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Advanced Principles C > Introduction to Neuro > Flashcards

Introduction to Neuro Flashcards

1
Q

Cranial I Name:
Nerve Type:
Function:

A

Cranial I Name: Olfactory
Nerve Type: Sensory
Function: Smell

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2
Q

Cranial II Name:
Nerve Type:
Function:

A

Cranial II Name: Optic
Nerve Type: Sensory
Function: Vision

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3
Q

Cranial III Name:
Nerve Type:
Function:

A

Cranial III Name: Oculomotor
Nerve Type: Motor
Function: Most eye movement

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4
Q

Cranial IV Name:
Nerve Type:
Function:

A

Cranial IV Name: Trochlear
Nerve Type: Motor
Function: Moves eyes to look at nose

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5
Q

Cranial V Name:
Nerve Type:
Function:

A

Cranial V Name: Trigeminal
Nerve Type: Both Sensory and Motor
Function: Face sensation, mastication

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6
Q

Cranial VI Name:
Nerve Type:
Function:

A

Cranial VI Name: Abducens
Nerve Type: Motor
Function: Abducts the eye

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7
Q

Cranial VII Name:
Nerve Type:
Function:

A

Cranial VII Name: Facial
Nerve Type: Both Sensory and Motor
Function: Facial expression, taste

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8
Q

Cranial VIII Name:
Nerve Type:
Function:

A

Cranial VIII Name: Vestibulocochlear
Nerve Type: Sensory
Function: Hearing, Balance

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9
Q

Cranial IX Name:
Nerve Type:
Function:

A

Cranial IX Name: Glossopharyngeal
Nerve Type: Both Sensory and Motor
Function: Taste, Gag Reflex

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10
Q

Cranial X Name:
Nerve Type:
Function:

A

Cranial X Name: Vagus
Nerve Type: Both Sensory and Motor
Function: Gag Reflex, Parasympathetic Innervation

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11
Q

Cranial XII Name:
Nerve Type:
Function:

A

Cranial XII Name: Hypoglossal
Nerve Type: Motor
Function: Swallow, Speech

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12
Q

Cranial XI Name:
Nerve Type:
Function:

A

Cranial XI Name: Accessory
Nerve Type: Motor
Function: Shoulder Shrug

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13
Q

Which Cranial Nerves are both sensory and motor?

A
  • Trigeminal (V)
  • Facial (VII)
  • Glossopharyngeal (IX)
  • Vagus (X)
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14
Q

Which Cranial Nerves are only sensory?

A
  • Olfactory (I)
  • Optic (II)
  • Vestibulocochlear (VIII)
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15
Q

Which Cranial Nerves are only motor?

A
  • Oculomotor (III)
  • Trochlear (IV)
  • Abducens (VI)
  • Accessory (XI)
  • Hypoglossal (XII)
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16
Q

What part of the brain deals with higher function?

A

Cerebrum

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17
Q

Name the function of the Cerebellum

A
  • Balance
  • Posture
  • Coordination
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18
Q

What part of the brain deals with automatic functions?

A

Brainstem

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19
Q

What is the frontal lobe responsible for?

A
  • Personality
  • Behavior
  • Speech
  • Self awareness
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20
Q

What is the parietal lobe responsible for?

A
  • Language
  • Words
  • Sense of touch
  • Spatial perception
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21
Q

What is the occipital lobe responsible for?

A

Interpretation of visual stimuli (light, color)

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22
Q

What is the temporal lobe responsible for?

A
  • Understanding language
  • Memory
  • Hearing
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23
Q

The surface of the cerebrum is called the _________________

A

Cortex

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24
Q

Differentiate between a Gyri and Sulci

A
  • Gyri are the bumps or raised ridges on the cerebral cortex
  • Sulci are the grooves or indentations on the cerebral cortex

The gyri and sulci are the folds taht increases the surface area of the brain, contains 16 billion neurons.

