neurocritical care Flashcards
what type of edema is involved in obstructive hydrocephalus?
interstitial
what type of edema is associated with brain tumors?
vasogenic
what type of edema is associated with hypoxic ischemic injury?
cytotoxic.
what symptoms does and uncal herniation cause?
ipsilateral dilated pupil, contralateral hemiparesis.
what is the normal range of ICP?
5-15 cm H2O
When using hyperventilation to treat increased ICP, what is the goal pCO2?
30 mm Hg
When using Mannitol to treat increased ICP, what is the goal serum osmolality?
320 mOsm/L
what are some associated complications to using mannitol?
wasting of Potassium, magnesium and phosphorus. Should not be used if there is significant disruption of the BBB.
stupor
pathologically reduced consciousness but arousable with vigorous external stimulation.
Coma
patient is unarousable. May grimace or have stereotyped withdrawal to noxious stim, but does not localize.
vegitative state
unresponsive patient with an apparent sleep-wake cycle. Persistent if lasts > 30 days.
under what circumstances is surgical evacuation of SDH indicated?
when it is larger than 1cm or of there is midline shift.
what are 3 complications of SAH?
- vasospasm 2. acute hydrocephalus 3. rebleeding
what foramina does the middle meningeal artery pass through?
foramen spinosum.
sensitivity of CT in SAH
95% in the first 48 hours.
rate of sodium correction in hyponatremia to avoid CPM.
no more than 12 mEq/L/day or 0.5mEQ/L/hr
what is the Ca channel blocker of choice to prevent vasospasm after SAH.
Nimodipine.
What is the “triple H” treatment of vasospasm after SAH?
Hypertension, hypervolemia (with isotonic fluids) and hemodilution.
what is apneustic breathing and in what lesions is it seen?
pause at the end of full inspiration. Seen with bilateral pontine lesions.