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TX WES class of 2026 > Mordi's Assessment Neurological Diseases in Anesthesia > Flashcards

Mordi's Assessment Neurological Diseases in Anesthesia Flashcards

1
Q

Cerebral Blood flow is modulated by?

A

Cerebral metabolic rate
CPP (MAP-ICP)
Aterial blood CO2
Aterial blood O2
Various drugs and intracranial pathologies

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2
Q

With autoregulation CBF is approx (blank) brain tissue per minute.

Which is _____ ml/min

this is how much of COP?

A

50 mL/ 100g
750 mls/ min
15%

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3
Q

What contains the neural tissue (brain + spinal cord), blood and CSF?

A

intracranial and spinal vault

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4
Q

The vault is enclosed by the?

A

dura mater and bone

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5
Q

Brain tissue, intracranial CSF and Intracranial blood have a combined volume of?
what is the normal ICP at this volume?

A

1200 - 1500 mls
5-15 mmHg

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6
Q

Monro-Kellie hypothesis: an ______ in one component of intracranial volume must offset by a ____ in another component to prevent an _______

A

increase
decrease
elevated ICP

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7
Q

This is one of the determinants of CPP

A

ICP

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8
Q

______ mechanisms can _____ MAP to support CPP despite increases in ______

A

homeostatic
increase
increase
(eventually these mechanisms can fail –> cerebral ischemia)

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9
Q

This diagram describes what?

A

monroe-kellie hypothesis

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10
Q

the incracranial vault is considered what?

A

compartmentalized

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11
Q

this is reflection of the dura that seperatews the 2 cerebral hemispheres?

A

falx cerebri

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12
Q

a reflection of dura that lies rostral to the cerebellum and marks the border btw the supratentorial and infratentorial spaces

A

tentorium cerebelli

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13
Q

Herniation syndromes categorized based on?

A

regions of the brain affected
Increases in the contents of one region may cause regional increases in ICP, and in extreme instances, the contents can herniate into a different compartment

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14
Q

______ Herniation of hemispheric contents under _____ ; typically, compressing branches of the anterior cerebral artery , creating a _____

A

Subflacine Herniation
falx cerebri
midline shift

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15
Q

Transtentorial Herniation is herniation of the supratentorial contents past what?

A

tentorium cerebelli

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16
Q

This causes brainstem compression in the rostral to caudal direction?

A

transtentorial herniation
This leads to
- AMS
- defects in gaze and ocular reflexes
- hemodynamic
- respiratory compromise
- death

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17
Q

Uncas is located where?

A

medial portion of temporal lobe

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18
Q

this is a subtype of transtentorial herniation where the uncas herniates over the tentorium cerebelli

A

uncal herniation
Results in Ipsilateral oculomotor nerve dysfunction

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19
Q

what are the S&S of uncal herniation

A

pupillary dilatation
ptosis
lateral deviation of the affected eye
brainstem compression
death

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20
Q

can occur due to elevated infratentorial pressure, causing the cerebellar structures to herniate through the foramen magnum

A

herniation of the cerebellar tonsils

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21
Q

S&S of cerebellar tonsils herniation

A

medullary dysfunction, cardiorespiratory instability and subsequently death

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22
Q

label the numbers

A
  1. Subfalcine → midline shift
  2. Transtentorial -> pushing down caudally
  3. Cerebellar contents through foramen magnum -> towards the medulla
  4. Traumatic event → cause herniation out of cranial cavity
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23
Q

Tumors can increase ICP in 3 ways

A

1) directly d/t size
2) indirectly by causing edema in surrounding brain tissue
3) by obstructing CSF flow (like with tumors involving the 3rd ventricle)

Intracranial hematomas cause increased ICP similar to mass lesions

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24
Q

Blood in the CSF, as is seen in subarachnoid hemorrhage, may lead to?

