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SPR25: Health Assessment > Neurological Diseases > Flashcards

Neurological Diseases Flashcards

Test 3

1
Q

CBF is modulated by ____ (5)

A

Cerebral metabolic rate
CPP
PACO2
PAO2
Various drugs and intracranial pathology

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2
Q

CPP =

A

Cerebral perfusion pressure

CPP = MAP - ICP

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3
Q

Cerebral blood flow is ____

A

Autoregulated

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4
Q

What is the value of CBF?

A

50 ml/100g brain tissue per min –>
750ml/min

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5
Q

CBF is about ___% of CO

A

15%

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6
Q

What does the intracranial & spinal vault contain?

A

Neural tissue (brain/spinal cord)
Blood
CSF

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7
Q

The spinal vault is enclosed by the ______ & ______

A

Dura mater

Bone

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8
Q

What is the combined volume of brain tissue, CSF, and intracranial blood? What is the ICP at this volume?

A

1200 - 1500 ml

ICP = 5 - 15 mmHg

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9
Q

What is the Monro-Kellie hypothesis?

A

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

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10
Q

T/F: eventually, a point is reached with a small increase in intracranial content results in a large increase in ICP –> cerebral ischemia

A

T

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11
Q

The _______ separates the two cerebral hemispheres

A

Falx cerebri

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12
Q

Describe the Tentorium cerebelli

A

Rostral to the cerebellum

Separates the supratentorial & intratentoiral spaces

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13
Q

Increases in contents in 1 may cause ______ increases in ICP

A

regional

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14
Q

Describe a subfalcine herniation

A

Against the falx cerebri –> compress branches of anterior cerebral art. –> midline shift

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15
Q

Describe Transtentorial Herniation

A

Supratentorial contents against tentorium cerebelli –>** compress brainstem** (in a rostral to caudal direction)

S/S: AMS
Defects and ocular reflexes
Hemodynamic/respiratory compromise
Death

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16
Q

Describe Uncal herniation

A

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

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17
Q

describe herniation of the cerebellar tonsils

A

Caused by elevated infratentorial pressure –> cerebellar structures herniate thru foramen magnum

S/S: medullary dysfunction
Cardiorespiratory instability
Death

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18
Q

What causes an increase in ICP? (4) How?

A
  1. Tumors: size; causes edema in surrounding brain tissue; tumors in 3rd ventricle obstruct CSF flow
  2. Intracranial hematomas
  3. Blood in CSF: obstructs CSF absorption; granulations further IICP
  4. Infections (Meningitis/encephalitis): edema; obstruction of CSF reabsorption
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19
Q

List methods to decrease ICP (8)

A
  1. Elevate head
  2. Hyperventilation: lowers PaCO2
  3. EVD: drains CSF
  4. Hyperosmotic drugs: increase serum osmo –> drawing fluid across BBB
  5. Diuretics
  6. Corticosteroids
  7. Propofol (Cerebral vasoconstricting anesthetics): decreases CMRO2/CBF
  8. Sx decompression
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20
Q

What is MS? Rx; S/S; Triggers; Tx

A

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)

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21
Q

MS is more common in ______ and the onset is ______yo

A

females

20-40 yo

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22
Q

What my considerations with MS?

A
  1. Respiratory compromise –> pulm function tests
  2. Liver function tests lab if on dantrolene & azathioprine (bone marrow suppression & liver function impairment)
  3. Preop steriods
  4. temp management –> can trigger an exacerbation
  5. Avoid succs –> induce hyperkalemia
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23
Q

