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Neuro Flashcards

1
Q

Which cranial nerve is most prominent in eye movement? What muscles does it control?

A

CN3 - oculomotor
Superior rectus - supraduction
Medial rectus - adduction
Inferior rectus - infraduction
Inferior oblique - extorsion, elevation

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2
Q

Which cranial nerve is involved in intorsion/depression of the eye?

A

CN4 - trochlear
Superior oblique

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3
Q

Which cranial nerve is involved in the abduction of the eye?

A

CN 6 - abducens
Lateral rectus

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4
Q

What cranial nerve is part of the CNS?

A

CN 2 - optic

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5
Q

Which cranial nerves contribute to the parasympathetic nervous system?

A

CN 3 - oculomotor
CN 7 - facial
CN 9 - glossopharyngeal
CN 10 - vagus

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6
Q

Injury to what cranial nerve causes Bell’s Palsy?

A

CN 7 - facial

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7
Q

Tic douloureax results from what CN?

A

CN 5 - trigeminal
(trigeminal neuralgia)

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8
Q

What is the volume of CSF?

A

~150 mL

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9
Q

What is the specific gravity of CSF?

A

1.002 - 1.009

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10
Q

Where is CSF produced and at what rate/hr?

A

Ependymal cells of the choiroid plexus (in all four ventricles) at a rate of 30 mL/hr

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11
Q

What is CSF pressure?

A

5-15 mmHg

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12
Q

How does a decrease in CSF pH affect CBF?

A

CBF is increased (increased PaCO2 -> decreased cerebrovascular resistance)

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13
Q

At what PaCO2 does maximal vasodilation occur?

A

80-100 mmHg

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13
Q

At what PaCO2 does maximal vasoconstriction occur?

A

~25 mmHg

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13
Q

What is global CBF at a PaCO2 or 40 mmHg?

A

50 mL/100 g brain tissue/min

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13
Q

What is the change in CBF for a 1 mmHg increase in PaCO2?

A

increased by 1-2 mL/100 g brain tissue/min

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13
Q

Where in the brain is the blood brain barrier NOT located?

A

chemoreceptor trigger zone
hypothalamus
pineal gland
posterior pituitary gland
choroid plexus

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14
Q

What are SS of intracranial hypertension?

A

headache
N/V
papilledema (swelling of optic nerve)
pupil dilation and non-reactivity to light
focal neurologic deficit
seizures
coma

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15
Q

What is Cushing’s triad indicative of? What are the three components?

A

Intracranial hypertension
1. hypertension (increased ICP -> reduced CPP -> increased BP to preserve cerebral perfusion)
2. bradycardia (baroreceptor reflex activated by hypertension)
3. irregular respirations (compression of the medulla)

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16
Q

What is the most common site of transtentorial herniation?

A

The temporal uncus
oculomotor nerve crosses near here, fixed and dilated pupil results due to ischemia

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17
Q

What drugs reduce CSF production?

A

furosemide
acetazolamide

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18
Q

When should steroids not be used in a brain case?

A

TBI
functional pituitary adenoma

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19
Q

What are 4 ways to reduce intracranial hypertension?

A

Reduce cerebral spinal fluid
Reduce cerebral blood volume
Reduce cerebral edema
Reduce cerebral mass

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20
Q

Discuss blood supply and skull entry to the anterior circulation:

A

internal carotids enter the skull through the foramen lacerum
aorta -> common carotid -> internal carotid -> Circle of Willis -> cerebral hemispheres

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21
Q

Discuss blood supply and skull entry to the posterior circulation:

A

vertebral arteries enter the skull through the foramen magnum
aorta -> subclavian -> vertebral -> basilar -> posterior fossa structures and cervical spinal cord

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22
Q

List 6 risk factors for ischemic stroke:

A
  1. HTN (most important)
  2. smoking
  3. diabetes mellitus
  4. hyperlipidemia
  5. excessive alcohol intake
  6. elevated homocysteine level
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23
Q

When should a thrombolytic agent be initiated for an acute ischemic stroke?

A

within 4.5 hours of symptom onset (TPA)

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24
Q

When should large vessel occlusion embolectomy be performed?

A

within 6 hours of symptom onset

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25
Q

What are the three components of Triple H therapy? What is it used to treat?

