Neurological Disorder In Anesthesia (Part 2) Flashcards
Name the Disease of these (7) common symptoms
* ↑ICP
* Papilledema
* Headache
* AMS
* Mobility impairment
* Vomiting
* Autonomic dysfunction
* Seizures
Brain Tumors
The mass effects of any tumor can cause
- neurological deficits
Name the (2) Types of Brain Tumors
- Primary
- Metastatic
Name the most common CNS glial cell
Astrocytes
The (4) Types of Astrocytoma are _______, _________ astricytomas, _____________ astrocytomas and ____________ Multiforms.
- Gliomas
- Pilocyctic astrocytomas
- Anaplastic astrocytomas
- Glioblastoma Multiforms
_________ are primary tumors, least aggressive and are found in young adults w/ new onset seizures.
Gliomas
__________ Astrocytomas are found in children and young adults, are mostly benign with good outcomes if resectable.
Pilocyctic Astrocytomas
________ Astrocytoma are poorly differentiated and usually evolve into Glioblastoma Multiform.
Anaplastic Astrocytoma.
_________ _____________ has a high mortality, requires surgical debulking and chemo. Life expectancy is usually weeks, even with treatment.
Glioblastoma Multiform
Name (4) Brain Tumors
- Meningiomas
- Pituitary Adenomas
- Acoustic Neuromas
- Metastatic Carcinomas
____________ are usually benign, arise from dura or archnoid tissue and has a good prognosis w/ surgical resection.
Meningiomas
________ ________ are noncancerous. Transphenoidal or open craniotomy for removal is curative.
Pituitary Adenomas
_____________________ are benign schwannomas and involve vestibular components of CN VIII within the auditory canal. Has a good prognsis with resection and radiation.
Acoustic Neuromas
________ __________ vary widely in origin and symptoms and has less favorable outcomes.
Metastatic Carcinomas
Radiation and Chemotherapy for Brain Tumors can cause
- letharygy
- AMS
- Neurological effects
Patient’s with Brain Tumors are on place on steroids to minimize _________ ____________
- cerebral edema
______ is used to reduce intracranial volume and pressure in patients with Brain Tumors
Mannitol
Anticonvulsants are ______ used in Anesthesia for Brain Tumors d/t _________ lesions closer to ________ cortex.
- very common
- supratentorial lesions, closer to motor cortex
Name the (2) types of Strokes
- Ischemic
- Hemorrhagic
Globally, ________ is the leading cause of death and disability
Stroke
Blood is supplied to the brain by the:
- internal carotid arteries
- Vertebral arteries
The internal carotid arteries and verebral arteries join on the _________ surface of the brain to form the ______ ______ _____, which provides __________ circulation to multiple areas of the brain
- inferior
- Circle of Willis
- Collateral
An occlussion of this artery causes contralateral leg weakness.
Anterior Cerebral Artery
An Occlussion of this artery causes:
* Contralateral hemipharesis defict (face and arm more than leg)
* Aphasia
* Contralateral visual field defect
Middle Cerebral Artery
Occlussion of this Artery causes:
* Contralateral visual field defect
* Contralateral hemiparesis
Posterior Cerebral Artery
Occlussion to these arteries cause:
* Contralateral hemiparesis
* Contralateral hemisensory deficits
- Penetrating Arteries
Occlussion to this artery causes:
* Oculomotor deficits
and/or
* ataxia w/ crossed sensory and motor deficits
- Basilar Artery
Occlussion of this Artery causes:
* Lower cranial nerve deficits
and/or
* ataxia with crossed sensory deficits
Vertebral Artery
_________ stroke is an occulsion of a vessel that supplies a region of brain resulting in cellular ischemia
Ischemic Stroke
_________________ is a sudden focal vascular neurologic deficit that resolves within 24 hours
Transient Ischemic Stroke
__/__ of pts who experience a TIA will subsequently suffer a stroke
1/3
What is the goal time from Stroke Prognosis to the onset of thrombolytic intervention?
90 minutes
If a stroke is suspected, a STAT ___-_____ _____ is needed to distinguish between ischemic stroke and intracerebral hemorrhage.