T/F: With MS, you cant do GA

A

F

All anestheia options are acceptable

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24
Q

What is MG? Rx; S/S; Triggers; Tx

A

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

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25
MG affects _______ muscle and is exacerbated with ________
skeletal muscle (ONLY) exercise
26
MS has _____ & ______ involvement. What symptoms will you see?
ocular bulbar ocular: diplopia, ptosis Bulbar: laryngeal/pharyngeal weakness --> resp/aspiration!!!!
27
MG has _______hyperplasia and 90% of pts improves with ________
thymic thymectomy
28
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**
29
Eaton-Lambert has S/S similar to _____
MG
30
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
31
Eaton-Lambert syndrome is ________ sensitive than MG to muscle relaxants
More **ELS is very very sensitive to them!!!**
32
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
33
What is Muscular Dystrophy (MD)?
Hereditary disorder of muscle fiber degeneration --> dystrophin-glycoprotein breakdown --> skeletal muscle permeability; myonecrosis, fibrosis
34
There are ___ types of MD
6
35
What is the most common type of MD?
Duchenne MD **Most severe form**
36
Duchenne MD occurs in _____ and has an onset of ____
boys 2-5yo
37
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
38
What are the S/S of MD?
Progressive muscle wasting w/o muscle/sensory abnormalities; long bone fragility; resp weakness; **frequently PNA; EKG changes**
39
In MD, your _______ lab will be elevated. Why is this?
Creatine kinase dt muscle wasting
40
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!!**
41
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
42
What considerations should we have with MD?
EKG, Echo Hypermetabolic syndrome (no succs/VA) Have MH cart close
43
Why do we need an EKG and Echo for MD?
Evaluate for cardiomyopathy EKG changes can occur
44
What is the prefered type of anesthesia for MD? Why?
RA over GA to avoid triggers and cardiopulmonary complications
45
What are the 3 different types of Myotonic Dystrophies?
Myotonic Dystrophy Myotonia Congenita Central Core Disease
46
Define Myotonia (Myotonic)
Prolonged contraction after muscle stimulation
47
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**
48
Describe Myotonia Congenita
Involves skeletal muscles only
49
Describe Central Core Disease: s/s
Core muscle cells lack mitochondrial enzymes s/s: proximal muscle weakness, scoliosis
50
______ is seen in several muscle disorders
Myotonia
51
Which Myotonic dystrophy is the most common type?
Myotonic dystrophy
52
Which Myotonic dystrophy is the milder form?
Mytonia Congenita
53
Which Myotonic dystrophy is very rare?
Central core disease
54
What are all Myotonic dystrophies triggered by?
Stress Cold
55
What is the Tx for Myotonic dystrophies?
No cure Manage: Quinine, Procainamide (anti arrhythmic), steroids
56
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
57
What are the 3 Dementia Syndromes?
Alzheimer's (70%) Vascular dementia (25%) Parkinsons (5%)
58
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
59
What type of anesthesia is prefered in Dementia? Why?
RA or TIVA
60
Parkinsons disease has an _______ cause
unknown
61
T/F: You can give a Dementia pt versed
F Increased risk of postop delirium
62
What is the biggest risk factor for Parkinson's?
Advanced age
63
What is Parkinson's disease?
Degeneration of dopaminergic fibers of basal ganglia --> decreased dopamine release -->motor neurons overstimulated --> increased extrapyramidal motor system
64
What does dopamine suppress?
Overstimulation of the extrapyramidal motor system
65
What are the triad s/s of Parkinson's?
Skeletal muscle tremor Rigidity Akinesia
66
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
67
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
68
In Parkinson, PO Levodopa must be ________. Why?
Continued Avoid unstable, extreme extrapyramidal effects --> chest wall rigidity
69
What medications do you avoid in Parkinsons?
Reglan Phenothiazine Butyrophenones
70
If pt is taking an MAOI, you want to avoid giving ________
Demerol
71
In Parkinsons, what consideration should we have with deep brain stimulators?
Bipolar is recommended --> If not, discontinue. Need to avoid interaction with cautery
72
The main AE of brain tumurs are _______
Neuro deficits
73
What are the s/s of brain tumors:
-IICP -Papilledema -HA -AMS -Mobility impairment -N/V -Autonomic dysfunction -Seizures
74
What is the frontal lobe responsible for?
Personality Movement Sense of smell
75
What is the temporal lobe responsible for?
Memory Speech Musical Rhythm
76
What is the partietal lobe responsible for?
Identification of objects **Sense of pain & touch** Body navigation Spatial position
77
What part of the brain is responsible for identification of pain and touch?
Parietal Lobe
78
What is the occipital lobe responsible for?
Vision
79
What is the medulla responsible for?
Control of heart and lungs
80
What are the pons responsible for?
Control of eye and face movement
81
What is the most common CNS glial cells?
Astrocytes
82
What are the tumors originating from the astrocytes called? What are the different types?
Astrocytomas Types: Gliomas Pilocyctic astrocytomas Anaplastic astrocytoma Glioblastoma Multiforme
83
Describe Gliomas
Primary tumor found in yound adults s/s: new onset seizures
84
Describe Pilocyctic Astrocytomas