A

obstruction of CSF reabsorption, and granulations can further exacerbate increased ICP

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25
Q

Infections s/a meningitis or encephalitis can lead to?

A

edema or obstruction of CSF reabsorption

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26
Q

how does elevating the head decrease ICP?

A

helps w/ juglar venous outflow

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27
Q

how does hyperventilation (increase RR) decrease ICP?

A

lowers PaC02 (b/c CO2 vasodilate blood vessels)

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28
Q

how does CSF drainage decrease ICP?

A

external ventricular drain (EVD)

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29
Q

how does Hyperosmotic drugs decrease ICP?

A

increase osmolarity, drawing fluid across BBB

30
Q

how do Diuretics decrease ICP?

A

induce systemic hypovolemia

31
Q

how do corticosteroids decrease ICP?

A

decrease swelling and enhance the integrity of the BBB

32
Q

how does does cerebral vasoconstricting anesthetics like propofol decrease ICP?

A

decrease CMRO2 and CBF

33
Q

how does surgical decompression decrease ICP?

A

like tumor removal to restore normal blood flow

34
Q

what do you do for neurological assessment?

A
  • Know basic pathophysiology
  • Look at patients’ history, sx, and baseline neuro-deficits
  • Review imaging and test results
  • Review pts current drugs and tx’s
  • Evaluate potential risks/benefits of various anesthetic options to determine the most appropriate plan of care
  • Implement pre-op measures to optimize the patients’
    condition prior to anesthesia
  • Provide clear pre-op documentation of the factors above, and have a rationale for chosen anesthetic plan
35
Q

this is a progressive, autoimmune demyelination of central nerve fibers?

A

multiple sclerosis (MS)
- onset is 20-40
- characterized by periods of exacerbations and remissions

36
Q

Risk factors for MS

A

Rx factors: Female, 1st deg relative w/ MS, EBV, other AI disorders, smoking

37
Q

what triggers MS?

A

Triggers: stress, elevated temps, postpartum period

38
Q

S&S of MS

A

progressive motor weakness
sensory disorders
visual impairment
autonomic instability.
Sx vary b/o site of demyelination

39
Q

is there a cure for MS?

A

No, managed with corticosteroids, immune modulators and targeted antibodies

40
Q

For MS if respiratory compromise, consider?

A

Pulmonary function test

41
Q

LFT’s are drawn on MS only if?
what are some considerations with steroid use?

A

LFT if on Dantrolene & Azathioprine (bone marrow suppression, liver function impairment)

Close attn to glucose and electrolytes as steroids may impact levels

42
Q

Considerations for patients with MS on long term steroids are?

A

Consider giving pre-op steroids in anyone with long-term steroid use

LT steroids cause adrenal suppression, so a stress-dose of steroids may be necessary for surgery

43
Q

what are some anesthetic considerations for patients with MS?

A

temp management
GA, RA & PNB’s are acceptable options
Avoid Succinylcholine as it may induce hyperkalemia
(Upregulated N-ach receptors)

44
Q

Autoimmune; Antibodies generated against N-Ach-R’s at skeletal motor endplate

A

myasthenia Gravis (MG)

45
Q

MG effects what kind of muslce?

A

Effects skeletal muscle, not smooth or cardiac muscle

46
Q

Muscle weakness is worsened by what in MG?
S&S are exacerbated by what?

A

Muscle weakness, exacerbated w/exercise

Sx exacerbated by: pain, insomnia, infection, surgery

47
Q

Cranial symptoms associated with MG

A

Ocular sx common-diplopia, ptosis
Bulbar involvement → laryngeal/pharyngeal weakness→ respiratory insufficiency, aspiration rx

48
Q

This is common in 10% of MG cases

A

Thymic hyperplasia
(90% pts improve after thymectomy)

49
Q

what is the treatment for MG?

A

Tx: Ach-E inhibitors (Pyridostigmine), immunosuppressive agents, steroids, plasmapheresis, IVIG

50
Q

Preanesthetic Considerations with MG are?