- non-contrast CT
Causes of Ischemic Strokes are categorized according to the TOAST classification into 5 groups:
- Large artery occlussion
- Small vessel occlussion
- Cardioaortic embolic
- other etiology
- Undetermined Etiology
Carotid Stenosis is an example of what TOAST classification
Large Artery Occlussion
Lacunar Stroke is an example of what TOAST classification
Small vessel occlussion
Emboli from atrial fibrillation is an example of what TOAST classification
Carioaortic embolic
Stroke due to hypercoagulation states or vasculaopathies is an example of what TOAST classification
Other etiology
PO aspirin in the most common recommended intial treatement for
Acute ischemic stroke
IV ___ ____ _____ (___) is used when specific criteria is met and must be intiated within a limited time window
Tissue Plasminogen activator (TPA)
_______ _________ have been used to stent vessels and remove clots.
Thrombectomy devices
This intervention showed little benefit as they were time-consuming and carry a risk of creating fragemented embolization.
Thrombectomy devices
This treatement for CVAs is performed in intervential radiology (IR), allowing for angiographic assessment and radiographic guidance during administration of thrombolytics or thrombectomy.
Revascularization
Patient’s with ______ _______ frequently have CV risks including HTN, DM, CAD, Afib, and valvular diseases that could impact __________ drug choices and hemodynamic goals
- ischemic stroke
- vasoactive
This type of stroke results from bleeding inside the cranaial vault, in turn, impairs perfusion of the brain
- Acute hemorrhagic stroke
Hemorrhagic stroke is ___x more likely to cause death than ischemic stroke.
4
The 2 most reliable predictators of outcome for a Hemorrhagic CVA are:
- Estimated Blood Loss
- Change in LOC
Subtypes of Hemorrhagic strokes are defined base on……
- location of the blood
Hemmorrhagic stroke with blood in the brain is called____________ hemorrhage.
intraparenchymal hemorrhage
Hemorrhagic CVA with blood in the epidural, subdural and subarachnoid spaces are called
- epidural, subdural and subarachnoid hematoma/hemorrhage
Hemorrhagic stroke with blood in the ventricular system is called _________ hemorrhage and usually occues with other _________ strokes,
- intraventricular hemorrhage
- hemorrhagic strokes
Treatment of a hemorrhagic stroke that is centered around reduction in ICP, blood pressure control, seizure procautions and vigilant monitoring is known as
Conservative treatments
This treatment for a Hemorrhagic CVA involves evacuation of the hematoma
Surgical
Continuation of Intubation of a Hemorrhagic CVA depends on_________ stability.
cardiopulmonary stability
If you prescribes a new anticoagulant for CVA prophylaxis, when can the patient have an elective surgery?
3 months
You need to consult ______ to establish protocol for anticoagulants for CVA prophylaxis
prescriber
High Risk patient for a CVA that pause their long acting anticoagulants (warfarin) will need to take ______ ________ to bridge the gap.
- Shorting acting anticoagulant
- LMWH
- Unfractionated heparin
If you plan to do Regional Anesthesia on a patient for a planned procedure who is taking anticoagulants, what should you do?
- Plan for the patient to d/c anticoag for a sufficent time to safely perform the block.
Name (4) specific inquires for patients with CVA pre-op.
- Headaches
- tinnitus
- vision/memory loss
- bathroom issues
Vascular disease, embolic (a-fib, prosthetic valve, right-to-left shunt/PFO) are all examples of Root causes of _____ .
Root causes of CVA
Name the imaging required for surgery on patient with a CVA
- Carotid U/S
- CT/MRI head and neck
- echocardiogram
What vascular access do you need to have established before starting surgery on a patient with Cerebrovascular disease
- A-line
- 2 IVs
- CVC
T/F: Majority of aneurysms are diagnosised before rupture
- False
Only __/__ of aneurysm patients have symptoms before rupture
1/3
Headache, photophobia, confusion, hemiparesis and coma are all symptoms of a cerebral _________.
cerebral aneurysm.