A

hypertension
hypervolemia
hemodilution (Hct 27-32%)

cerebral vasospasm

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26
Q

Where does venous bleeding usually occur in a hemorrhagic stroke?

A

in the subdural space (between dura and arachnoid)

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27
Q

Where does arterial bleeding usually occur in a hemorrhagic stroke?

A

in the subarachnoid space (between arachnoid and pia)

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28
Q

How does nimodipine, a CCB, treat cerebral vasospasm?

A

It does not relieve the spasm, but rather increases collateral blood flow

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29
Q

Discuss motor response in the GCS:

A

NEF WiLl Obey
1- no response to pain
2 - extension to pain (decerebrate)
3 - flexion to pain (decorticate)
4 - withdraw from pain
5 - localize response to pain
6 - obeys commands

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30
Q

Discuss verbal response in the GCS:

A

1- no response
2 - incomprehensible sounds
3 - inappropriate words
4 - confused
5 - oriented

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31
Q

Discuss eye opening in the GCS:

A

1 - no eye opening
2 - eye opening to painful stimulus
3 - eye opening to speech
4 - spontaneous eye opening

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32
Q

Discuss pupil reaction in the GCS:

A

0 - both pupils dilate normally
-1 - only one pupil dilates normally
-2 - neither pupils dilate

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33
Q

Discuss grand mal seizures:

A

generalized tonic (rigidity) -clonic (jerking) activity
respiratory arrest -> hypoxia
acute treatment: propofol, diazepam, thiopental
surgical treatment: vagal nerve stimulator of foci resection

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34
Q

Discuss focal cortical seizures:

A

localized to a particular region
can be motor or sensory
usually no loss of consciousness

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35
Q

Discuss absence (petit mal) seizures:

A

temporary loss of awareness
remains awake
more common in kids

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36
Q

Discuss akinetic seizures:

A

temporary loss of consciousness and postural tone
can result in fall and head injury
more common in kids

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37
Q

Discuss status epilepticus:

A

seizure activity lasting > 30 minutes
OR
two grand mal seizures without regaining consciousness in between
respiratory arrest -> hypoxia
acute treatment: propofol, benzos, thiopental, phenobarbital, phenytoin, general anesthesia

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38
Q

What two types of seizures are more common in children?

A

akinetic
absence (petit mal)

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39
Q

The patient usually remains awake during what two types of seizures?

A

Focal cortical
Absence (petit mal)

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40
Q

What 3 medications are useful for locating seizure foci during cortical mapping?

A

alfentanil
etomidate
methohexital

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41
Q

Which anticonvulsants alter hepatic enzymes?

A

phenytoin - induction
carbamazepine - induction
valproic acid - inhibition

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42
Q

How are gabapentinoids excreted?

A

unchanged by the kidneys. caution in renal failure

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43
Q

Which anticonvulsants work by blocking voltage gated Na channels (membrane stabilization)?

A

phenytoin
carbamazepine
valproic acid

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44
Q

What is the mechanism of action of gabapentin?

A

inhibits the alpha 2 delta subunit of calcium channels in the CNS

45
Q

What is the pathophys of Alzheimers:

A

increased Ach

46
Q

What is the greatest risk factor of Parkinsons?

A

Old age

47
Q

How is Parkinsons diagnosed?

A

Must have 2/4 cardinal signs:

  1. resting ‘pill-rolling’ tremor
  2. skeletal muscle rigidity
  3. postural instability = loss of balance with an altered gait
  4. bradykinesia = very slow movement and reflexes
48
Q

What is Parkinsons treatment aimed at?

A

increasing dopamine or decreasing acetylcholine in the basal ganglia

49
Q

How does levodopa and carbidopa treat Parkinsons?

A

levodopa is precursor of dopamine
DA cannot penetrate CNS
carbidopa is a decarboxylase inhibitor that prevents levodopa metabolism in the blood
this allows more to enter the CNS

50
Q

What are SE of carbidopa and levodopa?

A

CV: increased inotropy, tachycardia, orthostatic hypotension
Other: dyskinesia, N/V

51
Q

What other medications can be used to treat Parkinsons?

