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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
Q

What percent of the brain is grey matter?
What makes up the grey matter?

A
  • 40%
  • Neuron bodies
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26
Q

What percent of the brain is white matter?
What makes up the white matter?

A
  • 60%
  • Axons that travel deeper into the brain to communicate with other areas
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27
Q

What are the function of glial cells?

A

To provide protection and support for the brain

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28
Q

How do neurons communicate with each other?

A

Through synaptic transmission (mostly chemical/ NT)

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29
Q

NT are stored in synaptic vesicles in the _________________

A

Axon Terminal

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30
Q

Where is Acetylcholine synthesized?

A

Pre-synaptic terminal

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31
Q

Acetylcholine is commonly associated with the NMJ in the ________________ nervous system.

A

Peripheral

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32
Q

What NT is in the preganglionic sympathetic and parasympathetic neurons?

A

Acetylcholine

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33
Q

How is ACh broken down?

A

Broken down by Acetylcholinesterase in the Synaptic Cleft

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34
Q

Acetylcholine Actions

A
  • Regulates heart contractions
  • Decreases HR
  • Decreases BP
  • Release Urine
  • Gland and Gastric Secretions
  • Skeletal Muscle Contraction
  • Attention, Memory, Arousal (CNS)
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35
Q

What Cholinesterase Inhibitor/ Anticholinesterase is used for the reversal of Non-depolarizing neuromuscular blockade?

A

Neostigmine

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36
Q

What Cholinesterase Inhibitor/ Anticholinesterase is used to treat Myasthenia Gravis?

A

Pyridostigmine

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37
Q

What are the unwanted side effects of Cholinesterase Inhibitor/ Anticholinesterase (Cholinergic SE)?

A
  • Salivation
  • Lacrimation
  • Urination
  • Diaphoresis
  • GI Issues (Diarrhea)
  • Emesis
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38
Q

How does Cholinesterase Inhibitor/ Anticholinesterase improve symptoms of Dementia, Alzheimer’s, and Parkinson’s Disease?

A

An increase in ACh in the CNS can help nerve cells better communicate

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39
Q

This group of drugs block the action of Acetylcholine

A

Anticholinergics

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40
Q

Blocking acetylcholine signals can decrease the following:

A
  • Digestion
  • Mucus Secretion
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41
Q

Unwanted side effects of anticholinergics

A
  • Urine Retention
  • Dry Mouth
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42
Q

The drug prevents communication b/w the nerves of the vestibule and the vomiting center in the brain

A

Scopolamine

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43
Q

What is the major excitatory NT in the brain and spinal cord (CNS)

A

Glutamate

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44
Q

Glutamate Actions

A
  • Learning/Memory
  • Cognition
  • Mood Regulation
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45
Q

What can negatively affect glutamate levels?

A

Chronic Stress

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46
Q

Problems with making or using glutamate can lead to the following conditions

A
  • Depression
  • Bipolar
  • Schizophrenia
  • Autism
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47
Q

Excessive activation of glutaminergic synapses can lead to very large influxes of ________________

A

Calcium (Excitotoxicity leading to cell damage and cell death)

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48
Q

Too much glutamate can lead to the following conditions

A
  • Parkinson’s
  • Huntington’s
  • Alzheimer’s
  • Depression
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49
Q

What essential amino acid is used to make Dopamine?

A

Phenylalanine

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50
Q

Does dopamine have an inhibitory or excitatory effect?

A

Generally inhibitory effects

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51
Q

Where are dopaminergic neurons located?

A
  • Between substantia nigra and caudate nucleus/ putamen
  • Limbic system (Reward System)
  • Retina
  • Olfactory System
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52
Q

What kind of effect does dopamine have outside the CNS?

A
  • Paracrine Effect (acts as a hormone on nearby cells)
  • Inhibit NE release
  • Increase Na+ excretion
  • Reduces insulin secretion
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53
Q

What condition is related to the degeneration of dopaminergic neurons?

A

Parkinson’s

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54
Q

What is the most effective Parkinson’s medication?

A

Levodopa

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55
Q

MOA of Levodopa

A

Passes into the brain and converts to dopamine

Dopamine can not cross through the BBB

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56
Q

What drug is given in combination with Levodopa to protect the drug from early conversion of dopamine outside the brain?

A

Carbidopa (Lodosyn)

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57
Q

Why would you want to avoid Reglan in someone with Parkinson’s disease?