Benign Found in children & young adults Good outcomes w/ resection
85
Describe Anaplastic Astrocytoma
Poorly differentiated Can evolve into a Glioblastoma Multiforme
86
Describe Glioblastoma Multiforme
High mortality requires sx debulking & chemo Life expectancy usually weeks even w/ Tx
87
What is the least aggressive astrocytoma?
Gliomas
88
What astrocytomas usually evolves into a Glioblastoma Multiforme?
Anaplastic Astrocytoma
89
Describe Meningiomas
Benign Arise from Dura or arachnoid tissue Good prognosis w resection
90
Describe Pituitary Adenomas
Non-cancerous Varying sub types tx: Transsphenoidal or open crani for removal --> curative
91
Describe Acoustic Neuromas
Benign Schawannomas vestibular component of CN VIII within auditory canal Good prognosis w/ resction/radiation
92
Which cranial nerve is within the auditory canal? Which tumor has involvement with this?
CN VIII (8) Acoustic Neuromas
93
Describe Metastatic Carcinomas
Vary widely in origin & s/s Outcomes less favorable
94
What are considerations w/ brain tumors?
-inquire about previous therapies -CT/MRI -Autonomic dysfunction -- EKG
95
Radiation damage can cause ______ and Chemotherapy can cause ______ effects
lethargy/AMS neuro
96
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
97
Why are supratentorial lesions at increased risk for seizures?
Closer to motor cortex
98
________ is often used to reduce intracranial volume/pressure
Mannitol
99
What are the 2 types of strokes? Which is more common? More deadly?
Ischemic -- more common Hemorrhagic -- more deadly
100
What is the leading cause of death and disability worldwide?
Stroke
101
Strokes are characterized by sudden _______ deficits
Neuro
102
____% of strokes are ischemic and _____% of strokes are hemorrhagic
88% 12%
103
What arteries supply blood to the brain?
Internal carotid arteries Vertebral arteries
104
The Internal carotid arteries & Vertebral arteries join on the _______ surface of the brain. What do they form?
Inferior Circle of Willis
105
What is the circle of Willis?
Vessel joint on the inferior surface of the brain Provides **collateral circulation** to multiple areas of the brain
106
The circle of Willis provides _______ circulation
Collateral
107
Artery occlusion presentation: Anterior cerebral
Contralateral leg weakness
108
Artery occlusion presentation: Middle cerebral
-Contralateral hemiparesis & hemisensory deficit -Aphasia -Contralateral visual field deficit
109
Artery occlusion presentation: Posterior cerebral
-Contralateral visual field deficit -Contralateral hemiparesis
110
Artery occlusion presentation: Penetrating arteries
-Contralateral hemiparesis -Contralateral hemisensory deficits
111
Artery occlusion presentation: Basilar artery
Oculomotor deficits ataxia crossed sensory deficit motor deficits
112
Artery occlusion presentation: Vertebral Artery
Lower cranial nere deficits ataxia crossed sensory deficit
113
Ischemic strokes are caused by an _______ and cause _______
Occlusion Brain cell necrosis
114
What is a TIA?
Transient ischemic attack Sudden focal vascular neuro deficit
115
TIAs normally resolve within _____hrs
24
116
T/F: Pts who experience TIAs normally dont have strokes
F 1/3 of pts who have a TIA will experience a stroke
117
If a stroke is suspected, a STAT ___________ is needed
NONCONTRAST CT
118
Thrombolytic therapy should be initiated within ______ of hospital arrival
90 mins
119
What is the TOAST classification?
Categorizes ischemic strokes into 5 groups/classes based on cause
120
Describe TOAST classification: class 1
Large artery artherosclerosis ex) carotid stenosis
121
Describe TOAST classification: class 2
Small vessel occlusion Ex) Lacunar stroke
122
Describe TOAST classification: class 3
Cardioaortic embolic Ex. emboli from afib
123
Describe TOAST classification: class 4
Other etiology Ex. hypercoag/vasculopathies
124
Describe TOAST classification: class 5
Undetermined etiology
125
What is the initial Tx in Ischemic CVA?
Aspirin
126
What is the time frame for TPA post onset of s/s?
3 - 4.5 hrs
127
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
128
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)
129
Hemorrhagic stroke is _____x more likely to cause death than ischemic
4x
130
What are the 2 most reliable predictors of outcome in hemorrhagic stroke?
Blood volume Change in LOC
131
Subtypes of hemorrhagic stroke are based on ________. What are they?
Location 1. Intraparenchymal hemorrhage: blood w/i brain 2. epidural hematoma 3. subdural hematoma 4. subarachnoid hemorrhage 5. Intraventricular hemorrhage: blood w/i ventricle
132
Which subtype of hemorhagic stroke usually occurs in conjuction w another?
Intraventricular hemorrhage:
133
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
134
With new anticoagulants for thrombus, when is the soonest you can do an elective Sx?
No elective Sx within 3 months
135
If you need to pause warfarin (LA anticoagulants), what can you bridge it with?
Heparin
136
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
137
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
138
T/F: Majority of cerebral aneuryms are Dx before ruputure
F Only 1/3 of pts Dx/Sx before ruputure
139
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
140
T/F: Males are more at risk of cerebral aneurysms
F females
141
Interventions for cerebral aneurysms should be performed w/i ______ for best outcomes
72 hours
142
