1. Herniation against the flax cerebri (midline shift) 2. Herniation of surpatentorial contents against tentorium cerebello (compress brainstem)

1. Subfalcine 2. Transtentorial

Neuro (Exam III) '25 Flashcards by Amanda M.

What are the main categories of neurological diseases?

Neurological Diseases, Genetic Disorders, Degenerative Disorders, Cerebral Vascular Disorders, Congenital Brain Diseases, Traumatic Brain Injury, Seizure Disorders.

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How is cerebral blood flow (CBF) modulated? (6)

cerebral metabolic rate
cerebral perfusion pressure (CPP)
arterial blood carbon dioxide (PaC02)
arterial blood oxygen (Pa02)
various drugs
intracranial pathologies.

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What is the normal CBF rate?

Approximately 50 mL/100g brain tissue per minute, totaling 750 mL/min which is 15% of cardiac output.

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What does the Monro-Kellie hypothesis state?

Any increase in one component of intracranial volume must be offset by a decrease in another component to prevent elevated ICP.

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____ is a reflection of dura that separates the two cerebral hemispheres

Falx cerebri

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_____ is a reflection of dura that lies rostral to the cerebellum and separates the surpatentorial and infratertorial spaces

Tentorium cerebelli

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Herniation against the flax cerebri (midline shift)
Herniation of surpatentorial contents against tentorium cerebello (compress brainstem)

Subfalcine
Transtentorial

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What are the common causes of increased intracranial pressure (ICP)?

Tumors
Intracranial hematomas
Infections (meningitis or encephalitis)
Blood in the CSF
Edema in surrounding brain tissue.

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What are the methods to decrease ICP?

Elevation of the head
Hyperventilation
CSF drainage
Hyperosmotic drugs
Diuretics
Corticosteroids
Surgical decompression.

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What is Multiple Sclerosis (MS)?

A progressive, autoimmune demyelination of central nerve fibers, typically onset age 20-40.

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What are risk factors for MS?

female
1st deg relative
smoking

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What are common symptoms of Multiple Sclerosis?

Motor weakness
Sensory disorders
Visual impairment
Autonomic instability.

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What triggers exacerbations in Multiple Sclerosis?

Stress
Elevated temperatures
Postpartum period.

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How is MS treated?

No cure.
manage w
1. Corticosteroids
2. immune modulators
3. targeted antibodies (IVIG)

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MS anesthesia considerations

Manage temp
Avoid succs (will cause hyperk)
Give steroids if they are on long term steroids

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What is Myasthenia Gravis?

An autoimmune disorder characterized by antibodies against nicotinic acetylcholine receptors at the skeletal motor endplate.

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What are common symptoms of Myasthenia Gravis?

Muscle weakness, exacerbated with exercise
Ocular symptoms (diplopia, ptosis)
Bulbar involvement.

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What is Lambert Eaton Syndrome?

An autoimmune disorder characterized by antibodies against voltage-gated calcium channels, reducing ACh release at the neuromuscular junction.

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What are the symptoms of Lambert Eaton Syndrome?

Progressive limb-girdle weakness
Dysautonomia
Oculobulbar palsy.

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What is Muscular Dystrophy?

A hereditary disorder of muscle fiber degeneration caused by breakdown of the dystrophin-glycoprotein complex.

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What is the most common and severe form of Muscular Dystrophy?

Duchenne Muscular Dystrophy.

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What are the three major dementia syndromes?

Alzheimer’s (70%)
Vascular dementia (25%)
Parkinson’s (5%).

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What are common symptoms of Parkinson’s Disease?

Skeletal muscle tremor
Rigidity
Akinesia.

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What is the role of dopamine in Parkinson's Disease?

Dopamine suppresses overstimulation of the extrapyramidal motor system.

What are common symptoms of brain tumors?

* Increased ICP * Papilledema * Headache * Altered mental status * Mobility impairment.

What are the types of astrocytomas?

* Pilocytic astrocytomas * Anaplastic astrocytomas * Glioblastoma Multiforme.

What are the preanesthesia considerations for patients with neurological disorders?

* Assess existing deficits * Review imaging and neurological testing results * Evaluate risks/benefits of anesthetic options.

What is the average lifespan for a patient with Duchenne Muscular Dystrophy?

Approximately 20-25 years due to cardiopulmonary complications.

What should be avoided in patients with Myasthenia Gravis during anesthesia?

Succinylcholine, as it may induce hyperkalemia.

True or False: Hyperventilation can help decrease ICP.

True.

What is the effect of corticosteroids in the management of increased ICP?