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25
What percent of the brain is grey matter? What makes up the grey matter?
* 40% * Neuron bodies
26
What percent of the brain is white matter? What makes up the white matter?
* 60% * Axons that travel deeper into the brain to communicate with other areas
27
What are the function of glial cells?
To provide protection and support for the brain
28
How do neurons communicate with each other?
Through synaptic transmission (mostly chemical/ NT)
29
NT are stored in synaptic vesicles in the _________________
Axon Terminal
30
Where is Acetylcholine synthesized?
Pre-synaptic terminal
31
Acetylcholine is commonly associated with the NMJ in the ________________ nervous system.
Peripheral
32
What NT is in the preganglionic sympathetic and parasympathetic neurons?
Acetylcholine
33
How is ACh broken down?
Broken down by Acetylcholinesterase in the Synaptic Cleft
34
Acetylcholine Actions
* Regulates heart contractions * Decreases HR * Decreases BP * Release Urine * Gland and Gastric Secretions * Skeletal Muscle Contraction * Attention, Memory, Arousal (CNS)
35
What Cholinesterase Inhibitor/ Anticholinesterase is used for the reversal of Non-depolarizing neuromuscular blockade?
Neostigmine
36
What Cholinesterase Inhibitor/ Anticholinesterase is used to treat Myasthenia Gravis?
Pyridostigmine
37
What are the unwanted side effects of Cholinesterase Inhibitor/ Anticholinesterase (Cholinergic SE)?
* Salivation * Lacrimation * Urination * Diaphoresis * GI Issues (Diarrhea) * Emesis
38
How does Cholinesterase Inhibitor/ Anticholinesterase improve symptoms of Dementia, Alzheimer's, and Parkinson's Disease?
An increase in ACh in the CNS can help nerve cells better communicate
39
This group of drugs block the action of Acetylcholine
Anticholinergics
40
Blocking acetylcholine signals can decrease the following:
* Digestion * Mucus Secretion
41
Unwanted side effects of anticholinergics
* Urine Retention * Dry Mouth
42
The drug prevents communication b/w the nerves of the vestibule and the vomiting center in the brain
Scopolamine
43
What is the major excitatory NT in the brain and spinal cord (CNS)
Glutamate
44
Glutamate Actions
* Learning/Memory * Cognition * Mood Regulation
45
What can negatively affect glutamate levels?
Chronic Stress
46
Problems with making or using glutamate can lead to the following conditions
* Depression * Bipolar * Schizophrenia * Autism
47
Excessive activation of glutaminergic synapses can lead to very large influxes of ________________
Calcium (Excitotoxicity leading to cell damage and cell death)
48
Too much glutamate can lead to the following conditions
* Parkinson's * Huntington's * Alzheimer's * Depression
49
What essential amino acid is used to make Dopamine?
Phenylalanine
50
Does dopamine have an inhibitory or excitatory effect?
Generally inhibitory effects
51
Where are dopaminergic neurons located?
* Between substantia nigra and caudate nucleus/ putamen * Limbic system (Reward System) * Retina * Olfactory System
52
What kind of effect does dopamine have outside the CNS?
* Paracrine Effect (acts as a hormone on nearby cells) * Inhibit NE release * Increase Na+ excretion * Reduces insulin secretion
53
What condition is related to the degeneration of dopaminergic neurons?
Parkinson's
54
What is the most effective Parkinson's medication?
Levodopa
55
MOA of Levodopa
Passes into the brain and converts to dopamine ## Footnote Dopamine can not cross through the BBB
56
What drug is given in combination with Levodopa to protect the drug from early conversion of dopamine outside the brain?
Carbidopa (Lodosyn)
57
Why would you want to avoid Reglan in someone with Parkinson's disease?
* Reglan is a dopamine antagonist * Reglan can worsen the condition of someone with Parkinson's
58
Epinephrine and Norepinephrine are made from this NT
Dopamine
59
Where is Epi produced in the nervous system
* Epi produced in small number of neurons in the brain stem * Medulla oblongata * Pons
60
Where is NE produced in the nervous system
Locus Coeruleus
61
Which NT (Epi or NE) has a greater effect on the blood vessel
Norepinephrine has a greater effect on the blood vessel
62
Which NT (Epi or NE) has a greater effect on the heart
Epinephrine has a greater effect on the heart
63
Actions of Epi/NE
* Flight or Flight * Sleep/Wake Cycle * Increase HR/ BP
64
