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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
Infections s/a meningitis or encephalitis can lead to?
edema or obstruction of CSF reabsorption
26
how does elevating the head decrease ICP?
helps w/ juglar venous outflow
27
how does hyperventilation (increase RR) decrease ICP?
lowers PaC02 (b/c CO2 vasodilate blood vessels)
28
how does CSF drainage decrease ICP?
external ventricular drain (EVD)
29
how does Hyperosmotic drugs decrease ICP?
increase osmolarity, drawing fluid across BBB
30
how do Diuretics decrease ICP?
induce systemic hypovolemia
31
how do corticosteroids decrease ICP?
decrease swelling and enhance the integrity of the BBB
32
how does does cerebral vasoconstricting anesthetics like propofol decrease ICP?
decrease CMRO2 and CBF
33
how does surgical decompression decrease ICP?
like tumor removal to restore normal blood flow
34
what do you do for neurological assessment?
- 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
this is a progressive, autoimmune demyelination of central nerve fibers?
multiple sclerosis (MS) - onset is 20-40 - characterized by periods of exacerbations and remissions
36
Risk factors for MS
Rx factors: Female, 1st deg relative w/ MS, EBV, other AI disorders, smoking
37
what triggers MS?
Triggers: stress, elevated temps, postpartum period
38
S&S of MS
progressive motor weakness sensory disorders visual impairment autonomic instability. Sx vary b/o site of demyelination
39
is there a cure for MS?
No, managed with corticosteroids, immune modulators and targeted antibodies
40
For MS if respiratory compromise, consider?
Pulmonary function test
41
LFT's are drawn on MS only if? what are some considerations with steroid use?
LFT if on Dantrolene & Azathioprine (bone marrow suppression, liver function impairment) Close attn to glucose and electrolytes as steroids may impact levels
42
Considerations for patients with MS on long term steroids are?
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
what are some anesthetic considerations for patients with MS?
temp management GA, RA & PNB’s are acceptable options Avoid Succinylcholine as it may induce hyperkalemia (Upregulated N-ach receptors)
44
Autoimmune; Antibodies generated against N-Ach-R’s at skeletal motor endplate
myasthenia Gravis (MG)
45
MG effects what kind of muslce?
Effects skeletal muscle, not smooth or cardiac muscle
46
Muscle weakness is worsened by what in MG? S&S are exacerbated by what?
Muscle weakness, exacerbated w/exercise Sx exacerbated by: pain, insomnia, infection, surgery
47
Cranial symptoms associated with MG
Ocular sx common-diplopia, ptosis Bulbar involvement → laryngeal/pharyngeal weakness→ respiratory insufficiency, aspiration rx
48
This is common in 10% of MG cases
Thymic hyperplasia (90% pts improve after thymectomy)
49
what is the treatment for MG?
Tx: Ach-E inhibitors (Pyridostigmine), immunosuppressive agents, steroids, plasmapheresis, IVIG
50
Preanesthetic Considerations with MG are?
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
what medication should be reduced in MG?
reduce paralytic dosage (avoid prolonged muscle weakness)
52
Why are opioids used with caution in MG?
avoid resp compromise
53
In MG, Ach -E inhibitors may prolong what?
Succ's and Ester LA's
54
Labs for MG include?
Labs: CBC, BMP, +/-LFT (LFT if on Azathioprine) Close attn to glucose and electrolytes as steroids may impact levels
55
Disorder causing the development of autoantibodies against VG Calcium Channels
Eaton Lambert Syndrome
56
what is the specific MOA of the Eaton Lambert Syndrome?
Reduce Ca++ influx into the presynaptic Ca++ channels→↓Ach release @ the NMJ
57
S&S of Eaton Lambert Syndrome
Sx similar to MG Sx: progressive limb-girdle weakness, dysautonomia, oculobulbar palsy >60% cases assoc w/ small cell lung carcinoma
58
Treatment for Eaton Lambert syndrome invovles what?
Selective K+ chnl blocker “3-4 diaminopyridine” Ach-E inhibitors immunologics (Azathioprine) steroids plasmapheresis IVIG
59
This represents what?
Lambert-Eaton syndrome
60
Pre-anesthetic Considerations for Eaton Lambert Syndrome
Assess existing deficits If respiratory compromise, consider pulmonary function tests
61
Eaton Lambert Syndrome is very sensative to what?
**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
Describe Muscular Dystrophy (MD)
Hereditary disorder of muscle fiber degeneration c/b breakdown of the **dystrophin-glycoprotein complex** leads to myonecrosis, fibrosis, and skeletal muscle mbrn permeability.
63
how many types of
6
64
Most common and severe form of MD
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
S&S of MD
progressive muscle wasting without motor/sensory abnormalities kyphoscoliosis long bone fragility respiratory weakness frequent pneumonia EKG changes
66
what labs specifically are elevated in MD?
Elevated serum creatine kinase c/b muscle wasting
67
Preanesthetic considerations for MD
CBC, BMP, PFTs, consider CK Pre-op EKG, echocardiogram. Evaluate for cardiomyopathy Caution with ND-NMB’s, careful monitoring throughout
68
Can happen when succs and volatiles are given with MD?
Hypermetabolic Syndrome Avoid Succs & VA as they exacerbate instability of muscle membrane Can lead to: rhabdomyolysis, hyperkalemia, Vfib, cardiac arrest
69
Alternative anesthetic for MD
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
what are the myotonic dystrophies mentioned in class?
myotonia myotonic dystrophy myotonia congenita central core disease
71
prolonged contraction after muscle stimulation seen in several muscle disorders
myotonia
72

TX WES class of 2026 (18 decks)

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