Neuro Flashcards
(125 cards)
1
Q
epidural hematoma
A
a collection of blood in the space between the skull and dura mater. normally a result of trauma to the parietal lobe which disrupts the middle meningeal artery appears as a lens on CT scan, which follows the curve of the skull and protrudes into brain tissue as a convex mass
2
Q
obstructive hydrocephalus
A
CSF flow restriction within or from ventricular system. May be a result of obstruction of arachnoid villi during a subarachnoid hemorrhage
3
Q
choroid plexus
A
A highly vascular portion of the lining of the ventricles that secretes cerebrospinal fluid. normal production 20ml/hr (500ml/day)
4
Q
What part of the brain is associated with coordination, balance, and muscle tone
A
cerebellum
5
Q
What is the inner protective layer of the brain
A
pia mater
6
Q
What cranial nerve innervates the muscles of the tongue
A
XII Hypoglossal
7
Q
What is the cranial nerve that carries sensory and motor signals from face and mouth
A
V Trigeminal
8
Q
What is the cranial nerve that controls muscles in the neck and shoulder
A
XI spinal accessory nerve
9
Q
cranial nerve that controls smiling and taste
A
VII facial nerve
10
Q
Wernicke’s area
A
controls language reception - a brain area involved in language comprehension and expression; usually in the left temporal lobe
11
Q
temporal lobe function
A
auditory stumli recognition, memory and speech
12
Q
olfactory nerve function (I)
A
sensory, smell
13
Q
basilar artery
A
Asingle midline artery, formed by the fusion of the vertebral arteries, that supplies blood to the brainstem and to the posterior cerebral arteries.
14
Q
anterior cerebral artery
A
supplies frontal lobe and superior medial portion of the parietal lobe circulation
15
Q
glossopharyngeal nerve (IX)
A
supplies motor function to the pharynx and sensory function to the posterior 3rd of the tongue
16
Q
Optic Nerve (II)
A
transmits visual information from the retina to the brain
17
Q
superior sagittal sinus
A
A venous sinus located in the midline just dorsal to the corpus callosum, between the two cerebral hemispheres.
18
Q
The majority of strokes are caused by occlusion of the what vessel
A
middle cerebral artery
19
Q
Vestibulocochlear nerve VIII
A
hearing and equilibrium
20
Q
Visual processing takes place in
A
occipital lobe
21
Q
most common location for cerebral aneurysm
A
anterior portion of circle of willis
22
Q
lacunar stroke
A
Occlusion of single, deep perforating artery causing ischemic lesions Rare
23
Q
Inclusion criteria for tPA
A
Clinical Diagnosis of ischemic stroke causing neurologic deficit; Onset of symptoms less than 4 ½ hours before beginning treatment, Age over 18 years
24
Q
exclusion criteria for tPA
A
SAH, Within 3 months: Head trauma, stroke or MI, GI bleed, major surgery, arterial puncture, BP over 185/110, INR over 1.7/anticoagulant, hypoglycemia under 50, Seizure, multilobar infarct
25
Blood pressure goal prior to tPA
lowered slowly to \<185/110
26
blood pressure goal after tPA
\<180/ 105 for at least 24hrs
27
What is tPA and what does it do?
TPA is tissue-type plasminogen activator. This cleaves plasminogen to make plasmin. Plasmin cleaves fibrin, breaking-up blood clots. (crab-linked clot).
