Neurological Diseases Flashcards
Test 3
CBF is modulated by ____ (5)
Cerebral metabolic rate
CPP
PACO2
PAO2
Various drugs and intracranial pathology
CPP =
Cerebral perfusion pressure
CPP = MAP - ICP
Cerebral blood flow is ____
Autoregulated
What is the value of CBF?
50 ml/100g brain tissue per min –>
750ml/min
CBF is about ___% of CO
15%
What does the intracranial & spinal vault contain?
Neural tissue (brain/spinal cord)
Blood
CSF
The spinal vault is enclosed by the ______ & ______
Dura mater
Bone
What is the combined volume of brain tissue, CSF, and intracranial blood? What is the ICP at this volume?
1200 - 1500 ml
ICP = 5 - 15 mmHg
What is the Monro-Kellie hypothesis?
Any increase in one component of intracranial volume must be offset by a decrease in another component to prevent in elevated ICP
T/F: eventually, a point is reached with a small increase in intracranial content results in a large increase in ICP –> cerebral ischemia
T
The _______ separates the two cerebral hemispheres
Falx cerebri
Describe the Tentorium cerebelli
Rostral to the cerebellum
Separates the supratentorial & intratentoiral spaces
Increases in contents in 1 may cause ______ increases in ICP
regional
Describe a subfalcine herniation
Against the falx cerebri –> compress branches of anterior cerebral art. –> midline shift
Describe Transtentorial Herniation
Supratentorial contents against tentorium cerebelli –>compress brainstem (in a rostral to caudal direction)
S/S: AMS
Defects and ocular reflexes
Hemodynamic/respiratory compromise
Death
Describe Uncal herniation
Uncus (medial portion of temporal lobe) herniate over the tentorium cerebelli
S/S: ipsilateral oculomotor nerve dysfunction
Pupil dilation
ptosis
Lateral deviation of the affected eye
Brainstem compression
Death
describe herniation of the cerebellar tonsils
Caused by elevated infratentorial pressure –> cerebellar structures herniate thru foramen magnum
S/S: medullary dysfunction
Cardiorespiratory instability
Death
What causes an increase in ICP? (4) How?
- Tumors: size; causes edema in surrounding brain tissue; tumors in 3rd ventricle obstruct CSF flow
- Intracranial hematomas
- Blood in CSF: obstructs CSF absorption; granulations further IICP
- Infections (Meningitis/encephalitis): edema; obstruction of CSF reabsorption
List methods to decrease ICP (8)
- Elevate head
- Hyperventilation: lowers PaCO2
- EVD: drains CSF
- Hyperosmotic drugs: increase serum osmo –> drawing fluid across BBB
- Diuretics
- Corticosteroids
- Propofol (Cerebral vasoconstricting anesthetics): decreases CMRO2/CBF
- Sx decompression
What is MS? Rx; S/S; Triggers; Tx
Multiple Sclerosis
Genetic Neurological disorder
Progressive, autoimmune
Demyelination of central nerve fibers
Rx: Female; smoking; other autoimmune disorders; EBV (Ebstein-barr virus), 1st degree relative that has it
S/S: motor weakness, sensory disorders, visual impairment, autonomic instability
Triggers: Stress, elevated temps; post partum
Tx: No cure
Managed w/ steroids, immune modulators, targeted antibodies (IVIG)
MS is more common in ______ and the onset is ______yo
females
20-40 yo
What my considerations with MS?
- Respiratory compromise –> pulm function tests
- Liver function tests lab if on dantrolene & azathioprine (bone marrow suppression & liver function impairment)
- Preop steriods
- temp management –> can trigger an exacerbation
- Avoid succs –> induce hyperkalemia
T/F: With MS, you cant do GA
F
All anestheia options are acceptable
What is MG? Rx; S/S; Triggers; Tx
Myasthenia Gravis
Genetic Neurological disorder
Autoimmune antibodies generated against N-ACh-r at skeletal motor endplate
S/S: muscle weakness, diplopia, ptosis
tiggers: pain, insomnia, infection, Sx
Tx: Ach-E inhibitors (pyridostigmine), immunosuppressants, steroids, plasmapheresis, IVIG, thymectomy
MG affects _______ muscle and is exacerbated with ________
skeletal muscle (ONLY)
exercise
MS has _____ & ______ involvement. What symptoms will you see?
ocular
bulbar
ocular: diplopia, ptosis
Bulbar: laryngeal/pharyngeal weakness –> resp/aspiration!!!!
