Neurocritical care

Question 1

What is normal ICP?

Answer 1

7.5 - 20 cm water

Question 2

How does hyperventilation lead to reduced ICP?

Answer 2

Hypercapnea leads to cerebral vasoconstriction and therefore cerebral blood volume

Question 3

Ruptured vessel in subdural? Epidural?

Answer 3

SDH: Bridging veins

Epidual: middle meningeal artery

Question 4

Features of A waves on ICP monitoring?

what are they associated with?

Answer 4

Duration 5-20 minutes, amplitude 50-100 mm Hg.

A/w intracranial HTN

Question 5

What skin finding can be seen in fat emobolism?

Answer 5

Petechial rash

also a/w petechial hemorrhage in brain autopsy

Question 6

What is “triple H” therapy for vasospasm in SDH:

Answer 6

Hypervolemia, hypertension, and hemodilution

Isotonic fluids +/- pressors

Question 7

Breathing pattern asociated with bilateral pontine lesions?

Medullary?

Answer 7

Pontine: Apneustic breathing (pause after full inspiration)

Medullary: Ataxic breathing (irregular, gasping)

Question 8

Pathway active to cause decerebrate posturing?

Pathway possibly active to cause decorticate posturing?

Answer 8

Decerebrate: Vestibulospinal (Extensor of all limbs)

Decorticate Rubrospinal (Flexion of arms) - controversial in humans

(Posturing comes from loss of inhibition from above tracts).

Question 9

Deficits in uncal herniation

Answer 9

Ipsilateral fixed dilated pupil (CN III)
Hemiplegia, usually contralateral
Decreased LOC

Question 10

What medication can be used to treat malignant hyperthermia?

Answer 10

Dantrolene (blocks Ca release from the SR)

Question 11

Genetic cause of malignant hyperthermia risk?

Answer 11

AD mutation in RyR

Question 12

What other neurological disease is associated with risk of malignant hyperthermia?

Answer 12

Central core myopathy (also due to a RyR receptor mutation)