28
mechanical thrombectomy
Catheter and other devices to go in and pull clot out of artery Can be performed up to 6hrs after onset --Earlier therapy improves outcomes Requires advanced stroke center --used in conjunction with tPA in eligible patients (large vessel occlusion)
29
complications of tPA
Hemorrhage (Dc tPA, CT, cryo) Angioedema (tx of allergic rx) Reperfusion syndrome
30
most common type of stroke
ischemic (87%)
31
thromotic stroke
blockage in diseased cerebral artery
32
embolic stroke
Fragments that break from a thrombus formed outside the brain
33
INR/PT
international normalized ratio (prothrombin time) -effectivness of Warfrin
34
hemorrhagic stroke
ICH or SAH
35
most common cause of a SAH
Trauma; the second most common is berry aneurysm
36
Hunt and Hess Scale
- used in aSAH (aneurysmal SAH) - classifies SAH severity for surgical risk 1- asymptomatic, minimal headache, slight nuchal rigidity 2- moderate to severe headache, nuchal rigidity, no neuro des or other cranial nerve palsy 3- drowsiness, confusion, mild focal defs 4- stupor, moderate to severe hemiparesis, possible early decerebrate rigidity 5- deep coma, decerebrate rigidity, moribund appearance
37
Fisher scale
-used to estimate risk of cerebral vasospasm after SAH 1- no subarachnoid blood detected 2- a diffuse depsoit or thin layer with all vertical layer of blood (inter hemispheric fissure, insular cistern, ambient cistern) \< 1mm thick 3- localized clot and/or vertical layer of blood \>= 1mm thick 4-Diffuse or no subarachnoid blood, but with intracerecral or intraventricular clots
38
SAH interventions
surgical clip or coiling within 24-48hrs
39
complications of SAH
- hydrocephalus 20% (normally caused by CSF outflow obstruction by a clot in the ventricular system - rebleed (1st 7 days after aSAH) - vasospasm 20-40% of SAH pts - hyponatremia (\<135mmol/L)
40
ICH
10-15% of strokes (65% brain stem, 57% lobular, 51% deep hemorrhage, 42% cerebellar)
41
blood pressure goal for ICH related to an epi/SAH(anurysmal)/int capsule/isxhemic CVA w tranformation
systolic \< 140, MAP\<110
42
ICH score
GCS Score: 3-4 (2) 5-12 (1) ICH Volume: \>30 mL (1) \< 30ml (0) IVH (Intraventricular Blood): Present (1) No (0) ICH Location: Infratentorial (1) no (0) Age: ≥80 years (1) \<80 (0) 30-Day Mortalities for Total ICH Scores 0 = 0% 1 = 13% 2 = 26% 3 = 72% 4 = 97% 5 = 100% 6 = estimated to be 100%; no patients in the study fell into this category
43
ICP monitoring
Normal value: 5-10 mmHg Recommend initiating treatment if ICP \> 20 mmHG, GCS \< 8, evidence of herniation
44
passive ICP management
analgesia, HOB elevation, sedation, glucose management, tempurature management, seizure management
45
CN 1
olfactory nerve- smell
46
CN 2
optic nerve- visual acuity
47
CN 3
oculomotor- pupil constriction
48
CN 4
trochlear- down and in eye movement
49
CN 5
trigeminal- facial sensation
50
CN 6
abducens- eye adbuction horizontal/lateral
51
CN 7
facial- facial expression
52
CN 8
vestibulocochlear- hearing/balance
53
CN 9
glossopharyngeal- shallow
54
CN 10
vagus- cough/gag
55
CN 11
accessory- shoulder shrug
56
CN 12
hypoglossal- tongue out
57
what cranial nerve are included in the eye movement
CN 3,4,6
58
brainstem assessment for unconscious pts
CN 2 + 3- light reflex CN 5 + 7- corneal reflex CN 9 + 10- cough/gag
59
monro-kellie doctrine
the cranial cavity is a closed rigid box, therefore a change in volume must be compensated for
60
components of the intracranial compartment
80% parenchyma 10% vascular 10% CSF
61
zone 1 of the intracranial pressure volume curve
ICP \< 15mmHg and compensatory mechanisms are able to compensate for changes
62
zone 2 of the intracranial pressure volume curve
intracranial volume expands and compensation becomes exhausted marked by a sharp increase in ICP
63
zone 3 of the intracranial pressure volume curve
Intracranial volume continues to increase until it plateaus, indicating herniation
64
hypercapnia effect on CBF
vasodilation increasing CBF of 2mg/100g/min for every 1mmHg PaCO2
65
con of hypocapnea used to manage ICP
-cerebral ischemia, particularly with brain injury -vasoconstriction lasts for 18-24hrs. Due to loss of cerebral interstitial bicarb, normalization of cerebral interstitial pH occurs and mitigates the vasoconstrictive effects of hyperventilation -rebound vasodilation can occur leading to lethal spikes in ICP -hypoxia results from cerebral vasodilation when PaO2 falls below 55mmHg
66
how does temperature effect CBF
-hypothermia slows metabolism - every 1 degree change over normal temp= 5-7% increase in CBF
67
CBF=
CPP/CVR
68
CPP=
MAP-ICP
69
Cushings Triad
bradycardia, HTN, wide PP occurs in response to brain stem ischemia
70
abducens nerve palsy
compression of CN 6 at base of the skull
71
fixed dilated pupil(s)
increased ICP in supratenorial compartmennt. compression of oculomotor nerve causing unilateral pupil dilation and contalatral hemiparesis
72
where is an EVD levelled to
foreman of mono (level of the trigus of the jaw)
73
major causes of increase ICP
-Intracranial mass lesions (eg, tumor, hematoma) -Cerebral edema (such as in acute hypoxic-ischemic encephalopathy, large cerebral infarction, severe traumatic brain injury) -Increased CSF production (eg, choroid plexus papilloma) -Decreased CSF absorption (eg, arachnoid granulation adhesions after bacterial meningitis) -Obstructive hydrocephalus -Obstruction of venous outflow (eg, venous sinus thrombosis, jugular vein compression, neck surgery) -Idiopathic ICH (pseudotumor cerebri)
74
how does the optic nerve sheath diameter reflect ICP?