A

Assess deficits

If respiratory compromise -> do pulmonary function tests

Optimize respiratory function

Consider pre-op steroids in anyone with long-term steroid use

Counsel patients on the increased risk of needing post-op resp support/ventilation until fully recovered from anesthesia

51
Q

what medication should be reduced in MG?

A

reduce paralytic dosage (avoid prolonged muscle weakness)

52
Q

Why are opioids used with caution in MG?

A

avoid resp compromise

53
Q

In MG, Ach -E inhibitors may prolong what?

A

Succ’s and Ester LA’s

54
Q

Labs for MG include?

A

Labs: CBC, BMP, +/-LFT (LFT if on Azathioprine)
Close attn to glucose and electrolytes as steroids may impact levels

55
Q

Disorder causing the development of autoantibodies against VG Calcium Channels

A

Eaton Lambert Syndrome

56
Q

what is the specific MOA of the Eaton Lambert Syndrome?

A

Reduce Ca++ influx into the presynaptic Ca++ channels→↓Ach release @ the NMJ

57
Q

S&S of Eaton Lambert Syndrome

A

Sx similar to MG
Sx: progressive limb-girdle weakness, dysautonomia, oculobulbar palsy
>60% cases assoc w/ small cell lung carcinoma

58
Q

Treatment for Eaton Lambert syndrome invovles what?

A

Selective K+ chnl blocker “3-4 diaminopyridine”
Ach-E inhibitors
immunologics (Azathioprine)
steroids
plasmapheresis
IVIG

59
Q

This represents what?

A

Lambert-Eaton syndrome

60
Q

Pre-anesthetic Considerations for Eaton Lambert Syndrome

A

Assess existing deficits
If respiratory compromise, consider pulmonary function tests

61
Q

Eaton Lambert Syndrome is very sensative to what?

A

VERY sensitive to ND-NMB & D-NMB
more sensitive to ND-NMB than MG patients

Extreme caution with paralytic and opioid dosing

Counsel on risks for needing post-op resp support until fully recovered from anesthesia

62
Q

Describe Muscular Dystrophy (MD)

A

Hereditary disorder of muscle fiber degeneration c/b breakdown of the dystrophin-glycoprotein complex
leads to myonecrosis, fibrosis, and skeletal muscle mbrn permeability.

63
Q

how many types of

A

6

64
Q

Most common and severe form of MD

A

Duchenne MD
occurs only in boys
onset is 2-5 yrs
wheel chair bound by 8-10 years
avg lifespan is 20-25 years d/t cardiopulmonary complications

65
Q

S&S of MD

A

progressive muscle wasting without motor/sensory abnormalities
kyphoscoliosis
long bone fragility
respiratory weakness
frequent pneumonia
EKG changes

66
Q

what labs specifically are elevated in MD?

A

Elevated serum creatine kinase c/b muscle wasting

67
Q

Preanesthetic considerations for MD

A

CBC, BMP, PFTs, consider CK

Pre-op EKG, echocardiogram. Evaluate for cardiomyopathy

Caution with ND-NMB’s, careful monitoring throughout

68
Q

Can happen when succs and volatiles are given with MD?

A

Hypermetabolic Syndrome

Avoid Succs & VA as they exacerbate instability of muscle membrane

Can lead to: rhabdomyolysis, hyperkalemia, Vfib, cardiac arrest

69
Q

Alternative anesthetic for MD

A

Consider low dose rocuronium and TIVA for GA

Have MH cart with Dantrolene available

RA preferred over GA to avoid triggers and cardiopulmonary complications

70
Q

what are the myotonic dystrophies mentioned in class?

A

myotonia
myotonic dystrophy
myotonia congenita
central core disease

71
Q

prolonged contraction after muscle stimulation
seen in several muscle disorders

A

myotonia

72
Q
A

TX WES class of 2026 (18 decks)

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