MG has _______hyperplasia and 90% of pts improves with ________
thymic
thymectomy
What are MG considerations?
-Reduce paralytic dose – prolong muscle weakness
-Caution w/ opioids – resp compromise
Pyridostigmine may prolong Succs & Ester LA –> this is bc this med is used in the treat tx of this.
-Liver function test if on Azathioprine
-Preop steroids
Counsel pt on risk of needing to be on vent longer post Sx
Eaton-Lambert has S/S similar to _____
MG
What is Eaton-Lambert syndrome? Rx; S/S; Tx
Genetic Neurological disorder
Autoimmune antibodies against VG Ca++ channels
Reduces Ca influx into presynaps –> decrease Ach release at NMJ
Sx: progressive limb-girdle weakness, dysautonomia, oculobulbar palsy (similar to MG)
Tx: 3-4 diaminopyridine (K channel blocker), Azathioprine, Ach-E inhibitors, steroids, plasmapheresis, IVIG
Eaton-Lambert syndrome is ________ sensitive than MG to muscle relaxants
More
ELS is very very sensitive to them!!!
What are Eaton-Lambert syndrome considerations?
Optimize resp. function
Very sensitive to muscle relaxants
Use EXTREME caution with opioids as well
Counsel on needing vent post Sx
What is Muscular Dystrophy (MD)?
Hereditary disorder of muscle fiber degeneration –> dystrophin-glycoprotein breakdown –> skeletal muscle permeability; myonecrosis, fibrosis
There are ___ types of MD
6
What is the most common type of MD?
Duchenne MD
Most severe form
Duchenne MD occurs in _____ and has an onset of ____
boys
2-5yo
Duchenne MD will be wheelchair bound by _______ and has a lifespan of _____. What is this caused by?
Wheelchair bound: 8-10 yrs
Lifespan: 20-25yrs
Death caused by: cardiopulmonary complications
What are the S/S of MD?
Progressive muscle wasting w/o muscle/sensory abnormalities; long bone fragility; resp weakness; frequently PNA; EKG changes
In MD, your _______ lab will be elevated. Why is this?
Creatine kinase
dt muscle wasting
What is hypermetabolic syndrome? What patholgy is this seen in?
Seen in MD
Similar to MH –> triggered by Succs & VA
Can lead to rhabdo, hyperK+, vfib, cardiac arrest
Keep MH cart close w/ Dantrolene!!
What medications do you avoid in MD? Why? What can you use instead?
Succs & VA
exacerbate instability of muscle membrane –> hypermetabolic syndrome
You can use Roc and TIVA for GA
What considerations should we have with MD?
EKG, Echo
Hypermetabolic syndrome (no succs/VA)
Have MH cart close
Why do we need an EKG and Echo for MD?
Evaluate for cardiomyopathy
EKG changes can occur
What is the prefered type of anesthesia for MD? Why?
RA over GA to avoid triggers and cardiopulmonary complications
What are the 3 different types of Myotonic Dystrophies?
Myotonic Dystrophy
Myotonia Congenita
Central Core Disease
Define Myotonia (Myotonic)
Prolonged contraction after muscle stimulation
Describe Myotonic Dystrophy: Onset; s/s
Onset: 20-30yo
S/S: muscle wasting in face, masseter, hands, pretibial
-Can affect pharyngeal, laryngeal, diaphragm
-Cardiac Conduction may be affected 20% MVP
Describe Myotonia Congenita
Involves skeletal muscles only
Describe Central Core Disease: s/s
Core muscle cells lack mitochondrial enzymes
s/s: proximal muscle weakness, scoliosis
______ is seen in several muscle disorders
Myotonia
Which Myotonic dystrophy is the most common type?
Myotonic dystrophy
Which Myotonic dystrophy is the milder form?
Mytonia Congenita
Which Myotonic dystrophy is very rare?
Central core disease
What are all Myotonic dystrophies triggered by?
Stress
Cold
What is the Tx for Myotonic dystrophies?
No cure
Manage: Quinine, Procainamide (anti arrhythmic), steroids
What are the considerations for Myotonic dystrophies?