changes in diameter with CSF pressure changes as there is a layer of subarachnoid space between the nerve and its sheath, which expands due to raised intracranial pressure. EVD, SAH and hydrocephalus will cause falsley elevatd ICP
75
what does the neuro exam consist of
1 cranial nerves 2 motor/reflex/sensory 3 cerebellar 4 cognitive
76
what are the 5 parts of the CNS
cerebrum, diencephalon (thalamus and hypothalamus), brainstem, cerebellum and spinal cord
77
function of the cerebrum
-comprised of the cerebral hemispheres -processes higher-order functions -supplies neuronal connections to nervous system outlets to voluntary/involuntary muscles and diencephalon -receives sensory input from peripheral nervous system
78
what separates the left and right cerebral hemispheres
falx cerebri
79
what separates the posterior hemispheres from the intratentorial compartment
tentorium
80
what is contained in the intratentorial compartment
cerebellum and brainstem
81
thalamus
- part of the diencephalon - serves as a relay centre for sensory input from the body to the sensory cortex of the parietal lobe -regulates function of the basal ganglia, hypothalamus and cerebellum
82
hypothalamus
- derived from the ANS, regulates wakefulness/satiety/hormones/thermoregulation -site of ADH production which is stored in the posterior pituitary
83
brainstem
-midbrain, pons and medulla located between cerebrum and continues with the spinal cord - relays sensory of motor functions between cerebral cortex and spinal cord - houses 10 of the 12 CN - houses the RAS system -houses respiratory centre in the medulla
84
purpose of intracranial pressure monitoring
detect catastrophic intracranial patho
- prevent secondary injury
- monitor for cerebral edema
ICP \> 20-25mmHg- adverse outcomes
85
what therapy influences the parenchyma
sedation (propofol, midazolam, ketamine) ( managing flow-metabolic coupling)
tempurature control (every degree decreased = 10% decrease in metabolism and blood volume) aim for 36-37.5
osmotherapy ( no difference between mannitol to hypertonic in lowering ICP)
86
mannitol dose
hernaition 1 gram /kg
non- herniation 0.25- 5gram/kg
87
maximum sodium level where administering hypertonic saline could be detrimental
150
88
what treatment influences CSF
89
what treatment influence valsular volume
venous return (tube ties, collars, HOB at 30(5-10mmHg reduction), PEEP), PaCO2)
-TBI is a contraidication for permissive hypercapnea
90
MAP goal for epidural hematoma
91
MAP goal of subdural or DAI
92
best pressor to use in setting of brain injury
93
in the settin of cardiac arrest, when does the majority of brain damage occur
94
Mip's post arrest mamngemnt goals
map 80, normal co2, temp 35-36, hemoglobin 90, PaO2 100
95
what in CN 4 responsible for
96
what does unilateral pupil constriction indicate
97
what do you consider prior to hypertonic saline
sodium
98
what does doll's eyes examine
CN 8
if eyes stay midline-good
if eyes follow head turning-not good
99
meningitis
100
hallmarks of meningitis
fever, headache, nucal rigidity (if pt has 2 or more, consider it)
best rule out test manipulate neck side to side if headache doesnt get worse, unlikely meningitis
101
reason to do LP prior to CT
safe to LP(L3-5, 20-30ml removed) or not, LP can cause herniation
age\>55, immunocomprimed,
102
ABX for viral meningitis
ampicilin , Vancomycin ,acyc
103
GBS
acute demylinating disease
exposure to a infection = antibodies, antibodies cross react with mylin in peripheral nerves
presentaion: acute peripheral hand ascending upwards (attacks long mylin first), sensation is largly spared