They decrease swelling and enhance the integrity of the blood-brain barrier.

Fill in the blank: The triad of symptoms in Parkinson's Disease includes tremor, rigidity, and _______.

Akinesia.

What are Pituitary Adenomas?

Noncancerous tumors with varying subtypes ## Footnote Surgical removal through transsphenoidal approach or open craniotomy is usually curative.

What are Acoustic Neuromas?

Benign schwannomas involving the vestibular component of CN VIII within the auditory canal ## Footnote Good prognosis with resection and/or radiation.

What is the prognosis for Metastatic Carcinomas?

Generally less favorable outcomes ## Footnote Symptoms and origins can vary widely.

What are the key components of preanesthesia consideration?

* Review history & physical * Inquire about previous therapies * Assess presenting symptoms & neurological deficits * Monitor glucose levels if on steroids * Use anticonvulsants for supratentorial lesions * CBC, BMP, EKG * CT/MRI * Pre-op steroids & antiseizure meds per surgeon * Mannitol for intracranial pressure

What does CVA stand for?

Cerebral Vascular Accident

What is the leading cause of death and disability worldwide?

Stroke

What are the two main causes of strokes?

* Ischemia (88% of cases) * Hemorrhage (12% of cases)

What supplies blood to the brain?

* Internal carotid arteries * Vertebral arteries

What is an Ischemic CVA?

Occlusion of a vessel that perfuses a region of the brain, causing brain cell necrosis

What is a Transient Ischemic Attack (TIA)?

Sudden focal vascular neurologic deficit that resolves within 24 hours

What percentage of patients who experience a TIA will subsequently suffer a stroke?

1/3

What is the initial treatment for Ischemic stroke?

PO Aspirin is often recommended

What is the time window for administering IV or intra-arterial tissue plasminogen activator (TPA)?

3-4.5 hours post onset

What are the categories of causes for Ischemic stroke according to the TOAST classification?

* Large artery atherosclerosis * Small vessel occlusion * Cardioaortic embolic * Other etiology * Undetermined etiology

What is a Hemorrhagic CVA?

Bleeding inside the cranial vault that impairs perfusion of the brain

How much more likely is a Hemorrhagic stroke to cause death compared to an Ischemic stroke?

4 times more likely

What are the two most reliable predictors of outcome in Hemorrhagic strokes?

* Blood volume * Change in level of consciousness (LOC)

What are the subtypes of Hemorrhagic strokes based on the location of blood?

* Intraparenchymal hemorrhage * Epidural hematoma * Subdural hematoma * Subarachnoid hemorrhage * Intraventricular hemorrhage

What is the conservative treatment for Hemorrhagic stroke?

* Reduction of ICP * BP control * Seizure precautions * Monitoring

What is the surgical treatment for Hemorrhagic stroke?

Evacuation of the hematoma

What should be done if a patient is on anticoagulants for CVA prophylaxis?

Consult prescriber to establish protocol

What are the imaging studies used for cerebrovascular disease pre-op?

* Carotid U/S * CT/MRI of head & neck * Echocardiogram

What is a major characteristic of Cerebral Aneurysms?

Majority are not diagnosed before rupture

What are the symptoms of a ruptured Cerebral Aneurysm?

* Headache * Photophobia * Confusion * Hemiparesis * Coma

What is the recommended intervention time frame following a rupture of a Cerebral Aneurysm?

Within 72 hours for best outcomes

What is Triple H therapy used for?

To manage post-SAH vasospasms

What does AMV stand for?

Arteriovenous Malformation

What is the main characteristic of Arteriovenous Malformation?

Arterial to venous connection without intervening capillaries

What is Hydrocephalus?

Excessive accumulation of CSF causing increased ICP and ventricular dilatation

What are the surgical treatments for Hydrocephalus?

* Ventriculoperitoneal (VP) shunt * Endoscopic third ventriculostomy (ETV)

What is the Glasco Coma Scale used for?

To categorize the severity of Traumatic Brain Injury

What are the primary and secondary injuries in Traumatic Brain Injury?

* Primary injury occurs at time of insult * Secondary injuries include neuroinflammation, cerebral edema, hypoxia, anemia, electrolyte imbalances, and neurogenic shock

What is a seizure?

Transient, paroxysmal, synchronous discharge of neurons in the brain

What is Epilepsy?

Recurrent seizures due to congenital or acquired factors

What should be reviewed during pre-anesthesia for patients with seizure disorders?

Source of seizures and control level

Subtype of transtentorial herniation

Uncal