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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
worst ha of my life
SAH
26
cushings triad
Hypertension Bradycardia Respiratory Abnormalities- Cheyne stokes. Apnea, hyperventilation.
27
Most common site of transtentorial herniation
temporal uncus (Uncal herniation)
28
How to Decrease ICP
hob > 30 hyperventilation csf drainage hyperosmotic drugs (mannitol) diuretics corticosteroids surgical decompression
29
mannitol dose
1gm/kg…0.5gm/kg (give quickly)
30
decrease in hct lead to______
-decrease viscosity and increased CBF -Decreased O2 carrying capacity Increased hematocrit leads to increased viscosity and decreased CBF Optimal hematocrit – 30% to 34%
31
Luxury Perfusion
The combination of a decrease in CMRO2 and increase in CBF has been termed luxury perfusion.
32
Intracerebral Steal
vasodilatation in a normal area would shunt blood away from the diseased area.
33
Reverse steal/ robin hood phenomenon
Using hyperventilation to constrict cerebral vessels that supply healthy brain tissue. Flow is then redistributed to ischemia regions.
34
CN 1
olfactory ID of odors
35
CN 2
optic nerve snellen chart
36
CN3
oculomotor Accommodation-convergence; reaction to light
37
CN 4
trochlear Accommodation-convergence; reaction to light
38
CN 5
Trigeminal Facial sensation; palpation of masseter/temporalis muscles
39
CN 6
Abducens Accommodation-convergence; reaction to light
40
CN 7
Facial Facial symmetry; smile; tastes anterior 2/3
41
Cn 8
Acoustic Normal conversation; tuning fork
42
CN 9
Glossopharyngeal Gag reflex; taste posterior 1/3
43
CN 10
Vagus Swallowing; “ah”
44
CN 11
spinal accessory Shrugging shoulders; chin flexion against resistance
45
CN 12
Hypoglossal Tongue protrusion
46
Eye movement controlled by CN
CN 3,4 &6
47
Bell’s Palsy result from injury to
CN 7.
48
GCS eye
1; does not open 2; open to painful stimuli 3; open in response to eyes 4; spontaneously opens
49
GCS verbal
5; oriented 4; confused 3; utters incoherent words 2; incomprehensible sounds 1; makes no sounds
50
GCS motor
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
paraplegia associated injury
T2-T12
52
quadriplegia associated injury
C5-T1
53
diaphragmatic paralysis associated injury
>C5
54
lesion T1-T4 may result in....
bradycardia
55
how early do we avoid succ
Avoid succinylcholine after 48 hours if not sooner- risk of hyperkalemia.
56
Lesion T7 or higher may lose ability to .....
sweat and develop hyperthermia- may need to be cooled
57
Anterior Cord Syndrome
Anterior Spinal Artery Syndrome Ischemic insult Loss of pain and temperature sensation Maintain vibration and proprioception
58
Central Cord Syndrome
Most common incomplete SCI Motor deficit more pronounced in upper extremities Pain and Temperature sensation decreased in lower extremities
59
Brown-Sequard Syndrome
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
C8 dermatomes
little finger
61
T4 dermatomes
nipple
62
T6 dermatome
Xyphoid process
63
T10 dermatome
Umbilicus
64
Stroke pneumonic
face arm speech time
65
5th leading cause of death
stroke primary ischemic- 80% hemorrhage - 20%
66
Large Vessel Occlusions (LVO)
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
Risk factors in acute ischemic stroke
Systemic hypertension Cigarette smoking Hyperlipidemia Diabetes Excessive alcohol consumption
68
Management: ischemic stroke
ASA Thrombolytic therapy Management of airway/oxygenation/ventilation Control of blood pressure
69
Acute Hemorrhagic Stroke deterioration
May deteriorate for 1st 24-48 hours Cerebral edema
70
Acute Hemorrhagic Stroke Risk factors
Hypertension Cigarette smoking Cocaine abuse Female
71
Management: hemorrhagic stroke
PCC FFP Plat Ventricular drainage of blood Blood pressure control; Maintenance of CPP Aneurysm control nimodipine
72
Lucid interval present in....
epidural hematoma
73
Alzheimer’s Disease findings
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
Treatment for alzheimers
Cholinesterase inhibitors Aricept, Razadyne, Cognex palliative
75
Parkinson’s Disease
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
Parkinson’s Disease Primary Symptoms
Skeletal muscle rigidity Resting Tremor (Pill Rolling) Bradykinesia (slow movement and reflexes) Postural Instability
77
Parkinson’s Disease tx
Dopamine precursor Levodopa Decarboxylase inhibitor Peripheral conversion Side effects Deep brain stimulator
78
For DBS Preoperative
IV challenges Minimal sedation GABA drugs vs opioids and dex Hold levodopa so they can locate problem areas
79
What can exacerbate symptoms in MS patients?
1 degree Celsius can exacerbate symptoms; maintain warmth!
80
Classification of sz
LOC: simple/complex Focus: Partial/generalized
81
2 or more sz for a certain amount of time
Status Epilepticus
82
Goal of status epilepticus
Airway, ventilation IV access r/o hypoglycemia ABG monitoring…acidosis
83
AION-
Anterior Ischemic Optic Neuropathy Sudden, painless Asymmetric optic disk swelling
84
PION
Posterior Ischemic Optic Neuropathy More common postop No initial ophthalmoscopic findings
85
Ischemic Optic Neuropathy
Visual loss during 1st week after surgery Central &/or peripheral vision….slight decrease to blindness Minimal recovery
86
ION risk factors
Positioning- anemia hypotension Excessive fluid administration- papillary edema Excessive vasopressor use

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