-Assess cardiac/pulmonary abnormalites
-GI hypomotility –> aspiration risk
-High risk endocrine abnormalities –> check thyroid/glucose
-Keep pts warm
-optimize preop resp status
-Avoid Succs –> trigger
-Caution w/ opioids
-postop resp weakness
What are the 3 Dementia Syndromes?
Alzheimer’s (70%)
Vascular dementia (25%)
Parkinsons (5%)
What considerations should we have when Dementia?
-May not be able to give informed consent
-advanced directive
-potential aspiration (may have full stomach - cant remember/tell when last ate)
-Review preop meds – AChE-I, MAOI, psych meds
-risk of postop delirium – consider TIVA
-RA > GA
What type of anesthesia is prefered in Dementia? Why?
RA or TIVA
Parkinsons disease has an _______ cause
unknown
T/F: You can give a Dementia pt versed
F
Increased risk of postop delirium
What is the biggest risk factor for Parkinson’s?
Advanced age
What is Parkinson’s disease?
Degeneration of dopaminergic fibers of basal ganglia –> decreased dopamine release –>motor neurons overstimulated –> increased extrapyramidal motor system
What does dopamine suppress?
Overstimulation of the extrapyramidal motor system
What are the triad s/s of Parkinson’s?
Skeletal muscle tremor
Rigidity
Akinesia
What are the s/s of Parkinson’s? Tx?
s/s: Rhythmic “pill rolling”
facial rigidity
Slurred speech
Difficulty swallowing
Respiratory difficulty
Depression
Dementia
Akinesia
Tx: Levodopa; anticholinergics; MAOIs, deep brain stimulators
What are considerations for Parkinson’s?
-assess severity – degree of pulmonary compromise
-Home meds – MAOIs interact with demerol
-Pulm function test
-EKG/Echo
-aspirational risk –> most have dysphagia at baseline
In Parkinson, PO Levodopa must be ________. Why?
Continued
Avoid unstable, extreme extrapyramidal effects –> chest wall rigidity
What medications do you avoid in Parkinsons?
Reglan
Phenothiazine
Butyrophenones
If pt is taking an MAOI, you want to avoid giving ________
Demerol
In Parkinsons, what consideration should we have with deep brain stimulators?
Bipolar is recommended –> If not, discontinue.
Need to avoid interaction with cautery
The main AE of brain tumurs are _______
Neuro deficits
What are the s/s of brain tumors:
-IICP
-Papilledema
-HA
-AMS
-Mobility impairment
-N/V
-Autonomic dysfunction
-Seizures
What is the frontal lobe responsible for?
Personality
Movement
Sense of smell
What is the temporal lobe responsible for?
Memory
Speech
Musical Rhythm
What is the partietal lobe responsible for?
Identification of objects
Sense of pain & touch
Body navigation
Spatial position
What part of the brain is responsible for identification of pain and touch?
Parietal Lobe
What is the occipital lobe responsible for?
Vision
What is the medulla responsible for?
Control of heart and lungs
What are the pons responsible for?
Control of eye and face movement
What is the most common CNS glial cells?
Astrocytes
What are the tumors originating from the astrocytes called? What are the different types?
Astrocytomas
Types: Gliomas
Pilocyctic astrocytomas
Anaplastic astrocytoma
Glioblastoma Multiforme
Describe Gliomas
Primary tumor
found in yound adults
s/s: new onset seizures
Describe Pilocyctic Astrocytomas
Benign
Found in children & young adults
Good outcomes w/ resection
Describe Anaplastic Astrocytoma
Poorly differentiated
Can evolve into a Glioblastoma Multiforme
Describe Glioblastoma Multiforme
High mortality
requires sx debulking & chemo
Life expectancy usually weeks even w/ Tx
What is the least aggressive astrocytoma?
Gliomas
What astrocytomas usually evolves into a Glioblastoma Multiforme?
Anaplastic Astrocytoma
Describe Meningiomas
Benign
Arise from Dura or arachnoid tissue
Good prognosis w resection
Describe Pituitary Adenomas
Non-cancerous
Varying sub types
tx: Transsphenoidal or open crani for removal –> curative
Describe Acoustic Neuromas
Benign Schawannomas
vestibular component of CN VIII within auditory canal
Good prognosis w/ resction/radiation
Which cranial nerve is within the auditory canal? Which tumor has involvement with this?
CN VIII (8)
Acoustic Neuromas
Describe Metastatic Carcinomas
Vary widely in origin & s/s
Outcomes less favorable
What are considerations w/ brain tumors?
