Neurologic Diseases (Exam III) Flashcards

1
Q

What vessels provide the blood flow to the brain?

A
  • 80% via the carotid arteries
  • 20% via the vertebral arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the pertinent vasculature of the circle of Willis.

This card is just to look at the picture on the other side.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What factors affect cerebral blood flow?

A
  • CMR (cerebral metabolic rate)
  • CPP (cerebral perfusion pressure)
  • ICP
  • PaCO₂
  • PaO₂
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much O₂ is required by the brain per minute?

A

3 mlO₂ / 100g / min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the average cerebral blood blow?

A

50ml/100g/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs and/or metabolic states will decrease CMR?

A
  • Hypothermia
  • Anesthetic drugs (VAA, prop, etomidate, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drugs and/or metabolic states will increase CMR?

A
  • Hyperthermia
  • Seizures
  • Ketamine
  • N₂O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What temperature range do we generally want to keep our patients in?

A

36 - 38° C

This card previously said 42 which is 107.6F lol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is hypothermia mediated EEG suppression achieved?

A

18 - 20° C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypothermia will cause a ___% decrease for every 1°C decrease.

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What would a temperature of > 42°C do to the brain?

A

Denature proteins and destroy neurons (↓CBF)

This is a crazy high temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

At what cerebral blood flow rates would one expect irreversible brain damage?

A

≤ 10ml/100g/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is Cerebral Perfusion Pressure (CPP) calculated?

A

CPP = MAP - ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is MAP calculated?

A

MAP = DBP + ⅓(SBP - DBP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At what CPP and MAP does the brain exhibit autoregulation (myogenic response) ?

A

CPP of 50 - 150 mmHg
MAP of 60 - 160 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

With what pathologies/drugs is a loss of CPP seen?

A
  • Brain tumors
  • Head trauma
  • Volatile anesthetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can cause a rightward shift in the brain autoregulation curve?

A
  • Chronic HTN
  • SNS activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can cause a leftward shift in the brain autoregulation curve?

A

Volatile anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name the three components of the brain that form the Monroe-Kellie Doctrine.

A
  • Brain 80%
  • Blood 12%
  • CSF 8%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the Monroe Kellie Doctrine?

A

Any increase in one component of the intracranial space (blood, brain tissue, CSF) must be met with an equivalent decrease in another to prevent increased ICP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the normal CPP range?

A

80 - 100 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

An ICP > ____ mmHg will compromise CPP.

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What pathologic processes or disease states are known to cause an increase in ICP?

A
  • Tumors
  • Hematomas
  • Blood in CSF
  • Infection
  • Aqueductal Stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

At what CPPs would one expect to see EEG slowing?
What about irreversible brain damage?

A
  • EEG slowing: < 50mmHg
  • Brain damage: < 25 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the two types of hydrocephalus? Which is more common?

A
  • Obstructive (most common)
  • Communicating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What would occur from PaO₂ levels of < 50-60 mmHg in the brain?

A
  • Vasodilation
  • ↑CBF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Severe hypoxia will have what effect on cerebral blood flow?

A

↓O₂ = ↑CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PaO₂ exhibits an _______ mechanism in the brain similar to intracranial MAP.

A

autoregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What levels of PaCO₂ are maintained in the brain?

A

20 - 80 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

PaCO₂ levels are directly proportional to ______ of the cerebral vasculature.

A

vasodilation

Ex. ↑PaCO₂ = ↑dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A PaCO₂ increase of 1mmHg will correspond to an increase in CBF by how much?

A

1mmHg PaCO₂ increase = 1-2mls/100g/min increase in CBF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

A patient’s PaCO₂ is increased by 10mmHg, how much would you expect CBF to increase if the patients brain was measured to weigh 250g?

A

10mmHg x 1-2mls x 2.5 =

25 - 50 mls/min increase in CBF.

Someone check my math and the question itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

At what PaCO₂ levels does max cerebral vasodilation occur?

