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Krista: Neuro > Lecture 7: > Flashcards

Lecture 7: Flashcards

1
Q

What are the three components of the intracranial vault and their percentage of space:

A
  • Cerebral spinal fluid (10-15%
  • Brain (80-85%)
  • Blood (5-10%)
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2
Q

List the route CSF takes from production to absorption:

A
  • Produced in the lateral ventricles
  • Flow through the interventricular foramina
  • Third ventricle
  • Cerebral aqueduct
  • Fourth ventricle
  • Foramina of Luschka
  • Magendie
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3
Q

How much CSF is in the intracranial volume:

A

-10%

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4
Q

How much CSF is produced in a 24 hour period:

A

500 cc

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5
Q

How much CSF is there at any given time:

A

150 cc

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6
Q

What conditions increase CSF:

A
  • Choroid Plexus Papilloma
  • Hyperthermia
  • Decreased serum osmolality
  • Increased CSF osmolality
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7
Q

What conditions decrease CSF:

A
  • Hypothermia
  • Increased hydrostatic pressure
  • Diamax
  • Increased serum osmolality
  • Decreased CSF osmolality
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8
Q

How much blood occupies the intracranial space:

A

-10% (60 - 80 CC)

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9
Q

(Circle of Willis) Carotid arteries provide circulation of blood to which part of the brain:

A

-anterior cerebral circulation

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10
Q

List the path of that provides circulation to the anterior cerebral part of the brain from the heart:

A
  • Aorta
  • common carotid arteries
  • Bifurcates into external and internal carotid arteries
  • Internal branch enters the base of the skull
  • arterial supply of the eye via the ophthalmic artery
  • Bifurcates into the anterior and middle cerebral arteries
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11
Q

T/F: arterial supply of the eye is via the ophthalmic artery off of the internal carotid arteries.

A

TRUE

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12
Q

The vertebral arteries provide blood circulation to which part of the brain?

A

-Posterior brain

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13
Q

Where does the vertebral arteries enter the posterior fossa:

A

-Foramen Magnum

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14
Q

The basilar artery is from the _____ artery and is just below the _____ arteries.

A
  • vertebral

- pontine

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15
Q

The posterior inferior cerebellar artery and the spinal arteries are from which main artery.

A

-Vertebral artery

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16
Q

Is the basilar artery cephalad or caudad:

A

-cephalad

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17
Q

Is the posterior inferior cerebellar artery cephalad or caudad:

A

-caudad

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18
Q

The posterior cerebral artery is the terminal branch of the:

A

basilar artery

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19
Q

What artery communicates between the posterior cerebral artery and the internal carotid artery:

A

-posterior communicating artery

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20
Q

Where does the inferior and medial surfaces of the occipital and temporal lobes get their blood supply from:

A

Posterior cerebral arteries

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21
Q

Where does the medial side of the frantal and parietal lobes obtain their blood supply from:

A

-anterior cerebral artery

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22
Q

The left and right anterior cerebral arteries are connected by the:

A

-anterior cerebral arteries

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23
Q

Which cerebral artery is the largest:

A

-middle cerebral artery

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24
Q

The artery that runs along the lateral cerebral fissure is known as:

A

-middle cerebral artery

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25
Q

Which artery supplies the lateral surface of the cerebral hemisphere:

A

-middle cerebral artery

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26
Q

How does venous blood from the brain return:

A

-drains into the venous sinuses which lie between the layers of the dura mater and drain into the internal jugular vein.

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27
Q

What are FIVE main characteristics of the of the brains venous system:

A
  • Sinuses are valveless
  • Blood can flow back and forth
  • Pressure within them is negative (AIR EMBOLISM)
  • Little influence by the autonomic nervous system
  • Chemically influenced
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28
Q

What does the blood brain barrier allow passage of:

A
  • small molecules (H2O, O2, CO2)
  • Lipophilic moecules (EtOH, heroin)
  • Passive transport of glucose
  • active transport of amino acids/NT precursors
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29
Q

What does the blood brain barrier prevent the passage of:

A
  • Large molecules (dopamine)

- Charged (ionized) molecules

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30
Q

T/F: The left carotid artery arises from the aortic arch.

A

TRUE

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31
Q

T/F: The right carotid artery arises from the aortic arch.

A

FALSE (…arises from the right innominate artery.)

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32
Q

Does the BBB have many pores:

A

NO. It is the Paucity of pores that is responsible for what is termed the BBB.

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33
Q

How is water transported into the brain:

A

-Bulk Flow

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34
Q

What can disrupt the BBB:

A
  • Sever HTM (???>160 mmHG)
  • Tumors
  • Trauma
  • Stroke
  • Infection
  • High PaCO2
  • Hypoxia
  • sustained seizures
35
Q

What tissue in the brain requires the most cerebral blood flow:

A
  • Gray matter (Cortical)

- —–75-80mL/100g/min

36
Q

What increases the cerebral metabolism and flow:

A
  • stimulation
  • arousal
  • nociception
  • mild hyperthermia
37
Q

What decreases the cerebral metabolism and flow:

A
  • sedative hypnotic agent

- hypothermia

38
Q

Cerebral blood flow less than 30 mL/ 100gm/min means:

A

ischemia

39
Q

Cerebral blood flow less than 20mL/100gm/min means:

A

-abnormal EEG and infarct

40
Q

Cerbral blood flow less then 15mL/100gm/min means:

A

-irreversible damage

41
Q

CBF is coupled to cerebral metabolic rate of oxygen by an uncharacterized mechanism thought to involve:

A
  • K+
  • H+
  • Ca++
  • adenosine
  • prostaglandins
42
Q

What will occur to CBF if CMRO2 decreases:

A

-CBF decreases

43
Q

How do you factor CPP:

A

MAP - ICP = CPP

44
Q

What is normal CPP:

A

70 - 100 mmHg

45
Q

CBF is controlled by what factor:

A
  • CPP
  • PaCO2
  • H+, HCO3
  • PaO2
  • Temperature
  • Neurogenic
  • Autoregulation

-

46
Q

Cerebral blood flow will remain constant if MAP is between:

A

60 - 150 mmHg

47
Q

What will cause a loss in CBF autoregulation:

A
  • Hypoxia
  • Acidosis
  • Trauma
  • Volatile anesthetics (less with forane)
48
Q

What are the three compensation for intracranial pressure:

A
  • CSF Regulation
  • Cerebral Blood Flow-Auto Regulation
  • Metabolic Auto Regulation
49
Q

What is a potent CBF arterially:

A

-PaCO2

50
Q

If PaCO2 changes by 3 mmHg approximately how much will CBF change in percent from baseline:

A

~9% (CBF changes by ~3% of baseline for each 1 mmHg change in PaCO2)

51
Q

T/F: CBF changes 1-2 mL/100g/min per mmHg change in PaCO2.

A

True

52
Q

Which has a slower response to CBF, H+ or PaCO2 and why:

A
  • H+

- these ions take much longer due to entering the extra cellular fluid (ECF) slowly

53
Q

T/F: pH has a(n) inverse relationship with cerebral blood flow (CBF).

A

TRUE

54
Q

At what point does hypoxia take over and creates cerebral vasodilitation:

A

-PaO2 < 50 mmHg

55
Q

What is the usual venous PaO2:

A

35 mmHg (reduction below 30 mmHg is necessary to increase CBF

56
Q

Absence of effective blood flow results in loss of consciousness within:

A

10 - 15 seconds

57
Q

How is 85-90% of glucose obtained in the brain:

A

-oxidative pathway

58
Q

What will 8 degrees of Celsius do to the CMRO2 of the brain:

A

decrease by 1/2

59
Q

Which cranial nerve(s) are linked to controlling CBF:

A
  • X

- V

60
Q

What neurotransmitters are vasoactive in the brain:

A
  • Epi
  • Norepi
  • Dopamine
  • Serotonin
61
Q

Trendelenberg and anemia will cause a _________ increase in CBF.

A

increase

62
Q

Age, increase viscosity, and PEEP will cause a _____ decrease in CBF.

A

Decrease

63
Q

Generrally all CBF will be decreased with intravenous anesthetic agent except:

A

Ketamine

64
Q

Will anesthetic agents cause an increase in cerebral blood flow:

A

Yes, but only in high doses.

(Low doses of anesthetic agents have show little effect.

65
Q

Which anesthetic cause will most likely cause less cerebral vasodilatation Sevo, Des, Iso, or Halo.

A

Halo

66
Q

T/F: Succinylcholine does NOT increase ICP.

A

FALSE

67
Q

Alpha and beta agonist and antagonists have what effect on the CBF if the BBB is intact.

A

They have no effect.

68
Q

What will vasodilators do to CBF:

A

INCREASE CBF

69
Q

What is luxury perfusion syndrome:

A
  • Increase in local accumulation of metabolic by products causes an increase in vasodilation in that area
  • Vessels sstay maximally dilated or have increased flow
70
Q

What is cerebral steal syndrome:

A
  • In areas of focal ischemia with a resutling loss in autoregulation an increase in PaCO2 produces a resultant increase in CBF in the normal areas
  • This takes blood away from the already ischemic areas since the vessels in this area cannot dilate
71
Q

What is inverse steal or Robin Hood Syndrome:

A
  • The arterioles in an area are maximally dilated
  • They do not respond to a decrease in PaCO2 and will not constrict
  • Cerebral blood flow will be increased in this area and stolen away elsewhere
72
Q

Which classification system do most institutions use for brain tumor and describe the classification:

A

-World Health Organization

  • Benign (least aggressive)-Grade I
  • Malignant (most aggressive)-Grade IV
73
Q

T/F: Suproteatorial Tumors are more common in adults.

A

TRUE

74
Q

T/F: Infrteatorial Tumors are more common in pediatrics.

A

TRUE

75
Q

List the places where the brain can herniate through:

A
  • Cingulate gyrus
  • Uncinate gyrus
  • Level of the verebellar tonsils through the foramen magnum
  • opening in the skull
76
Q

What is vasogenic edema:

A

-breakdown in the blood brain barrier which allows protein to move into the extracellular tissue of the brain.

77
Q

What is cytotoxic edema:

A
  • result of neuronal damage

- Increases the amount of sodium and water in the brain cells, leading to increased brain cell volume

78
Q

What is the treatment of choice for many intracranial aneurysms.

A

-Endovascular therapy

79
Q

How long after can a stroke victim receive thrombosis or thrombectomy after the first S/S appear:

A

-up to 8 hours

80
Q

______ often accompanies subarachnoid hemorrhage resulting in ischemia.

A

vasospasm

81
Q

What type of therapy would most likely be used for vasospasms near the circle of willis.

A

-balloons

82
Q

Intracranial hemorrhage may demonstrate what changes on an EKG:

A
  • PVC

- ST-T

83
Q

What type of medication would be used for cerebral vasospasms:

A

Verapamil
nimodipine
nicardipine

Krista: Neuro (7 decks)

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