What amino acid is used to synthesize serotonin
Tryptophan
65
90% of serotonin produced produced at this spot
GI Tract Enterochromaffin Cells
66
Serotonin are stored in _____________. Released during clot formation and play an important role for wound healing.
Platelets
67
Serotonin causes _____________ in pathological states.
Vasoconstriction (HTN, Atherosclerosis)
68
Serotonin causes _____________ in physiological states.
Vasodilation (releases NO)
69
Serotonin Actions
* Modulation of pain * Biological Rhythms * Mood
70
If Serotonin isn’t being produced/used effectively it can cause the following:
* Depression * Anxiety * Digestive problems * OCD * Panic disorders * Phobias * Schizophrenia
71
What areas store large amount of GABA?
* Brain/ Spinal Cord * Pancreas (Beta Cells, inhibit glucagon secretion)
72
GABA actions
* Regulate formation of synapses, secretion of cytokines * Calm and control nerve cell hyperactivity * Immune response * Improve sleep
73
Effects of decreased GABA
* Anxiety * Mood disorders * Schizophrenia * Autism * Depression * Epilepsy/seizures
74
Effects of increased GABA
* Narcolepsy * Hypersomnia
75
What receptors do endorphins bind to in the PNS?
Mu-receptors to block to release of Substance P
76
What receptors do endorphins bind to in the CNS?
Mu-receptors in the brain to block GABA to increase dopamine
77
What arteries provide cerebral blood flow?
* 2 common carotid arteries (R/L) * 2 vertebral arteries (R/L)
78
The internal carotid arteries ascends and bifurcates into what arteries?
* Anterior Cerebral Artery * Middle Cerebral Artery
79
The vertebral arteries ascends posteriorly through the foramina of the cervical bodies and join to form the ____________ artery.
Basilar Artery
80
The basilar artery divides into ________________ cerebral arteries.
Posterior Cerebral Arteries
81
The anterior, middle, and posterior cerebral arteries merge and form _______________
Circle of Willis
82
Arteries that travel up and along the brain surface give rise to what kind of arteries?
Pial Arteries
83
What does the Pial Arteries branch into?
Penetrating Arteries
84
Penetrating arteries give rise to this structure which will perfuse deeper brain tissue
Intracerebral arterioles
85
Where is the major site of collateral circulation in the brain?
Circle of Willis ## Footnote * Loops of low resistance vascular connection. * Often asymmetrical
86
Label A
Anterior Cerebral Artery
87
Label B
Anterior Communicating Artery
88
Label C
Middle Cerebral Artery
89
Label D
Posterior Communicating Artery
90
Label E
Posterior Cerebral Artery
91
Label F
Basilar Artery
92
Label G
Vertebral Artery
93
Label the Black Star
Internal Carotid Artery
94
This region of the internal carotid artery is considered to be a part of the Circle of Willis
Distal Tip of the Internal Carotid Artery
95
What is the most prominent venous sinus that runs along the surface of the cerebrum?
Superior Sagittal Sinus
96
The veins deep in the brain tissue join behind the midbrain to form this structure.
Great Cerebral Vein (Great Vein of Galen)
97
The Great Cerebral Vein will drain blood into this sinus.
Inferior Sagittal Sinus
98
The Inferior Sinus will drain blood into this sinus.
Straight Sinus
99
The Superficial and Deep systems meet in this area.
Confluence of Sinuses
100
The blood in the confluence of sinuses make it's way down through this structure.
Internal Jugular Veins
101
Label A
Superior sagittal sinus
102
Label B
Inferior Sagittal Sinus
103
Label C
Great Vein of Galen
104
Label D
Straight sinus
105
Label E
Confluence of Sinuses
106
Label F
Internal Jugular Veins
107
Why is cerebral blood flow important for the brain?
* Cerebral blood flow is crucial in delivering oxygen and glucose to the brain * The brain does not have the ability to store glucose
108
The brain makes up only 2% of body weight but requires _____________% of resting cardiac output.
15-20% (Highly metabolic organ)
109
What is the Cerebral Blood Flow of an average adult?
* 750-900 mL/min * 50-60 mL of blood/ 100 grams of brain tissue/ minute
110
CBF under this amount might indicate cerebral impairment and slow EEG
Less than 20-30 ml/100g/min
111
CBF resulting in flat/ isoelectric EEG
15-20 mL/100g/min
112
CBF resulting in irreversible brain damage
10 ml/100g/min
113
What is the equation for Cerebral Perfusion Pressure (CPP)?