A

80 - 100 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

At what PaCO₂ levels does max cerebral vasoconstriction occur?

A

20 - 25 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does increased central venous pressure do to the brain?

A
  • ↓ venous drainage
  • ↑ cerebral blood volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What things will increase cerebral venous pressure?

A
  • Jugular compression (cervical collar, head rotation, etc.)
  • ↑ intrathoracic pressure (coughing, PEEP)
  • Vena Cava thrombus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What range is normal for ICP?

A

5 - 15 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What symptoms are seen with abnormally high ICP?

A
  • Headache
  • N/V
  • Papilledema
  • ↓LOC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does Cushing’s Triad indicate?
What is the triad?

A

↑ICP

  • ↑sBP
  • ↓HR
  • ↓RR (Cheyne-Stokes)
40
Q

What is the most common site of brain herniation?

A

Uncal

↑ICP forces temporal uncus into the infratentorial space (see 3 on the figure below).

41
Q

Why do the pupils become fixed and dilated with uncal herniation?

A

CN-3 (oculomotor) crosses near tentorium and is compressed by the herniation.

42
Q

How can ICP be qualitatively assessed with ultrasound?

A

By measuring the optic nerve diameter.

↑ICP = ↑ optic nerve sheath

43
Q

How can elevated ICP be treated?

Long list

A
  • Elevate HOB 30°
  • Hyperventilate
  • Drain CSF
  • Mannitol
  • Diuretics
  • Corticosteroids
  • Surgical decompression
44
Q

Increased hematocrit will result in what?

A
  • ↑ viscosity
  • ↓ CBF
45
Q

Decreased hematocrit will result in what?

A
  • ↓ viscosity
  • ↑ CBF
46
Q

What is the optimal hematocrit in the presence of elevated ICP?

A

30 - 34%

47
Q

What is luxury perfusion?

A

Combination of ↓CMRO₂ and ↑CBF

48
Q

Hypothermia ______ CBF and CMR.

A

decreases

49
Q

What is intracerebral steal?

A

When blood flow is shunted away from an ischemic area that needs that blood flow.

50
Q

How is intracerebral steal treated?

A

Reverse Steal.

Hyperventilation → vasoconstriction of healthy areas → flow redistributed to ischemic regions.

51
Q

What is CN I?

A

Olfactory - smells

52
Q

What is CN II?

A

Optic - vision

53
Q

What is CN III?

A

Oculomotor - vision (convergence, pupillary accomodation)

54
Q

What is CN IV?

A

Trochlear - vision (convergence, pupillary accommodation)

55
Q

What is CN V?

A

Trigeminal - Face

56
Q

What is CN VI?

A

Abducens - vision (convergence, pupillary accommodation)

57
Q

What is CN VII?

A

Facial -symmetry, smile, anterior tastes

58
Q

What is CN VIII?

A

Acoustic - hearing

59
Q

What is CN IX?

A

Glossopharyngeal - Gag; posterior taste

60
Q

What is CN X?

A

Vagus

61
Q

What is CN XI?

A

Spinal accessory - shrugging shoulders

62
Q

What is CN XII?

A

Hypoglossal - Tongue protrusion

63
Q

Injury to this cranial nerve results in bell’s palsy.

A

CN 7

64
Q

Eye movement in controlled by what cranial nerves?

A

3, 4, 6

65
Q

What is the Glascow Coma Scale?

A

see picture below

66
Q

What level of the spinal cord is affected with paraplegia?

A

T2 - T12

67
Q

What level of the spinal cord is affected with quadriplegia?

A

C5 - T1

68
Q

What level of the spinal cord is affected with diaphragmatic paralysis?

A

Above C5

69
Q

What is spinal shock?

A

Loss of vascular tone w/ flaccid paralysis below site of injury.

70
Q

When would one see bradycardia with a spinal injury?

A

If the injury is at T1 - T4.

71
Q

What signs/symptoms are seen with anterior cord syndrome?

