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Health Assessment > Grayson's Deck: Neurologic Diseases (Exam III) > Flashcards

Grayson's Deck: Neurologic Diseases (Exam III) Flashcards

1
Q

The brain consumes _______ % of cardiac output at rest.

The brain consumes _______ % of O2-inspired O2.

A

20%

20%

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2
Q

What vessels provide the blood flow to the brain?

A
  • 80% via the carotid arteries
  • 20% via the vertebral arteries
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3
Q

Name the pertinent vasculature of the circle of Willis.

This card is just to look at the picture on the other side.

A
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4
Q

What factors affect cerebral blood flow?

A
  • CMR (cerebral metabolic rate)
  • CPP (cerebral perfusion pressure)
  • ICP
  • PaCO₂
  • PaO₂
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5
Q

How much O₂ is required by the brain per minute?

A

3 mlO₂ / 100g / min

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6
Q

What is the average cerebral blood flow?

A

50ml/100g/min

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7
Q

What drugs and/or metabolic states will decrease CMR?

A
  • Hypothermia
  • Anesthetic drugs (VAA, prop, etomidate, etc)
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8
Q

What drugs and/or metabolic states will increase CMR?

A
  • Hyperthermia
  • Seizures
  • Ketamine
  • N₂O
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9
Q

What temperature range do we generally want to keep our patients in?

A

36 - 42° C

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10
Q

When is hypothermia mediated EEG suppression achieved?

A

18 - 20° C

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11
Q

Hypothermia will cause a ___% decrease for every 1°C decrease.

A

7

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12
Q

What would a temperature of > 42°C do to the brain?

A

Denature proteins and destroy neurons (↓CBF)

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13
Q

At what cerebral blood flow rates would one expect irreversible brain damage?

A

10ml/100g/min

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14
Q

How is Cerebral Perfusion Pressure (CPP) calculated?

A

CPP = MAP - ICP

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15
Q

How is MAP calculated?

A

MAP = DBP + ⅓(SBP - DBP)

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16
Q

At what CPP and MAP does the brain exhibit autoregulation (myogenic response) ?

A

CPP of 50 - 150 mmHg
MAP of 60 - 160 mmHg

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17
Q

With what pathologies is a loss of CPP seen?

A
  • Brain tumors
  • Head trauma
  • Volatile anesthetics
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18
Q

What can cause a rightward shift in the brain autoregulation curve?

A
  • Chronic HTN
  • SNS activation
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19
Q

What can cause a leftward shift in the brain autoregulation curve?

A

VAA’s

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20
Q

Name the three components of the brain that form the Monroe-Kellie Doctrine.

A
  • Brain 80%
  • Blood 12%
  • CSF 8%
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21
Q

What is the Monroe Kellie Doctrine?

A

Any increase in one component of the intracranial space (blood, brain tissue, CSF) must be met with an equivalent decrease in another to prevent increased ICP.

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22
Q

What is the normal CPP range?

A CPP below _________ mmHg will result in slowing of EEG.

A

80 - 100 mmHg

50 mmHg

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23
Q

An ICP > ____ mmHg will compromise CPP.

What is normal ICP?

A

30 mmHg

5-15 mmHg

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24
Q

What pathologic processes or disease states are known to cause an increase in ICP?

A
  • Tumors
  • Hematomas
  • Blood in CSF
  • Infection
  • Aqueductal Stenosis
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25
Q

At what CPPs would one expect to see EEG slowing?
What about irreversible brain damage?

A
  • EEG slowing: < 50mmHg
  • Brain damage: < 25 mmHg
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26
Q

What are the two types of hydrocephalus? Which is more common?

A
  • Obstructive (most common)
  • Communicating
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27
Q

What would occur from PaO₂ levels of < 50-60 mmHg in the brain?

A
  • Vasodilation
  • ↑CBF
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28
Q

Severe hypoxia will have what effect on cerebral blood flow?

A

↓O₂ = ↑CBF

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29
Q

PaO₂ exhibits an _______ mechanism in the brain similar to intracranial MAP.

A

autoregulation

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30
Q

PaCO₂ between this range will experience a linear change in vasodilation and cerebral blood flow.

A

20 - 80 mmHg

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31
Q

PaCO₂ levels are directly proportional to ______ of the cerebral vasculature.

A

vasodilation

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32
Q

A PaCO₂ increase of 1mmHg will correspond to an increase in CBF by how much?

A

1mmHg PaCO₂ increase = 1-2mls/100g/min increase in CBF.

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33
Q

A patient’s PaCO₂ is increased by 10mmHg, how much would you expect CBF to increase if the patients brain was measured to weigh 250g?

A

10mmHg x 1-2mls x 2.5 =

25 - 50 mls/min increase in CBF.

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34
Q

At what PaCO₂ levels does max cerebral vasodilation occur?