The risk of a vasospasm happens in _______ post Subarachnoid hemorrhage (SAH)
3 - 15 days
143
What triggers a Subarachnoid hemorrhage (SAH) vasospasm? What is the patho of this?
Free hgb triggers inflmmatory mediators --> decrease NO --> increase endothelin 1 --> vasconstriction
144
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
145
What are the interventional Tx for Subarachnoid hemorrhage (SAH) vasospasm?
Balloon dilation & direct injection of vasodilators
146
What is AV malformation?
Arteriovenous malformation **Congenital** Arterial to venous connection WITHOUT capillaries
147
Majorit of AV malformations are _________
Supratentorial
148
What is the Dx for AV malformation? Tx?
Dx: Angiogram MRI Tx: radiation angio-guided embolization surgical-resect (higher mortality)
149
Which AV malformation Tx has the highest mortality?
Surgical Resection
150
What is a congenital brain abnormalities?
Hereditary defect in development or structure of the CNS
151
T/F: Congenital brain abnormalities can be diffuse or confined
T
152
What are the common Congenital brain abnormalities? (4)
1. Chiari Malformation 2. Tuberous Sclerosis 3. Von Hippel-Lindau Disease 4. Neurofibromatosis
153
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
154
Chiari malformation had ____ different types
4
155
Describe Type 1 Chiari Malformation
Downward displacement of cerebellum
156
Describe Type 2 Chiari Malformation
"Arnold Chiari" Downward displacement of cerebellar vermis Associated w myelomeningocele
157
Describe Type 3 Chiari Malformation
rare occipital encephalocele w/ downward cerebellar displacement
158
Describe Type 4 Chiari Malformation
Cerebellar hypoplasia w/o pisplacement of posterior fossa contents Not compatible w life
159
Which Chiari Malformation is associated with myelomeningocele?
Type 2
160
Which Chiari Malformation is not compatible with life?
Type 4
161
With Chiari Malformation, you can __________ to decrease ICP
hyperventilate
162
What is Tuberous Sclerosis?
Genertic disease causing benign hematomas, angiofibromas, and other malformations ANYWHERE IN THE BODY
163
Tuberous Sclerosis is also called _______
Bournevile disease
164
In Tuberous Sclerosis, lesions of the brain include _____ tumors & giant cell _________
cortical tumors giant cell astrocytomas
165
In Tuberous Sclerosis, often involves co-existing tumors in which places?
Face Oropharnyx Heart Lungs Liver Kidney
166
How will Tuberous Sclerosis present?
Mental retardation Seizures
167
What are considerations w Tuberous Sclerosis?
Airway compromise Cardiac & kidney involvement
168
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
169
What congenital disorder may present with pheochromocytoma? What considerations should we have?
Von Hippel-Lindau Disease Increased catecholamines --> increased BP!!!
170
What type of anesthesia may be limited in Von Hippel-Lindau Disease. Why?
Neuraxial anesthesia May have co-existing spinal tumor
171
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
172
What are the 3 types of Neurofribromatosis? Which chromosomes are affected?
Type 1: chromosome-17 Type 2: Chromosome-22 Schwannomatosis: Chromosome-22
173
Which type of Neurofribromatosis is most common?
Type 1
174
Which type of Neurofribromatosis is most rare?
Schwannomatosis
175
What are the considerations w Neurofribromatosis?
IICP Airway Scoliosis possibility of pheochromocytoma
176
What type of anesthesia should we avoid with Neurofribromatosis? Why?
Neuraxial anesthesia High likelihood of spinal tumors
177
T/F: No 2 cases of Neurofribromatosis are the same
T They are HIGHLY varied and unpredictable
178
Neurofribromatosis affects almost ___% of organs in the body
100%
179
What is the patho for hydrocephalus?
Imbalance between CSF production/absorption --> CSF accumulation--> IICP --> ventricular dilation
180
T/F: Hydrocephalus can be congenital or acquired
T
181
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)
182
what is a VP shunt? What is it a treatment for?
"Ventriculoperitoneal shunt" Drain place in brain ventricle --> empties into peritoneum Tx for Hydrocephalus
183
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)
184
The _______ is rarely used to drain with ETV
pleural space
185
VP shunt malfuntion is mostly likely to occur within ______ of placement
1 year
186
How are TBIs categorized?
By breech of dura as either "Penetrating" or "Nonpenetrating"
187
Severity of a TBI is based on the ______
GCS (Glasgow-Coma Scale)
188
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
189
Intubation is usually required in a TBI if GCS is less than ____
9
190
With a TBI we need a stat ______
CT of head/neck
191
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
192
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
193
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
194
What causes seizures?
Could be congenital Transient abnormalities: hypoglycemia -hyponatremia -hyperthermia -intoxication
195
Anti-epileptic drugs decrease ________ & enhance ________
Neuronal excitability Neuron inhibition
196
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
197
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**
198
what procedure do you use to intubate post seizure?
RSI w/ cricoid pressure
199
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
200
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.

SPR25: Health Assessment (11 decks)

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