A

selegiline (MAO-B inhibitor -> decreased DA metabolism in CNS)
dopamine agonists
anticholinergics
catechol-o-methyltransferase inhibitors
amantadine
hormone replacement

52
Q

Should levodopa be continued before surgery? Why or why not?

A

Yes, give morning of to prevent worsening symptoms like rigidity (impacts ventilation).
If longer surgery, can be given via OG tube.

53
Q

What drugs are contraindicated in Parkinsons? What can they cause?

A

antidopaminergics like metoclopramide
butyrophenones like haloperidol and droperidol
phenothiazines like promethazine

can exacerbate extrapyramidal ss

54
Q

What meds can be used to treat acute exacerbation of Parkinsonian symptoms?

A

anticholinergics

55
Q

What procedure risk factors lead to increased occurrence of ischemic optic neuropathy?

A

prone positioning
Wilson frame
long duration of anesthesia
large blood loss
large ratio of colloid to crystalloid resuscitation
hypotension

56
Q

What patient risk factors lead to increased occurrence of ischemic optic neuropathy?

A

male sex
obesity
diabetes
hypertension
smoking
old age
athersclerosis

57
Q

Is ischemic optic neuropathy a nerve problem or a vessel problem?

A

a nerve problem

58
Q

Is central retinal artery occlusion a nerve problem or a vessel problem?

A

a vessel problem

59
Q

What are risk factors for central retinal artery occlusion?

A

horseshoe headrest (most common)
embolism
administering N2O after an intraocular gas bubble has been placed

60
Q

What four classic signs and symptoms occur with Beck’s syndrome (anterior spinal artery syndrome)?

A

flaccid paralysis of lower extremities
bowel and bladder dysfunction
loss of pain and temp sensation
preserved touch and proprioception

61
Q

List three spinal pathways that are supplied by the anterior spinal artery.

A

spinothalamic tract
corticospinal tract
autonomic motor fibers

62
Q

List one spinal pathway that is supplied by the posterior spinal artery:

A

dorsal column

63
Q

Which spinal cord tract transmits crude touch and pressure?

A

ventral spinothalamic tract

64
Q

Which spinal cord tract transmits fine touch and proprioception?

A

dorsal column (cuneatus and gracilis)

65
Q

Which spinal cord tracts transmit pain and temperature?

A

Tract of Lissauer
Lateral spinothalamic tract

66
Q

Which spinal cord tract transmits limb motor function?

A

lateral corticospinal tract

67
Q

Which spinal cord tract transmits posture motor function?

A

ventral corticospinal tract

68
Q

What do Pacinian corpuscles transmit?

A

vibration

69
Q

What do Meissner’s corpuscles transmit?

A

vibration
two point discriminative touch

70
Q

What do Merkel’s discs transmit?

A

continuous touch

71
Q

What do Ruffinis endings transmit?

A

prolonged touch and pressure
proprioception

72
Q

What type of nerve fibers are first order neurons?

A

usually A-beta
some A-alpha

73
Q

Where do first order neurons enter the spinal cord?

A

dorsal root ganglion

74
Q

What information do first order neurons transmit and to where?

A

transmit sensory info from the dorsal column to the medulla

75
Q

Where do first order neurons synapse?

A

ascend same side and synapse with second order neurons in the medulla

76
Q

Where do second order neurons cross? Where do they ascend to?

A

cross to contralateral side in medulla
ascend to thalamus via medial lemniscus

77
Q

Where do second order neurons synapse with third order neurons?

A

thalamic relay station - the ventrobasal complex

78
Q

Where do third order neurons go?

A

pass through internal capsule and go toward somatosensory cortex in post central gyrus in parietal lobe

79
Q

What is another name for the dorsal column?

A

medial lemniscal system

80
Q

What type of fibers make up the first order neurons in the anterolateral system?

A

A-delta: “fast” pain, mechanoreceptors
C fibers: “slow” pain, polymodal nociceptors

81
Q

At what laminae and where do pain neurons synapse with the second order neuron?

A

Rexed’s lamina 2 and 3 in the substantia gelatinosa

82
Q

Where do second order neurons of the anterolateral system synapse with third order neurons?

A

reticular activating system and thalamus

83
Q

Which sensory tract in the spinal cord transmits pressure?

