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CCP S2 > Neuro > Flashcards

Neuro Flashcards

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

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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

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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)

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4
Q

What part of the brain is associated with coordination, balance, and muscle tone

A

cerebellum

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5
Q

What is the inner protective layer of the brain

A

pia mater

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6
Q

What cranial nerve innervates the muscles of the tongue

A

XII Hypoglossal

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7
Q

What is the cranial nerve that carries sensory and motor signals from face and mouth

A

V Trigeminal

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8
Q

What is the cranial nerve that controls muscles in the neck and shoulder

A

XI spinal accessory nerve

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9
Q

cranial nerve that controls smiling and taste

A

VII facial nerve

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10
Q

Wernicke’s area

A

controls language reception - a brain area involved in language comprehension and expression; usually in the left temporal lobe

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11
Q

temporal lobe function

A

auditory stumli recognition, memory and speech

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12
Q

olfactory nerve function (I)

A

sensory, smell

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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.

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14
Q

anterior cerebral artery

A

supplies frontal lobe and superior medial portion of the parietal lobe circulation

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15
Q

glossopharyngeal nerve (IX)

A

supplies motor function to the pharynx and sensory function to the posterior 3rd of the tongue

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16
Q

Optic Nerve (II)

A

transmits visual information from the retina to the brain

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17
Q

superior sagittal sinus

A

A venous sinus located in the midline just dorsal to the corpus callosum, between the two cerebral hemispheres.

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18
Q

The majority of strokes are caused by occlusion of the what vessel

A

middle cerebral artery

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19
Q

Vestibulocochlear nerve VIII

A

hearing and equilibrium

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20
Q

Visual processing takes place in

A

occipital lobe

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21
Q

most common location for cerebral aneurysm

A

anterior portion of circle of willis

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22
Q

lacunar stroke

A

Occlusion of single, deep perforating artery causing ischemic lesions Rare

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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

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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

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25
Q

Blood pressure goal prior to tPA

A

lowered slowly to <185/110

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26
Q

blood pressure goal after tPA

A

<180/ 105 for at least 24hrs

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27
Q

What is tPA and what does it do?

A

TPA is tissue-type plasminogen activator. This cleaves plasminogen to make plasmin. Plasmin cleaves fibrin, breaking-up blood clots. (crab-linked clot).

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28
Q

mechanical thrombectomy

A

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)

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29
Q

complications of tPA

A

Hemorrhage (Dc tPA, CT, cryo) Angioedema (tx of allergic rx) Reperfusion syndrome

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30
Q

most common type of stroke

A

ischemic (87%)

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31
Q

thromotic stroke

A

blockage in diseased cerebral artery

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32
Q

embolic stroke

A

Fragments that break from a thrombus formed outside the brain

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33
Q

INR/PT

A

international normalized ratio (prothrombin time) -effectivness of Warfrin

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34
Q

hemorrhagic stroke

A

ICH or SAH

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35
Q

most common cause of a SAH

A

Trauma; the second most common is berry aneurysm

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36
Q

Hunt and Hess Scale

A
  • 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
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37
Q

Fisher scale

A

-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

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38
Q

SAH interventions

A

surgical clip or coiling within 24-48hrs

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39
Q

complications of SAH

A
  • 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)
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40
Q

ICH

A

10-15% of strokes (65% brain stem, 57% lobular, 51% deep hemorrhage, 42% cerebellar)

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41
Q

blood pressure goal for ICH related to an epi/SAH(anurysmal)/int capsule/isxhemic CVA w tranformation

A

systolic < 140, MAP<110

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42
Q

ICH score

A

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

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43
Q

ICP monitoring

A

Normal value: 5-10 mmHg Recommend initiating treatment if ICP > 20 mmHG, GCS < 8, evidence of herniation

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44
Q

passive ICP management

A

analgesia, HOB elevation, sedation, glucose management, tempurature management, seizure management

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45
Q

CN 1

A

olfactory nerve- smell

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46
Q

CN 2

A

optic nerve- visual acuity

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47
Q

CN 3

A

oculomotor- pupil constriction

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48
Q

CN 4

A

trochlear- down and in eye movement

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49
Q

CN 5

A

trigeminal- facial sensation

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50
Q

CN 6

A

abducens- eye adbuction horizontal/lateral

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51
Q

CN 7

A

facial- facial expression

52
Q

CN 8

A

vestibulocochlear- hearing/balance

53
Q

CN 9

A

glossopharyngeal- shallow

54
Q

CN 10

A

vagus- cough/gag

55
Q

CN 11

A

accessory- shoulder shrug

56
Q

CN 12

A

hypoglossal- tongue out

57
Q

what cranial nerve are included in the eye movement

A

CN 3,4,6

58
Q

brainstem assessment for unconscious pts

A

CN 2 + 3- light reflex CN 5 + 7- corneal reflex CN 9 + 10- cough/gag

59
Q

monro-kellie doctrine

A

the cranial cavity is a closed rigid box, therefore a change in volume must be compensated for

60
Q

components of the intracranial compartment

A

80% parenchyma 10% vascular 10% CSF

61
Q

zone 1 of the intracranial pressure volume curve

A

ICP < 15mmHg and compensatory mechanisms are able to compensate for changes

62
Q

zone 2 of the intracranial pressure volume curve

A

intracranial volume expands and compensation becomes exhausted marked by a sharp increase in ICP

63
Q

zone 3 of the intracranial pressure volume curve

A

Intracranial volume continues to increase until it plateaus, indicating herniation

64
Q

hypercapnia effect on CBF

A

vasodilation increasing CBF of 2mg/100g/min for every 1mmHg PaCO2

65
Q

con of hypocapnea used to manage ICP

A

-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
Q

how does temperature effect CBF

A

-hypothermia slows metabolism - every 1 degree change over normal temp= 5-7% increase in CBF

67
Q

CBF=

A

CPP/CVR

68
Q

CPP=

A

MAP-ICP

69
Q

Cushings Triad

A

bradycardia, HTN, wide PP occurs in response to brain stem ischemia

70
Q

abducens nerve palsy

A

compression of CN 6 at base of the skull

71
Q

fixed dilated pupil(s)

A

increased ICP in supratenorial compartmennt. compression of oculomotor nerve causing unilateral pupil dilation and contalatral hemiparesis

72
Q

where is an EVD levelled to

A

foreman of mono (level of the trigus of the jaw)

73
Q

major causes of increase ICP

A

-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
Q

how does the optic nerve sheath diameter reflect ICP?