vital capcitiy ,20ml/kg = intubate (caution due to automonic instability (brady or hypertensive) = prior to intubation prepare atropin and hydralazine
long term tx: IV IG, plasma
104
myasthenia gravis
autoimmune disease (antibodies) that act against ACH in neuromuscular junction. Pt will have preserved sensation, proximal weakness
indication to intubate: bulbuar dysfunction, vital capacity \< 20ml/kg (caution, pt will have hypersecretions)
myasthenia crisis: tipping pt into crisis with meds
TX: steroids, IV IG and plasmapheresis
105
Contraindication for giving phenytoin
toxicity or injestion of a sodium blocker (TCAs)
106
refractory status epilecticus treatment
propofol, mizaloam or ketamine IV infusion
107
other considerations for seizure management
reduce fever (fever reduces seizure threshold), magnesium (2-5g maintian mg \> 1)
108
approach to causes of seizures
DIMS
drugs- non-compliance with AEDs, OD (salicylates,sympathomimetics, isoniazid)
infection- meningitis/encephalitis (especially HSV)
metabolic- NA,Mg,Ca, renal failure/uremia, hypogycelmia, liver failure
structural- neoplasm, TBI, NMD
stroke- ischemic, ICH
other- antibody
109
when do you administer seizure prophylaxis in TBIs
temporal lobe pathology, penatrating trauma, diagnosed with seizure disorder prior to injury
110
Asia scale
111
at what level of spinal injury do you intubate pts
C 5 and above
if bicepts are fuctioning, unlikely to require intubation
112
at what level do you expect neurogenic shock
T 1 and below is where sympathetic efferent nerves inervate the heart. therefore injurieas above =unopposed vagus cardiac stimuli, and poolin gof blood due to lack of A1 innervation to lower
meds of choice: norepinephrine, epinephrine
MAP goal: 85
113
what is the treatment goal for an unsecured aneurysm
prevension of rebleed: bleed occurs during systole, that is why systolic goal is less than 140 SYSTOLIC
114
complications of SAH
hydocephalus
vasospasm
Na (high or low) (low can be DI due to hypothalmus not functioning)
seizures
cardiac (arrythmias, cardiomyopapthy for catecholmine storm )
115
BP targets for SAH management
BP \< 180 if lysed
BP \<220 if not
BP \<140 is hemorrhagic complication
116
signs of uncul herniation
unilateral pupil dilation unreactive pupil, contralateral paralysis (motor crosses below midbrain)
117
tonsilar herniation
cerebellum pahtology (stroke or hem) herniation which compresses the brain stem (DLOC, weakness,central apnea, CN reflexe loss (too late)). This is because the tentorum is above it, stoping it from herniating upwards
118
meningies extend to what level of the spinal cord
L 1-2
119
how is a sensory stimuli transmitted to the brain
touch pressure vibration proproseption sensed and enters the dorsal tract where it interacts with interneurons and sends a signal up the dorsal root, to the medulla and transmitted up the opposited side of the brain through the thamli. Motor responses exit through the ventral tract to the effector muscle
120
lower limbs- lumbar
upper limbs-cervical
121
aterospinal artery infarct
- infacarct of 2/3 of the spinal cord
- bilateral loss of motor function, pain/temp sensation
- doral column spared= intact vibration/fine touch/proprioception
122
central cord syndrome
- hyperextension of the neck (backwards), imcomplete cord syndrome
- variable sensory
- weak proximal muscle weakness
- distal muscles are strong
123
brown sequard syndrome
- hemipalaysis and hemi anesethia
- loss of pain and temp contralateral
- ipsilateral weakness
124
cauda equina
- tx within 24hrs
- loss of bladder, lower sphicter, lower leg loss of control
125
bs, central, anterispinal infact, cauda equina, subacute
