Medicine (Neurological Disorders) Flashcards
What is ALS?
-Amyotrophic Lateral Sclerosis
-Progressive neurodegenerative disease of upper and lower motor neurons due to degeneration of lateral corticospinal tracts
-Leads to muscle failure
-Dysphagia/aspiration
-Death typically from respiratory complications
What is the treatment for ALS?
-No treatment
-Supportive (G tube, trach)
What is your management for a patient with ALS?
-Consult physician (baseline respiratory status)
-OR for airway management/increased risk of aspiration
-No succinylcholine due to hyperkalemia secondary to denervation/immobilization
-Concern for post-op respiratory depression
What is alzheimer’s disease?
-A Neurodegenerative disease characterized by progressive loss of cortical neurons and formation of amyloid plaques and intraneuronal neurofibrillary tangles
-Familial form (early onset, rare) and sporadic form
How is alzheimer’s diagnosed?
-Post-mortem autopsy (amyloid plaques and neurofibrillary tangles)
-MRI: Cortical atrophy with ventricular enlargement
How is alzheimer’s treated?
-No cure
-Cholinesterase inhibitors and glutamate antagonists
-Manage behavioral disturbances
What is your management for a patient with alzheimer’s disease?
-Understand patient’s power of attorney
-Decreased anesthetic doses (30%)
-Avoid atropine and scopolomine. Glycopyrrolate does not cross blood brain barrier and is better
What is Parkinson’s disease?
-Neurodegenerative disease characterized by bradykinesia, rigidity and resting tremor
-Caused by preogressive loss of dopaminergic neurons
What is the treatment for parkinsons’
-Carbidopa-levodopa
-Optimize amount of levodopa that enters into CNS
What is your management for a patient with Parkinsons?
-Continue medications pre-op
-Caution with opioids
-Mindful of seratonin syndrome (HTN, tachycardia, hyperthermia, diaphoresis)
-Avoid ketamine
What is multiple sclerosis?
-Inflammatory demyelinating disease of the CNS
-Possible autoimmune disease trigger
-Periventricular areas of brain
-MRI with gadolinium
What is your management for a patient with MS?
-Avoid surgery during periods of relapse
-Risk of aspiration
-Avoid succinylcholine
-Pre-op CBC
What is a seizure?
-Sudden onset of abnormal, highly synchronous discharges of neurons
-May include involuntary movements, sensations and impaired consciousness
What is epilepsy?
-A chronic disorder of recurrent seizures. Two separate unprovoked seizures
-Can be from congenital or acquired factors in the cerebral cortex
Describe the different classifications/types of seizures.
-Partial/generalized (one vs multiple foci)
-Simple/complex (LOC)
-Simple partial
-Secondary generalized tonic/clonic
-Abscence
-Myoclonic
-Primary generalized tonic/clonic
What is status epilepticus?
-A medical emergency of continuous episode of prolonged seizure activity or multiple seizures without recovery
How is status epilepticus treated?
-Activate EMS if no resolution within 5 minutes
-ABCs
-Supplemental oxygen
-Establish venous access
-Midazolam 10 mg for >40 kg or 5 mg for 13-40 kg
-Diazepam 0.15-0.2 mg/kg/dose, max 10 mg/dose
-Rule out hypoglycemia
What is your management for a patient with seizures/epilepsy?
-Consult neurologist
-Identify seizure triggers, frequency
-Utilize benzos/propofol (raise seizure threshold)
-Avoid ketamine, flumazenil, etomidate
-Patient’s antiepileptic drugs may have additive effect with other anesthetics
-Avoid tramadol
What is a CVA?
-Cerebrovascular accident (stroke).
-Sudden onset of neurological deficits that occurs secondary to cerebral ischemia or cerebral hemorrhage
-TIA: Sudden onset of focal neurological deficits that resolve within 24h
How is an ischemic and hemorrhagic stroke treated?
-Ischemic: Possible thrombolytics within 3-4.5 hr
-Hemorrhagic: Reverse anticoagulants if possible
-Consider FFP or PCC
What is the management of a patient with CVA/TIA?
-Neurology/PCP consultation
-Pt is ASA 4 if CVA <6 months or substantial residual deficit
-Manage BP (avoid rapid decrease, avoid HTN ketamine/epi)
-Aspiration risk
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