A

80 - 100 mmHg

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35
Q

At what PaCO₂ levels does max cerebral vasoconstriction occur?

A

25 mmHg

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36
Q

What does increase venous pressure do to the brain?

A
  • ↓ venous drainage
  • ↑ cerebral blood volume
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37
Q

What things will increase cerebral venous pressure?

A
  • Jugular compression (cervical collar, head rotation, etc.)
  • ↑ intrathoracic pressure (coughing, PEEP)
  • Vena Cava thrombus
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38
Q

What range is normal for ICP?

A

5 - 15 mmHg

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39
Q

What symptoms are seen with abnormally high ICP?

A
  • Headache
  • N/V
  • Papilledema
  • ↓LOC
40
Q

What does Cushing’s Triad indicate?
What is the triad?

A

↑ICP

  • ↑sBP (Hypertension)
  • ↓HR (Bradycardia)
  • Respiratory Abnormalities (Cheyne-Stokes)
41
Q

What is the most common site of brain herniation?

A

Uncal

↑ICP forces temporal uncus into the infratentorial space (see 3 on the figure below).

42
Q

Why do the pupils become fixed and dilated with uncal herniation?

A

CN-3 (oculomotor) crosses near tentorium and is compressed by the herniation.

43
Q

How can ICP be qualitatively assessed with ultrasound?

A

By measuring the optic nerve diameter.

↑ICP = ↑ optic nerve sheath

44
Q

How can elevated ICP be treated?

Long list

A
  • Elevate HOB 30°
  • Hyperventilate (transient fix)
  • Drain CSF
  • Mannitol (0.5-1 g/kg) - give quickly
  • Diuretics
  • Corticosteroids
  • Surgical decompression
45
Q

Decreased hematocrit will result in what?

A
  • ↓ viscosity
  • ↑ CBF
46
Q

Increased hematocrit will result in what?

A
  • ↑ viscosity
  • ↓ CBF
47
Q

What is the optimal hematocrit in the presence of elevated ICP?

A

30 - 34%

48
Q

What is luxury perfusion?

A

Combination of ↓CMRO₂ and ↑CBF

49
Q

Hypothermia ______ CBF and CMR.

A

decreases

50
Q

What is intracerebral steal?

A

When blood flow is shunted away from an ischemic area that needs that blood flow.

51
Q

How is intracerebral steal treated?

A

Reverse Steal.

Hyperventilation → vasoconstriction of healthy areas → flow redistributed to ischemic regions.

52
Q

What is CN I?

Exam?

A

Olfactory - smells

ID of odors
Cranial 1 gave me a whiff, is that C diff?

53
Q

What is CN II?

Exam?

A

Optic - vision

Snellen Chart

2nd nerve helps me see right. Central and Peripheral sight.

54
Q

What is CN III?

Exam?

A

Oculomotor - vision (convergence, pupillary accomodation)

Accommodation - convergence; reaction to light

Pupils are constricting, third nerve, eyes are moving.

55
Q

What is CN IV?

Exam?

A

Trochlear - vision (convergence, pupillary accommodation)

Accommodation - convergence; reaction to light

Trochlear nerve works the superior oblique; hard to look down if it’s weak.

56
Q

What is CN V?

Exam:

A

Trigeminal - Face

Facial sensation: palpation of masseter/temporalis muscles

Trigeminal nerve works mastication, it’s sensory and motor, deals with face sensation.

57
Q

What is CN VI?

Exam?

A

Abducens - vision (convergence, pupillary accommodation)

Accommodation, convergence; reaction to light

Abducens is 6th, does eye abduction. Motor nerve for motion helps prevent double vision.

58
Q

What is CN VII?

Exam?

A

Facial -symmetry, smile, anterior tastes

Facial symmetry, smile; taste anterior 2/3

Facial is the 7th, test facial expression, it’s sensory and motor, 2/3 of taste sensation.

59
Q

What is CN VIII?

Exam?

A

Acoustic - hearing

Normal conversation; tuning form

Vestibulocochlear (Acoustic), 8th nerve, body balancer. Used for the sound sensor.

60
Q

What is CN IX?

Exam?

A

Glossopharyngeal - Gag; posterior taste

Gag reflex, posterior 1/3

Glossopharyngeal nerve, senses tase from the 1/3 back of the tongue, 9th nerve, it helps us swallow.

61
Q

What is CN X?

Exam

A

Vagus

Swallow and say ‘Ah’

10th nerve is Vagus, helps us speak and say stuff, custard only if dysphagia.

62
Q

What is CN XI?

Exam

A

Spinal accessory - shrugging, chin flexion against tension

Accessory nerve is the 11th, so shrug your shoulders and test head resistance.

63
Q

What is CN XII and Test?