CPP = MAP - ICP ## Footnote Normal CPP: 60-80 mmHg Normal ICP: 7-15 mmHg Normal MAP: 60-100 mmHg
114
What are the 3 main factors affecting CBF?
* Myogenic * Neurogenic * Metabolic
115
How will cerebral autoregulation curve be affected for patients with chronic HTN?
Cerebral Autoregulation curve will be shifted to the right
116
Describe how CBF autoregulation is affected by Myogenic Control
* Cerebral vasculature smooth muscles (in arterioles) is highly responsive to changes in cerebral perfusion pressure * Dilates when CPP is down to increase CBF * Constricts with CPP is up to decrease or maintain CBF
117
How will a decrease cardiac output affect myogenic regulation?
* Decrease MAP will activate myogenic regulation * This will cause dilation to encourage more blood flow to the brain
118
Describe how CBF autoregulation is affected by Neurogenic Control
* CBF can be affected by SNS innervation of large brain arteries and vasoactive NT * Myogenic mechanism can override these effects. * Increase SNS, decrease CBF * Minor role compared to the effects of myogenic and metabolic control
119
What factors are involved with Metabolic Control for CBF autoregulation?
* CMRO2 * CO2/ H+ concentration * O2 concentration * Astrocytes
120
What is Cerebral Metabolic Rate of Oxygen (CMRO2)
Rate of oxygen consumption by the brain
121
Increase brain activity (can be good/bad) will lead to increase in what category?
* Cerebral Metabolism * Demand for O2 * Increase CBF
122
Due to the high metabolism of the brain, the organ needs a second by second delivery of what substances to maintain viability?
* Glucose * Oxygen ## Footnote If the brain is not receiving O2 or glucose, there can be dysfunction and unconsciousness in seconds
123
What is the CMRO2 of the brain?
* 3 ml O2 per 100g of brain tissue PER MINUTE in a resting state * 40-50 mL of O2/min
124
How will hypoxia affect the arterioles of the brain?
Hypoxia will cause vasodilation (PaO2 <60 mmHg, SpO2 <90%)
125
What is the meaning of Neurovascular Coupling?
* In a state of health, CBF will proportionally match Cerebral Metabolic needs (CMRO2) & O2 demand * Blood flow matches neuronal activity ## Footnote * In a pathologic state… responses to hypoxia change * O2 delivery may not match up with O2 demand
126
How will hemodilution cause vasodilation of the cerebral arterioles?
* Hemodilution can cause a decrease in CaO2 (arterial oxygen content) * Results in local regulatory mechanism leading to vasodilation
127
What are non-pharmacologic factors affecting CMRO2?
* Temperature * Glucose * Seizure Activity
128
How will hypothermia affect CMRO2?
* Degree-dependent reduction in CMRO2 * 1C reduction = CMRO2 reduction by 6-7%, until completely depressed
129
How will hyperthermia affect CMRO2?
* Increases CMRO2 until 42C * >42C will result in decrease CMRO2 d/t toxic effects
130
How does severe hypoglycemia affect CMRO2 and CBF?
* Blood glucose < 36 mg/dL will result in an increase CBF * Hypoglycemia increases CMRO2
131
How will seizure activity affect CMRO2?
* Direct increase in CMRO2 * Important to control/prevent
132
How does Carbon Dioxide cause vasodilation?
* Excess CO2 in arterial blood combines with water * Formation of Carbonic Acid * Dissociates to H+ and HCO3- * Causes vasodilation of cerebral vessels
133
What is cerebral blood flow is directly proportional to?
PaCO2
134
Vasodilation is directly proportional to the increase in H+. What are the sources of H+?
* Dissociation of carbonic acid * Lactic Acid * Pyruvic Acid * Other acidic material formed during metabolism
135
Why is it important to draw an ABG for Neurosurgery?
* Check ABG for PaCO2 * Note the difference between PaCO2 and ETCO2 * Provide mild hyperventilation to keep CO2 at desired level to provide brain protection
136
What is the primary function of astrocytes?
* Provide support and nutrition to neurons * Help regulate neuroinflammation * Antioxidant response ## Footnote * Star shaped glial cell * Foot projections that contact neurons and blood vessels
137
Describe the patho for Astrocyte-mediated Vasodilation
* Glutaminergic excitatory neurons stimulate astrocytes * Increase Ca2+ ion concentration in foot projections * VASODILATION of nearby arterioles/capillaries * Astrocytes also release substances including Nitric Oxide (NO) leading to VASODILATION of nearby arterioles/capillaries
138
Factors That Disturb Autoregulation
