the cerebellum
Type 1-4

65
Q

Treatment for chiari malformations?

A

Surgical resections

66
Q

Another name for tuberous sclerosis?

A

Bourneville disease

67
Q

What is tuberous sclerosis?

A

Genetic disease causing benign abnormal tumors/growths all over the body
Usually presents with mental retardation and seizure disorders

68
Q

What is Von-Hippel Lindau Disease?

A

Genetic disease involving formations of benign tumors of the CNS, eyes, adrenals, pancreas and kidneys
May present with pheochromocytoma

69
Q

Anesthetic concerns for VHLD?

A

NA anesthesia may be limited d/t co-existing spinal tumor
Exaggerated HTN from pheochromocytoma

70
Q

What is neurofibromatosis?

A

Tumors form on the nerves in the body anywhere
Types 1, 2, and schwannomatosis

71
Q

Anesthesia concerns for neurofibromatosis?

A

account for increased ICP, airway issues, scoliosis, possibility of pheochromocytoma
avoid NA d/t high likelihood of spinal tumors

72
Q

Treatments for hydrocephalus?

A

Diuretics - furosemide and acetazolamide
VP shunt
ETV - endoscopic third ventriculostomy

73
Q

When does shunt malfcunction occur most frequently?

A

Within 1st year of placement

74
Q

What should you avoid in TBI patients?

A

NGT/OGT - potential for basal skull fracture

75
Q

What transient abnormalities can cause seizures?

A

hypoglycemia, hyponatremia, hyperthermia, and intoxication

76
Q

What drugs that treat seizures are enzyme inducers?
What does this mean for us?

A

Phenytoin, Tegretol, and Barbituates
Require higher doses of hepatically cleared medications

Assessment (16 decks)

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