Medicine (Neurological Disorders)

Question 1

What is ALS?

Answer 1

-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

Question 2

What is the treatment for ALS?

Answer 2

-No treatment
-Supportive (G tube, trach)

Question 3

What is your management for a patient with ALS?

Answer 3

-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

Question 4

What is alzheimer’s disease?

Answer 4

-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

Question 5

How is alzheimer’s diagnosed?

Answer 5

-Post-mortem autopsy (amyloid plaques and neurofibrillary tangles)
-MRI: Cortical atrophy with ventricular enlargement

Question 6

How is alzheimer’s treated?

Answer 6

-No cure
-Cholinesterase inhibitors and glutamate antagonists
-Manage behavioral disturbances

Question 7

What is your management for a patient with alzheimer’s disease?

Answer 7

-Understand patient’s power of attorney
-Decreased anesthetic doses (30%)
-Avoid atropine and scopolomine. Glycopyrrolate does not cross blood brain barrier and is better

Question 8

What is Parkinson’s disease?

Answer 8

-Neurodegenerative disease characterized by bradykinesia, rigidity and resting tremor
-Caused by preogressive loss of dopaminergic neurons

Question 9

What is the treatment for parkinsons’

Answer 9

-Carbidopa-levodopa
-Optimize amount of levodopa that enters into CNS

Question 10

What is your management for a patient with Parkinsons?

Answer 10

-Continue medications pre-op
-Caution with opioids
-Mindful of seratonin syndrome (HTN, tachycardia, hyperthermia, diaphoresis)
-Avoid ketamine

Question 11

What is multiple sclerosis?

Answer 11

-Inflammatory demyelinating disease of the CNS
-Possible autoimmune disease trigger
-Periventricular areas of brain
-MRI with gadolinium

Question 12

What is your management for a patient with MS?

Answer 12

-Avoid surgery during periods of relapse
-Risk of aspiration
-Avoid succinylcholine
-Pre-op CBC

Question 13

What is a seizure?

Answer 13

-Sudden onset of abnormal, highly synchronous discharges of neurons
-May include involuntary movements, sensations and impaired consciousness

Question 14

What is epilepsy?

Answer 14

-A chronic disorder of recurrent seizures. Two separate unprovoked seizures
-Can be from congenital or acquired factors in the cerebral cortex

Question 15

Describe the different classifications/types of seizures.

Answer 15

-Partial/generalized (one vs multiple foci)
-Simple/complex (LOC)

-Simple partial
-Secondary generalized tonic/clonic
-Abscence
-Myoclonic
-Primary generalized tonic/clonic

Question 16

What is status epilepticus?

Answer 16

-A medical emergency of continuous episode of prolonged seizure activity or multiple seizures without recovery

Question 17

How is status epilepticus treated?

Answer 17

-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

Question 18

What is your management for a patient with seizures/epilepsy?

Answer 18

-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

Question 19

What is a CVA?

Answer 19

-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

Question 20

How is an ischemic and hemorrhagic stroke treated?

Answer 20

-Ischemic: Possible thrombolytics within 3-4.5 hr

-Hemorrhagic: Reverse anticoagulants if possible
-Consider FFP or PCC

Question 21

What is the management of a patient with CVA/TIA?

Answer 21

-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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