A
  • Loss of pain and temperature
  • Retention of vibration and proprioception
72
Q

What signs/symptoms are seen with central cord syndrome?

A
  • Motor deficit in upper extremities
  • Pain and temperature decreased in lower extremities
73
Q

What signs/symptoms are seen with Brown-Sequard syndrome?

A
  • Lateral hemiplegia
  • Loss of proprioception/vibration on injured side.
  • Loss of pain/temperature on the contralateral side.
74
Q

What should be known about dermatomes?

A

Nothing, this is too much. Save this for another time. Take the L on this one for this test.

75
Q

Are more strokes ischemic or hemmorrhagic?

A
  • Ischemic (80%)
  • Hemmorrhagic (20%)
76
Q

Which type of stroke is more likely to cause death?

A

Hemmorrhagic (4x more likely)

77
Q

What are specific risk factors for hemmorrhagic stroke?

A
  • HTN
  • Cigarettes
  • Cocaine
  • Female
78
Q

What are specific risk factors for ischemic stroke?

A
  • HTN
  • Cigarettes
  • HLD
  • DM
  • EtOH
79
Q

Where is bleeding located with an epidural hematoma?

A

Inbetween the dura and the skull

80
Q

What intracranial bleed is characterized by:

lucidity → unconscious → conscious → unconscious

A

Epidural hematoma

81
Q

Where is bleeding in subdural hematomas located?

A

Between the dura mater and the arachnoid mater.

82
Q

What intracranial bleed is often characterized as the “worst headache of one’s life”?

A

Subarachnoid hemorrhage

83
Q

What location is often the site of bleeding in subarachnoid hemmorhaging?

A

Circle of Willis (usually aneurysmal rupture)

84
Q

Cerebral _______ is one of the complications often caused by subarachnoid hemorrhage.

A

vasospasm

Often occurs 3rd day post bleed and peaks 5-7 days in.

85
Q

How is cerebral vasospasm treated?

A

Triple “H” Therapy

  • HTN
  • Hypervolemia
  • Hemodilution
86
Q

What type of hemorrhage occurs within the brain tissue itself?

A

Intracerebral (intra-parenchymal) hemorrhage.

87
Q

What anti-cholinergic is best for Alzheimer’s patients?
Why is this?

A

Glycopyrrolate (doesn’t cross the BBB)

88
Q

What factors possibly increase the risk of developing Parkinson’s?

A
  • Welding
  • Herbicides
  • Pesticide
  • Genetics
89
Q

What s/s are associated with Parkinson’s disease?

A
  • Muscle rigidity
  • Pill-rolling tremor
  • Bradykinesia
  • Postural instability
90
Q

What drugs will counteract levodopa and are contraindicated in Parkinson’s patients?

A
  • Metoclopramide
  • Haloperidol
  • Droperidol
  • Promethazine
91
Q

What treatments are used for Multiple Sclerosis?

A
  • Corticosteroids
  • Interferon
  • Azathioprine
  • Methotrexate
92
Q

What induction agent is a good first-line agent for treatment of acute seizures?

A

Propofol

93
Q

What anesthetic drugs may be used to locate seizure foci due to their EEG potentiating effects?

A

Etomidate
Methohexital

94
Q

What are the s/s of seizures whilst under anesthesia?

A
  • ↑HR
  • HTN
  • ↑ ETCO₂
95
Q

What is anterior ischemic optic neuropathy (AION) ?
What should be known about AION?

A
  • Vision loss post-op
  • sudden and painless
  • Asymmetric optic disc swelling
96
Q

What is posterior ischemic optic neuropathy (PION) ?
What should be known about PION?

A
  • Vision loss post-op
  • More common than AION
  • No initial findings on exam
97
Q

What risk factors exist for developing ischemic optic neuropathy (ION) ?

A
  • Positioning
  • Anemia
  • ↓BP
  • Excessive fluids
  • Excessive vasopressors