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Neuro Flashcards

1
Q

What supplies the majority of blood to the brain

A

80% - Internal carotid arteries- the majority
—20% - Vertebral arteries

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2
Q

What affect CBF

A

Cerebral metabolic rate- how much does the brain need coming into it
Cerebral perfusion pressure
Intracranial pressure
Arterial PaCO2
Arterial PaO2

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3
Q

Cerebral metabolic rate / CMRO2 normal

A

Average – 50ml/min (3-3.8 ml/100g/min)
Measured as O2 consumption- how much oxygen does the brain need

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4
Q

things that Decrease CMR

A

-Hypothermia-7% decrease for every 1 Degree C in temp, achieve EEG suppression at 18-20 degrees C
-Anesthetic agents-VAA’s, propofol, etomidate and barbiturates. – put them into a sedation induced coma to decrease cmr.

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5
Q

Things that increase cmr

A

-Hyperthermia, seizures (give prophylaxis), ketamine (causes systemic surge), nitrous oxide (increase ICP w/ vasodilation), pneumocephalis
Causes; Shivering = increase cmr (keep sedated and paralyzed), warming blanket, hot IV fluid, infections process, head trauma.

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6
Q

Hyperthermia >42 causes what

A

denatures proteins and destroys neurons, CBF decreases

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7
Q

2 things that kill neuro patients

A

hypoxia
hypotension

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8
Q

Bad temperatures

A

low; 36
high; 42

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9
Q

Cerebral perfusion pressure equation

A

CPP=MAP-ICP

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10
Q

MAP equation

A

(2DBP + SBP)/ 3

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11
Q

normal CPP and map

A

CPP 80-100 mmHg or MAP of 60-160

not in range; Otherwise, pressure-dependent

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12
Q

Cerebral Autoregulation

A

↑ MAP Cerebral vasoconstriction
↓ MAP Cerebral vasodilatation
Constant CBF is maintained

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13
Q

CPP above 150mmHg causes….

A

Disruption BBB
Cerebral edema
Hemorrhage

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14
Q

medication that can creat shift the L

A

Volatile anesthetic agents
Ketamine

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15
Q

MONRO-KELLIE DOCTRINE

A

The cranial vault is a rigid structure with fixed volume
Brain 80%; diuresis
Blood 12%; crani
CSF 8%; vp shunt

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16
Q

things that cause increases in Intracranial Pressure

A

Tumor
Hematoma
Blood in CSF- LP, SAH
Infection- meningitis,
Aquaductal stenosis-

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17
Q

ICP > 30mmHg causes

A

compromise CPP
More dependent on MAP

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18
Q

CPP autoregulation range

A

50-150 mmhg
or MAP of 60-160mmhg

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19
Q

most common type of hydrocephalus

A

obstructive hydrocephalus

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20
Q

decrease PaO2 causes

A

immediate vasodilation (to encourage bf)
Pao2 <50-60 causes vasodilation and increases CBF- to encourage blood flow

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21
Q

Arterial PaCO2

A

Excess CO2 combines with water…carbonic acid… H- ion
Vasodilation of cerebral vessels
CBF constant PaCO2 between 20 – 80 mmHg

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22
Q

Vasodilation and vasoconstriction for Paco2

A

Max vasodilation occurs at PACO2 80-100
Max constriction occurs at PACO2 ~25

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23
Q

Intracranial pressure normal

A

Normal 5-15 mmHg

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24
Q

tearing back pain

A

AAA

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25
Q

worst ha of my life

A

SAH

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26
Q

cushings triad

A

Hypertension
Bradycardia
Respiratory Abnormalities- Cheyne stokes. Apnea, hyperventilation.

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27
Q

Most common site of transtentorial herniation

A

temporal uncus (Uncal herniation)

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28
Q

How to Decrease ICP

A

hob > 30
hyperventilation
csf drainage
hyperosmotic drugs (mannitol)
diuretics
corticosteroids
surgical decompression

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29
Q

mannitol dose

A

1gm/kg…0.5gm/kg (give quickly)

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30
Q

decrease in hct lead to______

A

-decrease viscosity and increased CBF
-Decreased O2 carrying capacity

Increased hematocrit leads to increased viscosity and decreased CBF
Optimal hematocrit – 30% to 34%

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31
Q

Luxury Perfusion

A

The combination of a decrease in CMRO2 and increase in CBF has been termed luxury perfusion.

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32
Q

Intracerebral Steal

A

vasodilatation in a normal area would shunt blood away from the diseased area.

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33
Q

Reverse steal/ robin hood phenomenon

A

Using hyperventilation to constrict cerebral vessels that supply healthy brain tissue. Flow is then redistributed to ischemia regions.