A

Dorsal column

84
Q

Which sensory tract in the spinal cord transmits temperature?

A

anterolateral system

85
Q

Which sensory tract in the spinal cord contain slow conducting fibers?

A

anterolateral system

86
Q

Which sensory tract in the spinal cord has 2-point discrimination?

A

dorsal column

87
Q

Which sensory tract in the spinal cord contains rapid conducting fibers?

A

dorsal column

88
Q

Which sensory tract in the spinal cord transmits vibration?

A

dorsal column

89
Q

Which sensory tract in the spinal cord transmits proprioception?

A

dorsal column

90
Q

Which sensory tract in the spinal cord transmits pain?

A

anterolateral system

91
Q

Which sensory tract in the spinal cord transmits sexual sensations?

A

anterolateral system

92
Q

Which sensory tract in the spinal cord consists of large myelinated fibers?

A

dorsal column

93
Q

Which sensory tract in the spinal cord consists of small unmyelinated fibers?

A

anterolateral system

94
Q

What is another name for the corticospinal tract? Why?

A

pyramidal tract
the pyramids are formed by the corticospinal neurons as they run through the medulla
other motor pathways outside of corticospinal tract are called “extrapyramidal tract” since the don’t pass through the pyramids

95
Q

What is the path of motor neurons in the corticospinal tract?

A

exit - precentral gyrus frontal lobe
pass through - internal capsule
travel inferiorly - through pyramids of the medulla

96
Q

Where do fibers that innervate the limbs crossover?

A

the fibers in the lateral corticospinal tract cross to the contralateral side in the medulla
then descend spinal cord

97
Q

Where do fibers that innervate the axial muscles crossover?

A

the fibers in the ventral corticospinal tract remain ipsilateral as they descend and cross to the contralateral side when they reach the cervical or upper thoracic area

98
Q

Where do fibers that innervate the axial muscles crossover?

A

the fibers in the ventral corticospinal tract remain ipsilateral as they descend and cross to the contralateral side when they reach the cervical or upper thoracic area

99
Q

What are examples of upper motor neuron disease?

A

cerebral palsy
amyotrophic lateral sclerosis

100
Q

In an upper motor neuron injury, what actions result?

A

contralateral spastic paralysis
hyperreflexia

101
Q

Where do the upper motor neurons originate and end?

A

cerebral cortex
ventral horn of the spinal cord

102
Q

Where do the lower motor neurons originate and end?

A

ventral horn of the spinal cord
neuromuscular junction

103
Q

How does a lower motor neuron injury present?

A

ipsilateral flaccid paralysis
impaired reflexes

104
Q

What three symptoms are associated with upper spinal cord injury?

A

hypotension
hypothermia
bradycardia

105
Q

What type of anesthetic is best with chronic spinal cord injury?

A

general or spinal

106
Q

What is the best treatment of hypertension in autonomic hyperreflexia?

A

remove the stimulus
deepens the anesthetic
use a rapid-acting vasodilator like Na nitroprusside

107
Q

What is the best treatment of bradycardia in autonomic hyperreflexia?

A

atropine or glycopyrrolate
avoid positive chronotropes that cause vasoconstriction (would worsen htn)

108
Q

What is amyotrophic lateral sclerosis?

A

progressive degeneration of motor neurons in the corticospinal tract

109
Q

Where does ALS start and spread to?

A

weakness starts in hands and spreads to rest, affecting tongue, pharynx, larynx, and chest

110
Q

What is the most common cause of death in ALS?

A

respiratory failure

111
Q

What is the only drug that reduces mortality in ALS?

A

Riluzole - a NMDA receptor antagonist

112
Q

How are the heart and ocular muscles affected in ALS?

A

They are not affected

113
Q

Discuss neuromuscular blockers and ALS:

A

Avoid sux due to lethal hyperkalemia (lower motor neuron dysfunction -> proliferation of post junctional nicotinic receptors)

increased sensitivity to nondepolarizing neuromuscular blockers

consider postop mechanical ventilation if NMBs are given

114
Q

What SS does upper motor neuron damage lead to?

A

spasticity
hyperreflexia
loss of coordination

115
Q

What SS does lower motor neuron damage lead to?

A

muscle weakness
fasciculations
atrophy

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