-inquire about previous therapies
-CT/MRI
-Autonomic dysfunction – EKG
Radiation damage can cause ______ and Chemotherapy can cause ______ effects
lethargy/AMS
neuro
What meds are pts usually on that have/has had a brain tumor? What do we need to consider?
Steroids – continue to& monitor glucose
Anticonvulants
Why are supratentorial lesions at increased risk for seizures?
Closer to motor cortex
________ is often used to reduce intracranial volume/pressure
Mannitol
What are the 2 types of strokes? Which is more common? More deadly?
Ischemic – more common
Hemorrhagic – more deadly
What is the leading cause of death and disability worldwide?
Stroke
Strokes are characterized by sudden _______ deficits
Neuro
____% of strokes are ischemic and _____% of strokes are hemorrhagic
88%
12%
What arteries supply blood to the brain?
Internal carotid arteries
Vertebral arteries
The Internal carotid arteries & Vertebral arteries join on the _______ surface of the brain. What do they form?
Inferior
Circle of Willis
What is the circle of Willis?
Vessel joint on the inferior surface of the brain
Provides collateral circulation to multiple areas of the brain
The circle of Willis provides _______ circulation
Collateral
Artery occlusion presentation: Anterior cerebral
Contralateral leg weakness
Artery occlusion presentation: Middle cerebral
-Contralateral hemiparesis & hemisensory deficit
-Aphasia
-Contralateral visual field deficit
Artery occlusion presentation: Posterior cerebral
-Contralateral visual field deficit
-Contralateral hemiparesis
Artery occlusion presentation: Penetrating arteries
-Contralateral hemiparesis
-Contralateral hemisensory deficits
Artery occlusion presentation: Basilar artery
Oculomotor deficits
ataxia
crossed sensory deficit
motor deficits
Artery occlusion presentation: Vertebral Artery
Lower cranial nere deficits
ataxia
crossed sensory deficit
Ischemic strokes are caused by an _______ and cause _______
Occlusion
Brain cell necrosis
What is a TIA?
Transient ischemic attack
Sudden focal vascular neuro deficit
TIAs normally resolve within _____hrs
24
T/F: Pts who experience TIAs normally dont have strokes
F
1/3 of pts who have a TIA will experience a stroke
If a stroke is suspected, a STAT ___________ is needed
NONCONTRAST CT
Thrombolytic therapy should be initiated within ______ of hospital arrival
90 mins
What is the TOAST classification?
Categorizes ischemic strokes into 5 groups/classes based on cause
Describe TOAST classification: class 1
Large artery artherosclerosis
ex) carotid stenosis
Describe TOAST classification: class 2
Small vessel occlusion
Ex) Lacunar stroke
Describe TOAST classification: class 3
Cardioaortic embolic
Ex. emboli from afib
Describe TOAST classification: class 4
Other etiology
Ex. hypercoag/vasculopathies
Describe TOAST classification: class 5
Undetermined etiology
What is the initial Tx in Ischemic CVA?
Aspirin
What is the time frame for TPA post onset of s/s?
3 - 4.5 hrs
What is the best option for an Ischemic stroke? Describe this
Revascularization
Done in the IR
Angiographic fluoroscopy is used
Direct administration of thrombolytics or thrombectomy to the clot
What considerations should we have w revascularization?
Be concise/efficient – not use alot of time/avoid delay
Focus: baseline neuro
Ability to lay flat
CV function
Can procedure be done under sedation
Secure airway? (Aspiration)
Consider other CV risk factors that may effect hemodynamics (HTN, DM, CAD, Afib, Valve)
Hemorrhagic stroke is _____x more likely to cause death than ischemic
4x
What are the 2 most reliable predictors of outcome in hemorrhagic stroke?
Blood volume
Change in LOC
Subtypes of hemorrhagic stroke are based on ________. What are they?
Location
- Intraparenchymal hemorrhage: blood w/i brain
- epidural hematoma
- subdural hematoma
- subarachnoid hemorrhage
- Intraventricular hemorrhage: blood w/i ventricle
Which subtype of hemorhagic stroke usually occurs in conjuction w another?
Intraventricular hemorrhage:
What is the Tx for hemorrhagic stroke? What type of unit do they go to?