A

Hypoglossal - Tongue protrusion

The hypoglossal nerve is the 12 nerve, deals with tongue movement.

64
Q

Injury to this cranial nerve results in bell’s palsy.

A

CN 7

65
Q

Eye movement in controlled by what cranial nerves?

A

3, 4, 6

66
Q

What is the Glascow Coma Scale?

A

see picture below

67
Q

What level of the spinal cord is affected with paraplegia?

A

T2 - T12

68
Q

What level of the spinal cord is affected with quadriplegia?

A

C5 - T1

69
Q

What level of the spinal cord is affected diaphragmatic paralysis?

A

Above C5

70
Q

What is spinal shock?

A

Loss of vascular tone w/ flaccid paralysis below site of injury.

71
Q

When would one see bradycardia with a spinal injury?

A

If the injury is at T1 - T4.

72
Q

What signs/symptoms are seen with anterior cord syndrome (anterior spinal artery syndrome)?

A
  • Loss of pain and temperature
  • Retention of vibration and proprioception
73
Q

What signs/symptoms are seen with central cord syndrome?

A
  • Encountered during incomplete spinal injuries
  • Motor deficit in upper extremities
  • Pain and temperature decreased in lower extremities
74
Q

What signs/symptoms are seen with Brown-Sequard syndrome?

A
  • Lateral hemiplegia
  • Loss of proprioception/vibration on injured side.
  • Loss of pain/temperature on the contralateral side.
75
Q

What should be known about dermatomes?

A

Nothing, this is too much. Save this for another time. Take the L on this one for this test.

76
Q

Are more strokes ischemic or hemmorrhagic?

A
  • Ischemic (80%)
  • Hemmorrhagic (20%)
77
Q

Which type of stroke is more likely to cause death?

A

Hemmorrhagic (4x more likely)

78
Q

What are specific risk factors for hemmorrhagic stroke?

A
  • HTN
  • Cigarettes
  • Cocaine
  • Female
79
Q

What are specific risk factors for ischemic stroke?

A
  • HTN
  • Cigarettes
  • HLD
  • DM
  • EtOH
80
Q

Where is bleeding located with an epidural hematoma?

A

In between the dura and the skull

81
Q

What intracranial bleed is characterized by:

lucidity → unconscious → conscious → unconscious

A

Epidural hematoma

82
Q

Where is bleeding in subdural hematomas located?

A

Between the dura mater and the arachnoid mater.

83
Q

What intracranial bleed is often characterized as the “worst headache of one’s life”?

A

Subarachnoid hemorrhage

84
Q

What location is often the site of bleeding in subarachnoid hemmorhaging?

A

Circle of Willis (usually aneurysmal rupture)

85
Q

Cerebral _______ is one of the complications often caused by subarachnoid hemorrhage.

A

vasospasm

Often occurs 3rd day post bleed and peaks 5-7 days in.

86
Q

How is cerebral vasospasm treated?

This is a complication caused by subarachnoid hemorrhage.

A

Triple “H” Therapy

  • HTN
  • Hypervolemia
  • Hemodilution
87
Q

What type of hemorrhage occurs within the brain tissue itself?

A

Intracerebral (intra-parenchymal) hemorrhage.

88
Q

What factors possibly increase the risk of developing Parkinson’s?

A
  • Welding
  • Herbicides
  • Pesticide
  • Genetics
89
Q

What s/s are associated with Parkinson’s disease?

A
  • Muscle rigidity
  • Pill-rolling tremor
  • Bradykinesia
  • Postural instability
90
Q

What drugs will counteract levodopa and are contraindicated in Parkinson’s patients?

A
  • Metoclopramide
  • Haloperidol
  • Droperidol
  • Promethazine
91
Q

What treatments are used for Multiple Sclerosis?

A
  • Corticosteroids
  • Interferon
  • Azathioprine
  • Methotrexate
92
Q

What induction agent is a good first-line agent for treatment of acute seizures?

A

Propofol

93
Q

What drugs may be used to located seizure foci due to their EEG potentiating effects?

A

Etomidate
Methohexital

94
Q

What are the s/s of seizures whilst under anesthesia?

A
  • ↑HR
  • HTN
  • ↑ ETCO₂
95
Q

What is anterior ischemic optic neuropathy (AION) ?
What should be known about AION?

A
  • Vision loss post-op
  • sudden and painless
  • Asymmetric optic disc swelling
96
Q

What is posterior ischemic optic neuropathy (PION) ?
What should be known about PION?

A
  • Vision loss post-op
  • More common than AION
  • No initial findings on exam
97
Q

What risk factors exist for developing ischemic optic neuropathy (ION) ?

A
  • Positioning
  • Anemia
  • ↓BP
  • Excessive fluids
  • Excessive vasopressors

Health Assessment (27 decks)

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