* Hypoxia (limit brain blood flow) * Chronic HTN (shift curve right, keep MAP w/in 20-25% of baseline) * Trauma (head injury), can result in impaired autoregulation * Brain compression (tumors, bleeds, edema), can cause vasogenic edema, increase ICP
139
Negative effects of low CBF. Negative effects of high CBF.
* Low CBF can lead to ischemia * High CBF can lead to capillary leakage and edema
140
Effects of Nitrous on CBF and CMRO2
* N2O administration may result in minor increase in CMRO2 * Minor increase in CBF * Synergistic effect with volatile anesthetic
141
Effects of Ketamine on CBF and CMRO2
* Increase in CMRO2 and CBF * Potent cerebral vasodilator * Ketamine is usually not recommended for neurosurgery
142
Effects of Barbiturates on CBF and CMRO2
* Decrease CMRO2 * **“Robinhood Effect”/Reverse steal phenomenon** * Decrease cerebrovascular response to CO2, vasoconstrict “healthy” parts of the brain, and allow preferential perfusion to ischemic areas
143
Effects of Etomidate, Propofol, Opioids on CBF and CMRO2
Reduce CMRO2  and CBF in parallel
144
Effects of Volatile Agents on CBF and CMRO2
* Dose-dependent reduction in CMRO2 * BUT… They also have dose-dependent vasodilatory properties * Overall effect = balance between CMRO2-related CBF reduction AND vasodilatory-related increase in CBF * Circulator Steal phenomenon ## Footnote Circulator Steal phenomenon: Vasodilation in all brain areas… both healthy & ischemic
145
Effect of Volatiles below 1 MAC on CBF
Minimal effect
146
Effect of Volatiles above 1 MAC on CBF
* Potent cerebral vasodilation * Increase CBF
147
What arteries provide the blood support for the spinal cord?
* Anterior spinal artery (1) * Posterior spinal arteries (2) * Artery of Adamkiewicz
148
Where does the anterior spinal artery originate?
Vertebral Artery
149
The anterior spinal artery runs midline from the ____________ to the ____________.
Foramen magnum to filum terminale
150
The anterior spinal artery will supply blood to the anterior ______________(fraction) of the spinal cord.
2/3
151
The posterior spinal artery will supply blood to the posterior ______________(fraction) of the spinal cord.
1/3
152
What two arteries fed into the posterior spinal arteries at each spinal level?
* Radicular artery * Medullary artery
153
What is the largest anterior medullary segmental artery?
Artery of Adamkiewicz
154
The Artery of Adamkiewicz most commonly arises on which side of the aorta?
* Left side of the aorta from T9 to T12 * Most dominant artery seen on an angiogram (Recognizable d/t a hairpin turn)
155
Artery of Adamkiewicz provides the major blood supply to what area of the spinal cord?
Anterior Thoracolumbar Spinal Cord
156
Factors that can cause risk of ischemia or infarction if there is damage to the artery of Adamkiewicz from pathology?
* AAA dissection or repair * Malignancy * Vascular malformations or emboli * Spine surgery
157
Effects of a damage or obstructed Artery of Adamkiewicz?
* Impaired motor function of the legs * Paralysis * Urine/fecal incontinence * Sensory usually intact
158
Spinal Cord Disorder involving a mass effect can cause the following symptoms for the patient.
* Pain * Weakness * Paralysis
159
Considerations for a tumor on a spinal cord
* Surgical removal * Microsurgery * Preserve healthy tissue/function * Stabilization of spine
160
Considerations for a hematoma on a spinal cord
* Control bleeding * Remove blood to take pressure off spinal cord
161
Considerations for a abscess on a spinal cord
* Washout * Culture * Antibiotics
162
What spinal cord disorder must be corrected within 72 hours of birth to mitigate infection?
* Spina Bifida (Myelomeningocele) * Opening in the back with exposed nerves
163
What is Tethered Cord Syndrome?
* Spinal cord tissue attached to spinal column that limits the movement of the spinal cord * Can cause stretching and nerve damage
164
Anesthetic Considerations for Spinal Surgery
* Thorough pre-operative neuro assessment * Surgery may involve a laminectomy for access, or reconstruction/hardware placement * Pain control considerations… spine surgery hurts! * Consider multimodal when appropriate * Prone positioning considerations * Neuro check prior to extubation (awake extubation) * Caution using long acting sedatives

Advanced Principles C (11 decks)

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