Conservative: Reduce ICP, BP control, Seizure precautions, monitoring
Sx: Evac –> Neuro ICU required
With new anticoagulants for thrombus, when is the soonest you can do an elective Sx?
No elective Sx within 3 months
If you need to pause warfarin (LA anticoagulants), what can you bridge it with?
Heparin
T/F: If you’ve had a stroke, you have to continue your anticoags with RA
F
Need to d/c for sufficient time to safely before RA/LA
What are cerebrovascular/stroke consideration we should have?
Neuro assessment
Ask about HA, tinnitus, vision/memory, bathroom issues
Imaging
EKG
Labs
Aline, 2 IVs, CVC
T/F: Majority of cerebral aneuryms are Dx before ruputure
F
Only 1/3 of pts Dx/Sx before ruputure
What are s/s & risk factors of cerebral aneurysms? Tx?
s/s: HA
Photophobia
confusion
hemiparesis
coma
rx: HTN
smoking
female
PO contraceptives
cocaine
Tx: coiling, stenting, trapping/bypass
T/F: Males are more at risk of cerebral aneurysms
F
females
Interventions for cerebral aneurysms should be performed w/i ______ for best outcomes
72 hours
The risk of a vasospasm happens in _______ post Subarachnoid hemorrhage (SAH)
3 - 15 days
What triggers a Subarachnoid hemorrhage (SAH) vasospasm? What is the patho of this?
Free hgb triggers inflmmatory mediators –> decrease NO –> increase endothelin 1 –> vasconstriction
What is the Tx for Subarachnoid hemorrhage (SAH) vasospasm? What is the initial Tx? Why?
Triple H: HTN (initial)
Hypervolemia
Hemodilution
HTN is initial to avoid complications of hypervolemia
What are the interventional Tx for Subarachnoid hemorrhage (SAH) vasospasm?
Balloon dilation & direct injection of vasodilators
What is AV malformation?
Arteriovenous malformation
Congenital
Arterial to venous connection WITHOUT capillaries
Majority of AV malformations are _________
Supratentorial
What is the Dx for AV malformation? Tx?
Dx: Angiogram
MRI
Tx: radiation
angio-guided embolization
surgical-resect (higher mortality)
Which AV malformation Tx has the highest mortality?
Surgical Resection
What is a congenital brain abnormalities?
Hereditary defect in development or structure of the CNS
T/F: Congenital brain abnormalities can be diffuse or confined
T
What are the common Congenital brain abnormalities? (4)
- Chiari Malformation
- Tuberous Sclerosis
- Von Hippel-Lindau Disease
- Neurofibromatosis
What is Chiari Malformation? S/s; Tx.
Congenital displacement of the cerebellum
s/s: HA extending to shoulder/arm
visual disturbances
ataxia
Tx: Sx decompression
Chiari malformation had ____ different types
4
Describe Type 1 Chiari Malformation
Downward displacement of cerebellum
Describe Type 2 Chiari Malformation
“Arnold Chiari”
Downward displacement of cerebellar vermis
Associated w myelomeningocele
Describe Type 3 Chiari Malformation
rare
occipital encephalocele w/ downward cerebellar displacement
Describe Type 4 Chiari Malformation
Cerebellar hypoplasia w/o pisplacement of posterior fossa contents
Not compatible w life
Which Chiari Malformation is associated with myelomeningocele?
Type 2
Which Chiari Malformation is not compatible with life?
Type 4
With Chiari Malformation, you can __________ to decrease ICP
hyperventilate
What is Tuberous Sclerosis?
Genertic disease causing benign hematomas, angiofibromas, and other malformations ANYWHERE IN THE BODY
Tuberous Sclerosis is also called _______
Bournevile disease
In Tuberous Sclerosis, lesions of the brain include _____ tumors & giant cell _________
cortical tumors
giant cell astrocytomas
In Tuberous Sclerosis, often involves co-existing tumors in which places?
Face
Oropharnyx
Heart
Lungs
Liver
Kidney
How will Tuberous Sclerosis present?
Mental retardation
Seizures
What are considerations w Tuberous Sclerosis?
Airway compromise
Cardiac & kidney involvement
What is Von Hippel-Lindau Disease?
Genetic
formations of benign tumors of CNS
Location:Eyes
Adrenals
Pancreas
Kidneys
May present w pheochromocytoma
May have co-existing spinal tumor
What congenital disorder may present with pheochromocytoma? What considerations should we have?