A
  • Reglan is a dopamine antagonist
  • Reglan can worsen the condition of someone with Parkinson’s
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58
Q

Epinephrine and Norepinephrine are made from this NT

A

Dopamine

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59
Q

Where is Epi produced in the nervous system

A
  • Epi produced in small number of neurons in the brain stem
  • Medulla oblongata
  • Pons
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60
Q

Where is NE produced in the nervous system

A

Locus Coeruleus

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61
Q

Which NT (Epi or NE) has a greater effect on the blood vessel

A

Norepinephrine has a greater effect on the blood vessel

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62
Q

Which NT (Epi or NE) has a greater effect on the heart

A

Epinephrine has a greater effect on the heart

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63
Q

Actions of Epi/NE

A
  • Flight or Flight
  • Sleep/Wake Cycle
  • Increase HR/ BP
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64
Q

What amino acid is used to synthesize serotonin

A

Tryptophan

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65
Q

90% of serotonin produced produced at this spot

A

GI Tract Enterochromaffin Cells

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66
Q

Serotonin are stored in _____________. Released during clot formation and play an important role for wound healing.

A

Platelets

67
Q

Serotonin causes _____________ in pathological states.

A

Vasoconstriction (HTN, Atherosclerosis)

68
Q

Serotonin causes _____________ in physiological states.

A

Vasodilation (releases NO)

69
Q

Serotonin Actions

A
  • Modulation of pain
  • Biological Rhythms
  • Mood
70
Q

If Serotonin isn’t being produced/used effectively it can cause the following:

A
  • Depression
  • Anxiety
  • Digestive problems
  • OCD
  • Panic disorders
  • Phobias
  • Schizophrenia
71
Q

What areas store large amount of GABA?

A
  • Brain/ Spinal Cord
  • Pancreas (Beta Cells, inhibit glucagon secretion)
72
Q

GABA actions

A
  • Regulate formation of synapses, secretion of cytokines
  • Calm and control nerve cell hyperactivity
  • Immune response
  • Improve sleep
73
Q

Effects of decreased GABA

A
  • Anxiety
  • Mood disorders
  • Schizophrenia
  • Autism
  • Depression
  • Epilepsy/seizures
74
Q

Effects of increased GABA

A
  • Narcolepsy
  • Hypersomnia
75
Q

What receptors do endorphins bind to in the PNS?

A

Mu-receptors to block to release of Substance P

76
Q

What receptors do endorphins bind to in the CNS?

A

Mu-receptors in the brain to block GABA to increase dopamine

77
Q

What arteries provide cerebral blood flow?

A
  • 2 common carotid arteries (R/L)
  • 2 vertebral arteries (R/L)
78
Q

The internal carotid arteries ascends and bifurcates into what arteries?

A
  • Anterior Cerebral Artery
  • Middle Cerebral Artery
79
Q

The vertebral arteries ascends posteriorly through the foramina of the cervical bodies and join to form the ____________ artery.

A

Basilar Artery

80
Q

The basilar artery divides into ________________ cerebral arteries.

A

Posterior Cerebral Arteries

81
Q

The anterior, middle, and posterior cerebral arteries merge and form _______________

A

Circle of Willis

82
Q

Arteries that travel up and along the brain surface give rise to what kind of arteries?

A

Pial Arteries

83
Q

What does the Pial Arteries branch into?

A

Penetrating Arteries

84
Q

Penetrating arteries give rise to this structure which will perfuse deeper brain tissue

A

Intracerebral arterioles

85
Q

Where is the major site of collateral circulation in the brain?

A

Circle of Willis

  • Loops of low resistance vascular connection.
  • Often asymmetrical
86
Q

Label A

A

Anterior Cerebral Artery

87
Q

Label B

A

Anterior Communicating Artery

88
Q

Label C

A

Middle Cerebral Artery

89
Q

Label D

A

Posterior Communicating Artery

90
Q

Label E

A

Posterior Cerebral Artery

91
Q

Label F

A

Basilar Artery

92
Q

Label G

A

Vertebral Artery

93
Q

Label the Black Star

A

Internal Carotid Artery

94
Q

This region of the internal carotid artery is considered to be a part of the Circle of Willis

A

Distal Tip of the Internal Carotid Artery

95
Q

What is the most prominent venous sinus that runs along the surface of the cerebrum?

A

Superior Sagittal Sinus

96
Q

The veins deep in the brain tissue join behind the midbrain to form this structure.

A

Great Cerebral Vein (Great Vein of Galen)

97
Q

The Great Cerebral Vein will drain blood into this sinus.

A

Inferior Sagittal Sinus

98
Q

The Inferior Sinus will drain blood into this sinus.

A

Straight Sinus

99
Q

The Superficial and Deep systems meet in this area.

A

Confluence of Sinuses

100
Q

The blood in the confluence of sinuses make it’s way down through this structure.

