Intracranial and cerebrovascular disease

Question 1

Cerebral ischemia develops, and neurologic damage will ensue if the underlying process is not corrected within __ to __ minutes.

Answer 1

3 to 8

Question 2

This refers to global hypoxia (respiratory failure, asphyxia) or circulatory arrest wherein the brain is not perfused.

Answer 2

Global ischemia

Question 3

This can result from vasospasm, traumatic, hemorrhagic, embolic, or atherosclerotic events.

Answer 3

Focal ischemia

Question 4

A third group of patients experience neurologic dysfunction for longer than 24 hours, with spontaneous and complete recovery within 1 to 2 weeks. This phenomenon is termed?

Answer 4

Reversible ischemic neurologic deficit

Question 5

Atherosclerosis located where is the source of most cerebral ischemic events.

Answer 5

Bifurcation of the common carotid artery

Question 6

What are the two most important risk factors for cerebral ischemia?

Answer 6

Hypertension and cigarette smoking

Question 7

Cerebral autoregulation is functioning at what cerebral pressures?

Answer 7

50 to 150 mmHg

Question 8

Normal cerebral blood flow in humans is ___ and how much CO does it go to the brain?

Answer 8

40 to 60 mL/100 gm/min

15% of CO

Question 9

The cerebral metabolic rate for oxygen in adults is?

Answer 9

3-4 mL/100 gm/min

20% of whole body compsumption

Question 10

The cerebral blood flow at which ischemia becomes apparent on electroencephalogram (EEG), is termed as the?

Answer 10

Critical regional cerebral blood flow

18 to 20 mL/100 gm/min

Question 11

20% of rebleeding of aneurysms mostly occur within how long post op?

Answer 11

Within 2 weeks
Highest risk post op day 1
The etiology is believed to be subarachnoid blood around the circle of Willis in the basal cisterns.

Question 12

Vasospasm is most clearly demonstrated by angiography and involves the ______ artery 75% of the time.

Answer 12

Middle cerebral

Question 13

Describe the treatment options if vasospasm is suspected following an spontaneous subarachnoid hemorrhage.

Hypervolemia is achieved with ______ administration, with a goal of central venous pressure of __ to __ mm Hg or pulmonary artery wedge pressure of __ to __ mm Hg.

Answer 13

Colloid
8-12 mmHg
18 to 20 mmHg

Question 14

The desired level is a hematocrit of ___ to ___, thereby reducing viscosity and improving microcirculation.

Answer 14

27 to 30

Question 15

If the aneurysm is clipped, vasopressors (dopamine, phenylephrine) can be used to induce hypertension, with the goal being a mean arterial pressure approximately ____to ___ mm Hg greater than baseline systolic pressure.

Answer 15

20 to 30

Question 16

The key to SAH management is early diagnosis and surgical treatment within ___ hours. Vasospasm should be treated with HHH therapy.

Answer 16

72

Question 17

Glucose must be maintained between __ to __ mg/dl to prevent further neurologic insult.

Answer 17

80 to 120

Question 18

Neurosurgeons commonly place temporary occlusion clips on the parent artery that feeds the aneurysm before clipping it. Most studies have shown that this is tolerated for __ to __ minutes.

Answer 18

10 to 14

Question 19

The risk of ischemic injury increases up until __ minutes of temporary clipping, at which time the chance
of ischemic insult is nearly 100%.

Answer 19

31

Question 20

This phenomenon of cerebral edema is also called?

Answer 20

Autoregulation breakthrough