Von Hippel-Lindau Disease
Increased catecholamines –> increased BP!!!
What type of anesthesia may be limited in Von Hippel-Lindau Disease. Why?
Neuraxial anesthesia
May have co-existing spinal tumor
What is Neurofribromatosis? Tx
Genetic disorder of CNS that causes tumors to form on the nerves in the body anywhere at anytime
Tx: No cure
What are the 3 types of Neurofribromatosis? Which chromosomes are affected?
Type 1: chromosome-17
Type 2: Chromosome-22
Schwannomatosis: Chromosome-22
Which type of Neurofribromatosis is most common?
Type 1
Which type of Neurofribromatosis is most rare?
Schwannomatosis
What are the considerations w Neurofribromatosis?
IICP
Airway
Scoliosis
possibility of pheochromocytoma
What type of anesthesia should we avoid with Neurofribromatosis? Why?
Neuraxial anesthesia
High likelihood of spinal tumors
T/F: No 2 cases of Neurofribromatosis are the same
T
They are HIGHLY varied and unpredictable
Neurofribromatosis affects almost ___% of organs in the body
100%
What is the patho for hydrocephalus?
Imbalance between CSF production/absorption –>
CSF accumulation–> IICP –> ventricular dilation
T/F: Hydrocephalus can be congenital or acquired
T
what is the Tx for hydrocephalus?
Diuretics: Furosemide
-acetazolamide
Serial lumbar punctures as temporizing measure
Majority require Sx: Ventriculoperitoneal (VP) shunt
-endoscopic third ventriculostomy (ETV)
what is a VP shunt? What is it a treatment for?
“Ventriculoperitoneal shunt”
Drain place in brain ventricle –> empties into peritoneum
Tx for Hydrocephalus
What is an ETV? What is it treatment for?
“endoscopic third ventriculostomy”
Catheter placed into the lateral ventricle of brain –> drains into the peritoneal space, R atrium, or pleural space (rare)
The _______ is rarely used to drain with ETV
pleural space
VP shunt malfuntion is mostly likely to occur within ______ of placement
1 year
How are TBIs categorized?
By breech of dura as either
“Penetrating” or “Nonpenetrating”
Severity of a TBI is based on the ______
GCS (Glasgow-Coma Scale)
What is the difference between a primary and secondary injury in a TBI? What are examples.
Primary occurs at time of injury
Secondary is what happens after, as a result of the primary injury
Ex: neuroinflammation, cerebral edema, hypoxia, anemia, electrolyte, and balances, neurogenic shock
Intubation is usually required in a TBI if GCS is less than ____
9
With a TBI we need a stat ______
CT of head/neck
What is the main consideration with a TBI?
Do not delay surgery!!!!!!!
-C-spine stabilization
-uncrossmatched blood if no time for type&screen
-NO NGT/OGT!!!!!! – basal skill fx risk
-ISTAT, pressors, bicarb, Ca, blood
T/F: You can put a NGT/OGT in a pt with a TBI
F
You should refrain from doing this – risk of basal skull fx
What is a seizure? What is epilepsy?
Seizure: transient, paroxysmal, synchronous discharge of neurons in the brain
Epilepsy: recurrent seizures d/t congenital or acquired factors
What causes seizures?
Could be congenital
Transient abnormalities: hypoglycemia
-hyponatremia
-hyperthermia
-intoxication
Anti-epileptic drugs decrease ________ & enhance ________
Neuronal excitability
Neuron inhibition
What are anesthesia considerations with seizures?
-Determine source of seizure
-Figure how well the seizures are controlled
-give anti-seizure meds BEFORE incision
-review home meds
What anti-seizure medications are CYP450 inducer? What does this mean?
Phenytoin
Tegretol
Barbiturates
These drugs will increase the metabolism of other drugs that are metabolized in the liver –> ** drugs metabolized by the liver will require higher dosages**
what procedure do you use to intubate post seizure?
RSI w/ cricoid pressure
What is the grading system for the prognosis/mortality w aneurysm?
Hunt & Hess classification: Scores 1-5; higher score = increased mortality
World Federation of neurologic surgeons grading system –> Glasgow-Coma Scale
What is the AV Malformation (AVM) grading system called?
Spetzler-Martin AVM grading system: Points assigned; the more points totaled = the higher risk of neuro deficit.
