Neuro Flashcards
Cerebral Perfusion Pressure Formula
MAP-ICP
MAP Formula
((2 x DBP)+SBP)/3
Normal MAP range
80-100
Normal cerebral perfusion pressure
70-90
Normal ICP
0-10
What is Brudzinski’s Sign
Severe Neck stiffness causing the patinet’s hips and knees to flex when neck is flexed
Positive in meningitis and subarrachnoid bleed
What is “battle signs”
Bruising over the mastoid process as a result of extravation of blood along the path of the posterior auricular artery and indicates basilear skull fracture
Dolls Eye Relfex is
Also known as the oculocephalic reflex
reflex movement during the head movement by producing and eye movement in the direction opposite to the head movement
Absence of dolls eyes reflex (eyes remain in midposition when head is moved from side to side) can indicate injury to the midbrain or pons, cranial nerve III and VI.
What pupilary reaction occurs in Brain Herniation
Ipsilateral
What occurs in neurogenic shock (ie, CI, SVR, HR)
Low values in all due to a lack of sympathetic tone.
Pupillary dilation in response to the oculomotor nerve insult occurring in herniation is a result of
Loss of parasympathetic stimulation,
the uncus can compress the III crainal nerve, which afects the parasympathathetic input to the eye on the side of the affect nerve causing the pupil to dilate and fail to constrict
What vessel is usually responsible for Epidural bleeds
Middle meningeal artery
What is a skull fracture that appears to have a central focal point with multiple outward fractures on xray
Linear stellate
Skull fracture usual seen in infants and children, fracture line transverses one or more sutures of the skull causing a widening of the suture
Distatic
what kind of skull fracture usually occurs from blunt force trauma
compressed/depressed fracture
Fracture to the base of the skull, and presents with blood in the sinuses, CSF leading from nose or ears, racoons eyes, battles signs
Basilar
List cushings triad
Widening pulse pressures, bradycardia and irregular respirations
Classic Neurogenic Shock symptoms
Loss of sympathetic tone below the level of the injury results in loss of autoregulation, a decrease of vascular tone, and an inablility of the heart to increase its intrinisic rate
Hypertension, headaches, profuse sweating, facial erythema, flushing of the skin above the level of the injury, goosebumps, nasal stuffiness, bradycardia, anxiety and a feeling of doom are all signs of what and how is it treated
Autonomic Dysreflexia
Catherterization of the bladder or relief of a blocked urinary catheter tube may resolve the problem.
Which type of cord syndrome is characterizied by complete motor paralysis below the level of the lesion, loss of pain and temp sensation at and below the the level, and most offten occurs in hyperflexion injury
Anterior cord
Which type of cord syndrome is characterized by motor loss and numbness to touch and vibration on the same side of the spinal injury and loss of pain and temp on the opposite side. Most often occurs from penatrating injury that damaged one side of the cord
Brown-Sequard
Which type of cord syndrome is characterized by disproportionately greater motor impairment in the upper compared to the lower extremities and variable degree of sensory loss below the injury and most often occurs after hyperextension injury
Central Cord
Which electrolytes must be maintained which in normal limits when managing a head injured patient
Glucose and Sodium
Hyponatremia can lead to extracellular volume depletion and cerebral edema.
Sodium levels should be maintained at 145-155 and a serum os of 320.
What condition is characterized by excessive thirst and excretion of large amounts of diluted urine, with reduced fluid intake.
Deficiency of ADH.
Diabetes Insipidus
A positive Babinski’s Sign in an adult presents by
Plantar flexor reflex and indicates an upper motor neuron lesion
What is the first line drug for seizures in the neuocritical patient
Dilantin
What cranial nerve is associated with Bells palsy
The Facial Nerve VII
A patient diagnosed with Guillen Barre would most likely present with
Ascending paralysis, dysphagia,dysesthesia
Guillain-ABarre is an acute inflammatory demyelinating polyneurophathy. Noted by paralysis that begins in the lower extremities and progresses upward, complete loss of deep tendon reflexes
Motor function and sensory function loss below the nipple line is assossiated with which dermatome
T4
What is the oculocephalic relfex also known as and what is it
Dolls eye
The presence of dolls eyes reflex is normal and the absence indicates injury to the midbrain, pons including cranial nerve III, and VI. caused by lesions to the cerebellum and brain stem
What is the oculovestibular reflex is used to assess the
brainstem function
used to assess brain death can be preformed with the application of th eoculovestibular reflex, the cold-caloric exam.
With head on a bed at 30 degrees, instill 50 ml of iced water in to the ear canal. A normal response, the presence of the oculovestibular reflex, is tonic deviation of the eyes toward the irrigated ear.
Define mydriasis
excess dilation of the pupils due to disease, trauma, or use of drugs.
Battle’s Sign and racoons sign indicates
basilar skull fracture
Define miosis
Pinpoint pupils
Define Macewens Sign
Tapping the skull near the junction of the frontal temporal and parietal bones will priduce a stronger resonant sounds when hydrocephalus or brain abscess is present
Define Brocas Aphasia
Expressive aphasia, loss of ability to produce language
How is dysarhteria different from expressive aphasia
Inablity to move the muscles of the tongue to produce speech where as expressive asphasia is the inability to produce language written or spoken
Wernicke Aphasia is defined as
a patient is able to speak long sentances but the words have no meaning, add unnecessary words and creat new words.
They also have difficulty in understanding speech or themselves and others.
What presents with AMS, Fever, petechiae and/or brudzinski/kernig sign
Meningitis
brudzinski sign, reflexive flexion of the knees and hips following passive neck flexion
Kernig sign, flexing the thighs at the hip, and the knees, at 90 degree angles, and assessing whether subsequent extension of the knee is painful (leading to resistance), in which case it is deemed positive.
Spinal cord injury dermatome C3-C5
phrenic nerve
Spinal cord injury dermatome C6
Elbow flexion
Spin cord injury dermatome C7
elbow extension
Spinal cord injury dermatome associated T4
nipple line
Spinal cord injury dermatome T10
umbilicus
What cranial nerve is associated with visual acuity
II Optic nerve
What cranial nerve is associated with pupillary dilation and eye movement
III oculomotor
What cranial nerve is associated with mastication, face sensation and can cause trismus
V Trigeminal
What cranial nerve is associated with cardiac inhibition, swallowing and sensation oropharynx
X Vagus
What is fractured in the LeFort I
Maxilla
What is fractured in the LeFort II
Fractured below the zygomatic arch
What is fractured in the LeFort III
Fracutred above the zygomatic arch
Mass transfusion protocol
1-1-1 ratio or FFP, Platelets and PRBC’s
Blood products administration cause what shift on the oxy hemoglobin curve
Leftward
What does persistant bubbling in the atrium chamber indicate in the chest tubed patient
air leak or tracheobronchial tear/injury