A

Internal Jugular Veins

101
Q

Label A

A

Superior sagittal sinus

102
Q

Label B

A

Inferior Sagittal Sinus

103
Q

Label C

A

Great Vein of Galen

104
Q

Label D

A

Straight sinus

105
Q

Label E

A

Confluence of Sinuses

106
Q

Label F

A

Internal Jugular Veins

107
Q

Why is cerebral blood flow important for the brain?

A
  • Cerebral blood flow is crucial in delivering oxygen and glucose to the brain
  • The brain does not have the ability to store glucose
108
Q

The brain makes up only 2% of body weight but requires _____________% of resting cardiac output.

A

15-20%
(Highly metabolic organ)

109
Q

What is the Cerebral Blood Flow of an average adult?

A
  • 750-900 mL/min
  • 50-60 mL of blood/ 100 grams of brain tissue/ minute
110
Q

CBF under this amount might indicate cerebral impairment and slow EEG

A

Less than 20-30 ml/100g/min

111
Q

CBF resulting in flat/ isoelectric EEG

A

15-20 mL/100g/min

112
Q

CBF resulting in irreversible brain damage

A

10 ml/100g/min

113
Q

What is the equation for Cerebral Perfusion Pressure (CPP)?

A

CPP = MAP - ICP

Normal CPP: 60-80 mmHg
Normal ICP: 7-15 mmHg
Normal MAP: 60-100 mmHg

114
Q

What are the 3 main factors affecting CBF?

A
  • Myogenic
  • Neurogenic
  • Metabolic
115
Q

How will cerebral autoregulation curve be affected for patients with chronic HTN?

A

Cerebral Autoregulation curve will be shifted to the right

116
Q

Describe how CBF autoregulation is affected by Myogenic Control

A
  • 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
Q

How will a decrease cardiac output affect myogenic regulation?

A
  • Decrease MAP will activate myogenic regulation
  • This will cause dilation to encourage more blood flow to the brain
118
Q

Describe how CBF autoregulation is affected by Neurogenic Control

A
  • 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
Q

What factors are involved with Metabolic Control for CBF autoregulation?

A
  • CMRO2
  • CO2/ H+ concentration
  • O2 concentration
  • Astrocytes
120
Q

What is Cerebral Metabolic Rate of Oxygen (CMRO2)

A

Rate of oxygen consumption by the brain

121
Q

Increase brain activity (can be good/bad) will lead to increase in what category?

A
  • Cerebral Metabolism
  • Demand for O2
  • Increase CBF
122
Q

Due to the high metabolism of the brain, the organ needs a second by second delivery of what substances to maintain viability?

A
  • Glucose
  • Oxygen

If the brain is not receiving O2 or glucose, there can be dysfunction and unconsciousness in seconds

123
Q

What is the CMRO2 of the brain?

A
  • 3 ml O2 per 100g of brain tissue PER MINUTE in a resting state
  • 40-50 mL of O2/min
124
Q

How will hypoxia affect the arterioles of the brain?

A

Hypoxia will cause vasodilation (PaO2 <60 mmHg, SpO2 <90%)

125
Q

What is the meaning of Neurovascular Coupling?

A
  • In a state of health, CBF will proportionally match Cerebral Metabolic needs (CMRO2) & O2 demand
  • Blood flow matches neuronal activity

  • In a pathologic state… responses to hypoxia change
  • O2 delivery may not match up with O2 demand
126
Q

How will hemodilution cause vasodilation of the cerebral arterioles?

A
  • Hemodilution can cause a decrease in CaO2 (arterial oxygen content)
  • Results in local regulatory mechanism leading to vasodilation
127
Q

What are non-pharmacologic factors affecting CMRO2?

A
  • Temperature
  • Glucose
  • Seizure Activity
128
Q

How will hypothermia affect CMRO2?

A
  • Degree-dependent reduction in CMRO2
  • 1C reduction = CMRO2 reduction by 6-7%, until completely depressed
129
Q

How will hyperthermia affect CMRO2?

A
  • Increases CMRO2 until 42C
  • > 42C will result in decrease CMRO2 d/t toxic effects
130
Q

How does severe hypoglycemia affect CMRO2 and CBF?

A
  • Blood glucose < 36 mg/dL will result in an increase CBF
  • Hypoglycemia increases CMRO2
131
Q

How will seizure activity affect CMRO2?

A
  • Direct increase in CMRO2
  • Important to control/prevent
132
Q

How does Carbon Dioxide cause vasodilation?

A
  • Excess CO2 in arterial blood combines with water
  • Formation of Carbonic Acid
  • Dissociates to H+ and HCO3-
  • Causes vasodilation of cerebral vessels
133
Q

What is cerebral blood flow is directly proportional to?