A

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
Q

what does the neuro exam consist of

A

1 cranial nerves 2 motor/reflex/sensory 3 cerebellar 4 cognitive

76
Q

what are the 5 parts of the CNS

A

cerebrum, diencephalon (thalamus and hypothalamus), brainstem, cerebellum and spinal cord

77
Q

function of the cerebrum

A

-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
Q

what separates the left and right cerebral hemispheres

A

falx cerebri

79
Q

what separates the posterior hemispheres from the intratentorial compartment

A

tentorium

80
Q

what is contained in the intratentorial compartment

A

cerebellum and brainstem

81
Q

thalamus

A
  • 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
Q

hypothalamus

A
  • derived from the ANS, regulates wakefulness/satiety/hormones/thermoregulation -site of ADH production which is stored in the posterior pituitary
83
Q

brainstem

A

-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
Q

purpose of intracranial pressure monitoring

A

detect catastrophic intracranial patho

  • prevent secondary injury
  • monitor for cerebral edema

ICP > 20-25mmHg- adverse outcomes

85
Q

what therapy influences the parenchyma

A

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
Q

mannitol dose

A

hernaition 1 gram /kg

non- herniation 0.25- 5gram/kg

87
Q

maximum sodium level where administering hypertonic saline could be detrimental

A

150

88
Q

what treatment influences CSF

A
89
Q

what treatment influence valsular volume

A

venous return (tube ties, collars, HOB at 30(5-10mmHg reduction), PEEP), PaCO2)

-TBI is a contraidication for permissive hypercapnea

90
Q

MAP goal for epidural hematoma

A
91
Q

MAP goal of subdural or DAI

A
92
Q

best pressor to use in setting of brain injury

A
93
Q

in the settin of cardiac arrest, when does the majority of brain damage occur

A
94
Q

Mip’s post arrest mamngemnt goals

A

map 80, normal co2, temp 35-36, hemoglobin 90, PaO2 100

95
Q

what in CN 4 responsible for

A
96
Q

what does unilateral pupil constriction indicate

A
97
Q

what do you consider prior to hypertonic saline

A

sodium

98
Q

what does doll’s eyes examine

A

CN 8

if eyes stay midline-good

if eyes follow head turning-not good

99
Q

meningitis

A
100
Q

hallmarks of meningitis

A

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
Q

reason to do LP prior to CT

A

safe to LP(L3-5, 20-30ml removed) or not, LP can cause herniation

age>55, immunocomprimed,

102
Q

ABX for viral meningitis

A

ampicilin , Vancomycin ,acyc

103
Q

GBS

A

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
Q

myasthenia gravis

A

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
Q

Contraindication for giving phenytoin

A

toxicity or injestion of a sodium blocker (TCAs)

106
Q

refractory status epilecticus treatment

A

propofol, mizaloam or ketamine IV infusion

107
Q

other considerations for seizure management

A

reduce fever (fever reduces seizure threshold), magnesium (2-5g maintian mg > 1)

108
Q

approach to causes of seizures

A

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
Q

when do you administer seizure prophylaxis in TBIs

A

temporal lobe pathology, penatrating trauma, diagnosed with seizure disorder prior to injury

110
Q

Asia scale

A
111
Q

at what level of spinal injury do you intubate pts

A

C 5 and above

if bicepts are fuctioning, unlikely to require intubation

112
Q

at what level do you expect neurogenic shock

A

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
Q

what is the treatment goal for an unsecured aneurysm

A

prevension of rebleed: bleed occurs during systole, that is why systolic goal is less than 140 SYSTOLIC

114
Q

complications of SAH

A

hydocephalus

vasospasm

Na (high or low) (low can be DI due to hypothalmus not functioning)

seizures

cardiac (arrythmias, cardiomyopapthy for catecholmine storm )

115
Q

BP targets for SAH management

A

BP < 180 if lysed

BP <220 if not

BP <140 is hemorrhagic complication

116
Q

signs of uncul herniation

A

unilateral pupil dilation unreactive pupil, contralateral paralysis (motor crosses below midbrain)

117
Q

tonsilar herniation

A

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
Q

meningies extend to what level of the spinal cord

A

L 1-2

119
Q

how is a sensory stimuli transmitted to the brain

A

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
Q
A

lower limbs- lumbar

upper limbs-cervical

121
Q

aterospinal artery infarct

A
  • 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
Q

central cord syndrome

A
  • hyperextension of the neck (backwards), imcomplete cord syndrome
  • variable sensory
  • weak proximal muscle weakness
  • distal muscles are strong
123
Q

brown sequard syndrome

A
  • hemipalaysis and hemi anesethia
  • loss of pain and temp contralateral
  • ipsilateral weakness
124
Q

cauda equina

A
  • tx within 24hrs
  • loss of bladder, lower sphicter, lower leg loss of control
125
Q
A

bs, central, anterispinal infact, cauda equina, subacute

CCP S2 (10 decks)

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