Final quick hits Flashcards
Where does the anterior lateral system cross over?
Decussates at the dorsal horn
What does ipsilateral stand for?
Same side
What is the dorsal column responsible for?
Fine touch
Two touch
Vibration
Proprioception
What is the Antero-lateral system responsible for?
Pain
Temp
Crude touch
Pressure
Which cranial nerve is most likely to be compressed by a pituitary tumor?
Optic - CN 2
At a PaCO2 of 40 what is the CBF?
50mL/100g brain tissue
(10 points higher)
What does compression on the medulla cause?
Irregular respirations
What level of PaCO2 is recommended for hyperventilation?
30-35
<30 can cause cerebral ischemia
Most common symptom of SAH? (sub-arachnoid hemorrhage)
Headache
About 50% lose consciousness
What is the most significant source of morbidity and mortality in the patient with SAH?
Cerebral vasospasm - Delayed contraction of the cerebral arteries which may lead to infarction
How does free Hgb and the amount of blood observed on CT correlate to a cerebral vasospasm?
Increases the incidence
Incidence of a cerebral vasospasm?
About 25% of patients a week later
What is an additional treatment for a cerebral vasospasm outside of HHH therapy?
Nimodipine - doesn’t break spasm but increases collateral flow
Best treatment if the aneurysm ruptures during the procedure?
Reverse with protamine -1mg per 100 units of heparin
Two common ways of reducing ICP that should be avoided in TBI’s?
Hyperventilation
Steroids
What drugs are patients with Alzheimer’s disease on? How does this affect our anesthetic plan?
Cholinesterase inhibitors are given such as tacrine, donepezil, rivastigmine, and galantamine
These increase the duration of Succ
What is affected by Parkinson’s?
Dopaminergic neurons in the basal ganglia
This increases AcH (shaking from constant stimulation)
What drugs should be avoided in Parkinsons?
-Metoclopramide
-Butyrophenones (Haldol+Droperidol)
-Phenothiazines (promethazine)
How is ocular perfusion pressure calculated?
MAP - intraocular pressure
Where is the most common site of arterial bleed in the brain?
Arachnoid and pia matter
What are the three layers of the brain?
DAP
Dura
Arachnoid
Pia
Most common site for venous bleed in the brain?
Dura and arachnoid
What CN is responsible for pupil constriction ?
CN3
Order the path for posterior circulation
Subclavian
Vertebral
Basilar
Posterior cerebral artery
What part of the cerebellum maintains equilibrium?
Archicerebelleum
What part of the cerebellum maintains muscle tone?
Paleocerebellum
What part of the cerebellum coordinates voluntary muscle movement?
Neocerebellum
What part of the brainstem controls auditory and visual tracts?
Midbrain
What part of the brainstem controls autonomic integration?
Medulla and Pons
What part of the brainstem controls consciousness and sleep?
RAS
What part of the brain controls memory and learning?
Hippocampus
What part of the brain controls emotion, appetite, pain, and stress
Amygdala
What part of the brain controls cognition, movement, and sensation?
Cerebral cortex
What part of the brain has fine control of movement?
Basal ganglia
Cranial nerves photo
Seizure photo
Blood flow of brain photo
What nerves carry parasympathetic output?
3,7,9,10
What percent of all parasympathetic activity is the vagus nerve responsible for?
75%
Anterior or Posterior; What is the sensory pathway?
Posterior
SSEPS
posterior 1/3 of spinal cord
Anterior or Posterior; What is the motor pathway?
MEPs
anterior 2/3 of spinal cord
Which channelopathy is associated with hypokalemic periodic paralysis?
Calcium
What two drugs should be avoided in Guilian Barre?
Ephedrine Exageratted response)
Succ
Two common signs of a cerebral spasm?
New neurologic deficit
Altered LOC
Gold standard for diagnosing cerebral vasospasm?
Cerebral angiography
Treatment for TBI for patient on aspirin?
Hypertonic solution
Platelets to reverse aspirin
For a TBI, what should CPP be maintained above?
70
What three drugs are helpful in mapping seizures?
Etomidate
Methohexital
Alfentanil
How do locals affect the seizure threshold?
They reduce it but properly executed block does not increase the risk
Which anticonvulsant is excreted unchanged by the kidneys?
Gabapentin
What two changes are seen in Parkinsons?
Decreased dopamine in the basal ganglia
Increased GABA in the thalamus
Anterior Spinal Artery Syndrome - S&S?
Flaccid paralysis
Bowel and Bladder dysfunction
Low of temp and pain
What is preserved during Beck’s syndrome? (Anterior Spinal Artery syndrome) Why?
Preserved touch and proprioception
The dorsal column is perfused by the posterior (not anterior) which is why
What is supplied by the anterior artery?
Corticospinal tract (motor)
Autonomic function (Bowel and Bladder)
Spinothalamic tract - pain and temperature