A

PaCO2

134
Q

Vasodilation is directly proportional to the increase in H+. What are the sources of H+?

A
  • Dissociation of carbonic acid
  • Lactic Acid
  • Pyruvic Acid
  • Other acidic material formed during metabolism
135
Q

Why is it important to draw an ABG for Neurosurgery?

A
  • 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
Q

What is the primary function of astrocytes?

A
  • Provide support and nutrition to neurons
  • Help regulate neuroinflammation
  • Antioxidant response

  • Star shaped glial cell
  • Foot projections that contact neurons and blood vessels
137
Q

Describe the patho for Astrocyte-mediated Vasodilation

A
  • 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
Q

Factors That Disturb Autoregulation

A
  • 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
Q

Negative effects of low CBF.
Negative effects of high CBF.

A
  • Low CBF can lead to ischemia
  • High CBF can lead to capillary leakage and edema
140
Q

Effects of Nitrous on CBF and CMRO2

A
  • N2O administration may result in minor increase in CMRO2
  • Minor increase in CBF
  • Synergistic effect with volatile anesthetic
141
Q

Effects of Ketamine on CBF and CMRO2

A
  • Increase in CMRO2and CBF
  • Potent cerebral vasodilator
  • Ketamine is usually not recommended for neurosurgery
142
Q

Effects of Barbiturates on CBF and CMRO2

A
  • 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
Q

Effects of Etomidate, Propofol, Opioids on CBF and CMRO2

A

Reduce CMRO2 and CBF in parallel

144
Q

Effects of Volatile Agents on CBF and CMRO2

A
  • 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

Circulator Steal phenomenon: Vasodilation in all brain areas… both healthy & ischemic

145
Q

Effect of Volatiles below 1 MAC on CBF

A

Minimal effect

146
Q

Effect of Volatiles above 1 MAC on CBF

A
  • Potent cerebral vasodilation
  • Increase CBF
147
Q

What arteries provide the blood support for the spinal cord?

A
  • Anterior spinal artery (1)
  • Posterior spinal arteries (2)
  • Artery of Adamkiewicz
148
Q

Where does the anterior spinal artery originate?

A

Vertebral Artery

149
Q

The anterior spinal artery runs midline from the ____________ to the ____________.

A

Foramen magnum to filum terminale

150
Q

The anterior spinal artery will supply blood to the anterior ______________(fraction) of the spinal cord.

A

2/3

151
Q

The posterior spinal artery will supply blood to the posterior ______________(fraction) of the spinal cord.

A

1/3

152
Q

What two arteries fed into the posterior spinal arteries at each spinal level?

A
  • Radicular artery
  • Medullary artery
153
Q

What is the largest anterior medullary segmental artery?

A

Artery of Adamkiewicz

154
Q

The Artery of Adamkiewicz most commonly arises on which side of the aorta?

A
  • Left side of the aorta from T9 to T12
  • Most dominant artery seen on an angiogram (Recognizable d/t a hairpin turn)
155
Q

Artery of Adamkiewicz provides the major blood supply to what area of the spinal cord?

A

Anterior Thoracolumbar Spinal Cord

156
Q

Factors that can cause risk of ischemia or infarction if there is damage to the artery of Adamkiewicz from pathology?

A
  • AAA dissection or repair
  • Malignancy
  • Vascular malformations or emboli
  • Spine surgery
157
Q

Effects of a damage or obstructed Artery of Adamkiewicz?

A
  • Impaired motor function of the legs
  • Paralysis
  • Urine/fecal incontinence
  • Sensory usually intact
158
Q

Spinal Cord Disorder involving a mass effect can cause the following symptoms for the patient.

A
  • Pain
  • Weakness
  • Paralysis
159
Q

Considerations for a tumor on a spinal cord

A
  • Surgical removal
  • Microsurgery
  • Preserve healthy tissue/function
  • Stabilization of spine
160
Q

Considerations for a hematoma on a spinal cord

A
  • Control bleeding
  • Remove blood to take pressure off spinal cord
161
Q

Considerations for a abscess on a spinal cord

A
  • Washout
  • Culture
  • Antibiotics
162
Q

What spinal cord disorder must be corrected within 72 hours of birth to mitigate infection?

A
  • Spina Bifida (Myelomeningocele)
  • Opening in the back with exposed nerves
163
Q

What is Tethered Cord Syndrome?

A
  • Spinal cord tissue attached to spinal column that limits the movement of the spinal cord
  • Can cause stretching and nerve damage
164
Q

Anesthetic Considerations for Spinal Surgery

A
  • 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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