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34
Q

CN 1

A

olfactory
ID of odors

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35
Q

CN 2

A

optic nerve

snellen chart

36
Q

CN3

A

oculomotor
Accommodation-convergence; reaction to light

37
Q

CN 4

A

trochlear

Accommodation-convergence; reaction to light

38
Q

CN 5

A

Trigeminal

Facial sensation; palpation of masseter/temporalis muscles

39
Q

CN 6

A

Abducens

Accommodation-convergence; reaction to light

40
Q

CN 7

A

Facial

Facial symmetry; smile; tastes anterior 2/3

41
Q

Cn 8

A

Acoustic

Normal conversation; tuning fork

42
Q

CN 9

A

Glossopharyngeal

Gag reflex; taste posterior 1/3

43
Q

CN 10

A

Vagus

Swallowing; “ah”

44
Q

CN 11

A

spinal accessory

Shrugging shoulders; chin flexion against resistance

45
Q

CN 12

A

Hypoglossal

Tongue protrusion

46
Q

Eye movement controlled by CN

47
Q

Bell’s Palsy result from injury to

48
Q

GCS eye

A

1; does not open
2; open to painful stimuli
3; open in response to eyes
4; spontaneously opens

49
Q

GCS verbal

A

5; oriented
4; confused
3; utters incoherent words
2; incomprehensible sounds
1; makes no sounds

50
Q

GCS motor

A

1; no movement
2; extension to painful stimuli ( decerebrate)
3; flexion to painful stimuli (decorticate)
4; flexion / w/d to painful stimuli
5; localized painful stimuli
6; obeys commands

51
Q

paraplegia associated injury

52
Q

quadriplegia associated injury

53
Q

diaphragmatic paralysis associated injury

54
Q

lesion T1-T4 may result in….

A

bradycardia

55
Q

how early do we avoid succ

A

Avoid succinylcholine after 48 hours if not sooner- risk of hyperkalemia.

56
Q

Lesion T7 or higher may lose ability to …..

A

sweat and develop hyperthermia- may need to be cooled

57
Q

Anterior Cord Syndrome

A

Anterior Spinal Artery Syndrome
Ischemic insult

Loss of pain and temperature sensation
Maintain vibration and proprioception

58
Q

Central Cord Syndrome

A

Most common incomplete SCI
Motor deficit more pronounced in upper extremities
Pain and Temperature sensation decreased in lower extremities

59
Q

Brown-Sequard Syndrome

A

Usually occurs due to lateral SCI in the cervical or thoracic region

Present with lateral hemiplegia

Loss of proprioception and vibration on the side of the injury

Loss of pain and temperature sensation on the contralateral side

60
Q

C8 dermatomes

A

little finger

61
Q

T4 dermatomes

62
Q

T6 dermatome

A

Xyphoid process

63
Q

T10 dermatome

64
Q

Stroke pneumonic

A

face
arm
speech
time

65
Q

5th leading cause of death

A

stroke

primary ischemic- 80%

hemorrhage - 20%

66
Q

Large Vessel Occlusions (LVO)

A

Large vessel occlusions(LVOs) are ischemic strokes that result from a blockage in one of the major arteries of the brain.
Occurrence 17-20%

67
Q

Risk factors in acute ischemic stroke

A

Systemic hypertension
Cigarette smoking
Hyperlipidemia
Diabetes
Excessive alcohol consumption

68
Q

Management: ischemic stroke

A

ASA
Thrombolytic therapy
Management of airway/oxygenation/ventilation
Control of blood pressure

69
Q

Acute Hemorrhagic Stroke deterioration

A

May deteriorate for 1st 24-48 hours
Cerebral edema

70
Q

Acute Hemorrhagic Stroke Risk factors

A

Hypertension
Cigarette smoking
Cocaine abuse
Female

71
Q

Management: hemorrhagic stroke

A

PCC
FFP
Plat
Ventricular drainage of blood
Blood pressure control; Maintenance of CPP
Aneurysm control
nimodipine

72
Q

Lucid interval present in….

A

epidural hematoma

73
Q

Alzheimer’s Disease findings

A

Diffuse amyloid-rich plaques
Changes in synapses
Decreased neurotransmitters (Ach most common)
Progressive cognitive changes
Anesthesia is transiently blamed for increasing the rate of Alzheimer’s disease

74
Q

Treatment for alzheimers

A

Cholinesterase inhibitors
Aricept, Razadyne, Cognex

palliative

75
Q

Parkinson’s Disease

A

Neurodegenerative, unknown cause
Risk increases with age and environmental exposure (welding, herbicides, pesticides and possible genetics

Loss of dopaminergic fibers in basal ganglia
Unopposed stimulation of extrapyramidal motor neurons

76
Q

Parkinson’s Disease Primary Symptoms

A

Skeletal muscle rigidity
Resting Tremor (Pill Rolling)
Bradykinesia (slow movement and reflexes)
Postural Instability

77
Q

Parkinson’s Disease tx

A

Dopamine precursor
Levodopa

Decarboxylase inhibitor
Peripheral conversion
Side effects

Deep brain stimulator

78
Q

For DBS Preoperative

A

IV challenges
Minimal sedation
GABA drugs vs opioids and dex
Hold levodopa so they can locate problem areas

79
Q

What can exacerbate symptoms in MS patients?

A

1 degree Celsius can exacerbate symptoms; maintain warmth!

80
Q

Classification of sz

A

LOC: simple/complex
Focus: Partial/generalized

81
Q

2 or more sz for a certain amount of time

A

Status Epilepticus

82
Q

Goal of status epilepticus

A

Airway, ventilation
IV access
r/o hypoglycemia
ABG monitoring…acidosis

83
Q

AION-

A

Anterior Ischemic Optic Neuropathy

Sudden, painless
Asymmetric optic disk swelling

84
Q

PION

A

Posterior Ischemic Optic Neuropathy

More common postop
No initial ophthalmoscopic findings

85
Q

Ischemic Optic Neuropathy

A

Visual loss during 1st week after surgery

Central &/or peripheral vision….slight decrease to blindness

Minimal recovery

86
Q

ION risk factors

A

Positioning-
anemia
hypotension
Excessive fluid administration- papillary edema
Excessive vasopressor use

HA (15 decks)

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