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ABA Applied Exam > Neuro > Flashcards

Neuro Flashcards

1
Q

What is the most sensitive monitor for detecting a venous air embolism?

A

echocardiography

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2
Q

Why might hypothermia provide neuroprotection?

A

reduced release of excitatory neurotransmitters and catecholamines

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3
Q

What are the components of the intracranial space?

A

85% parenchyma

10% CSF

5-10% blood

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4
Q

What is the normal cerebral O2 requirement? Normal cerebral blood flow?

A

3.5 mL O2/min/100 g brain tissue

50 mL/min/100 g brain tissue

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5
Q

What is the relationship between PaCO2 and CBF?

A

linear between PaCO2 20-80

2% change in CBF for every 1 mmHg change in PaCO2

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6
Q

What is cerebral steal? In what setting does it occur?

A

shunting of blood flow away from patholigic regions toward normal regions in the setting of hypercapnea (vasodilatation)

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7
Q

What is inverse steal? In what setting does it occur?

A

shunting of blood flow toward patholigic regions away from normal regions in the setting of hypocapnea (vasoconstriction)

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8
Q

When should embolization of an intracranial mass be done relative to resection?

A

< 48 hours before

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9
Q

What are the primary concerns with operations in the posterior fossa?

A

small, noncompliant space

hemodynamic instability with traction on brainstem nuclei

risk to cranial nerve requiring NIOM

risk of VAE

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10
Q

What are the positioning concerns particular to posterior fossa surgery?

A

VAE

neck rotation obstructing jugular outflow

brachial plexus injury

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11
Q

What are the concerns for neurosurgery in the sitting position?

A

VAE and paradoxical embolus if a PFO is present

reduced preload causing bradycardia (Bezold-Jarisch reflex)

hypoperfusion of the brain or cervical spine

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12
Q

What is the goal of indirect neuroprotection? What are its components?

A

Preventing ischemia:

maintain cerebral oxygen delivery

maintain brain relaxation to minimize retratction

maintain serum glucose

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13
Q

What is the goal of direct neuroprotection? What are its components?

A

Tolerating ischemia:

reducing CMRO2

preventing apoptosis in response to ischemia

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14
Q

What is the optimal position of a multiorifice catheter for VAE aspiration? Success rate?

A

2 cm distal to the cavo-atrial junction

meh: 30-60%

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15
Q

What is normal serum osmolality? What is the upper limit when using hyperosmolar therapy?

A

normal: 275-295 mmol/kg

upper limit: 320 mmol/kg (higher can cause ATN)

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16
Q

What are the risks of mannitol?

A

leakage through a damaged BBB

hypovolemia leading to hypotension

serum osmolality >320 mosm/kg leading to ATN

expanding hematoma when tamponade effect is lost

17
Q

What can cause hyponatremia after TBI?

A

cerebral salt wasting

SIADH

HPA dysfunction

18
Q

What can cause hypernatremia after TBI?

A

mannitol or 3% saline use

diabetes insipidus (central)

19
Q

How is Mg neuroprotective?

A

limits Ca2+ influx through NMDA receptors (less excitotoxicity)

downregulates aquaporin 4 (less cerebral edema)

decreases p53 (less apoptosis)

20
Q

What is the role of gender in TBI?

A

death rate is significantly lower in women

(possible protection from estrogen/progesterone)

21
Q

What is the effect of decompressive hemicraniectomy on severe TBI?

A

better Glasgow Outcome Scales at 6 & 12 months (DECRA and RESCUEicp)

22
Q

How is severity of TBI categorized?

A

GCS 13-15: mild TBI

GCS 9-12: moderate TBI

GCS <9: severe TBI

23
Q

What is the ICP goal in patients with TBI? CPP goal? PbtO2 goal?

A

ICP < 20 mmHg

CPP 50-70 mmHg

PbtO2 > 20 mmHg

24
Q

Should patients with TBI be hyperventilated?

A

not routinely during the first 24 hours due to the risk of reduced CBF

25
Q

Should patients with TBI be given steroids?

A

no, increased mortality in CRASH trial

26
Q

How long should anti-seizure prophylaxis be given after TBI? Surgery?

A

typically 1 week for both

(less effective for late-onset seizures)

27
Q

How is hemorrhage managed during interventional neuroradiology procedures?

A

attempt to “glue” the hole or embolize feeding vessels

reverse heparin with protamine

place ventriculostomy

28
Q

What is the usual timecourse of neurogenic LV dysfunction?

A

resolves in 4-5 days

29
Q

What are the methods to decrased aneurysm transmural pressure during clip placement?

A

temporary clip placement on feeding vessel(s)

controlled hypotension

adenosine-induced circulatory arrest

deep hypothermic circulatory arrest

30
Q

Is hypothermia beneficial during aneurysm clipping?

A

no, the IHAST trial showed no benefit

31
Q

Besides the usual reasons for delayed emergence, what must be particularly considered in neurosurgery?

A

intra-operative seizure resulting in a post-ictal state

32
Q

What is the usual timecourse of vasospasm after SAH?

A

day 0-3: rare

day 3-10: peak incidence

day 10-14: resolving

ABA Applied Exam (12 decks)

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