HTN, smoking, female and oral contraceptives are all Risk factors for
Cerebral aneurysms
Diagnosis of a Cerebral Aneurysm requires..
- CT/angio
- MRI
- Lumbar puncture w/ CSF analysis if rupture suspected
For best outcomes, interventions for Cerebral Aneurysms should be preformed within ___ hours of rupture
72 hours
Name the medication to control BP for cerebral aneuysms
Mannitol
Name the (3) surgical treatments for Cerebral Aneurysms
- coiling
- stenting
- trapping/bypass
What specialty needs to be on standby in case of intra-op rupture/SAH?
Neurosurgeon
Risk for vasospam Post-SAH can last for __ - ___ days
3-15 days
____ _____ triggers inflammatory mediators, which reduces nitric oxide availability and increase ________-1, leading to vasoconstriction.
- Free Hemoglobin
- endothelin
Triple H therapy for Post-SAH Vasospams
- hypertension
- Hypervolemia
- Hemodilution
To avoid complications of Hypervolemia ,_____ is the intial treatment for Post-SAH Vasospasm
Hypertension
Interventional treatments such as ______ ______ and direct injection of ________ can relieve Post-SAH spasm
- balloon dilation
- direct injection of vasodilators
________ _________ is an arterial to venous connections without intervening capillaries. Creates an area of high flow, low resistance shunting.
Arteriovenous Malformations (AVM)
T/F: Ateriovenous Malformations are through to be congenital
True
Symptoms of Arteriovenous Malformations (AVM) is throught to range from _______ -effects to _________.
- mass effects to hemorrhage
Majority of AVMs are ________
supratentorial
Treatment of AVMs include_______, angio-guided _______ and ______ resection.
- radiation
- angio-guided embolization
- surgical resection
Name the treatment of AVM that has the highest mortality
Surgical resection
Before AVM surgery, you need to establish:
- BP control –mannitol
- seizure prophylaxis
- CVC or Lg bore IVs
- A-line
_______ ______ abnormalities are often hereditary, and the disease process may be diffuse or confined to specific neuronal structurs
Congenital Brain Abnormalities
This congenital brain abnormality is congenital displacement of cerebellum.
Chiari malformation
There are how many types of Chiari Malformation
4
This type of Chiari Malformation is characterized by downward displacement of cerebellum.
Type 1
This type of Chiari Malformation is characterized by downward displacement of cerebellar vermis often associated with myelomeningocele.
Type 2: Arnold Chiari
This type of Chiari Malformation is: Rare; occipital encephalocele w/ downward cerebellar displacement
Type 3
This type of Chiari Malformation is:
* not compatible with life
* cerebellar hypolasia without displacement of posterior fossa contents
Type 4
Symptoms of Chiari Malformation include _____ extending to shoulders/arms, ______ disturbances, ataxia and hydrocephalus.
- headache extending to shoulder/arms
- visual disturbances
- ataxia
- hydrocephalus
Treatment for Chiari malformation is Surgical _____________.
Surgical Decompression
Pre-anesthesia Chiari Malformation considerations include:
* __________ to ↓ICP
* Lg bore IV x__
* CVC
* ________
- Hyperventilate to ↓ICP
- Lg bore IV x2
- CVC
- A-line
__________ _________ is an autosomal dominant disease causing benign hematomas, angiofibromas and other malformations that can occur anywhere in the body
Tuberous Sclerosis
Tuberous Sclerosis can cause ______tumors and giant cell _________ in the brain.
- cortical tumors
- giant cell astrocytomas
Co-existing tumors of the face, oropharynx, heart, lungs, liver and kidneys with this Congenital Brain Abnormality
Tuberous Sclerosis
Patients with Tuberous Sclerosis present with ______ retardation and ________ disorders.
- mental retardation
- seizures disorders
Airway compromise and cardiac/kidney involvement are some anesthesia considerations for ______ _______.
Tuberous Sclerosis
This is an autosomal dominant disease with benign tumors of the CNS, eyes, adrenal, pancreas and kidneys.
Von-Hippel- Lindau Disease
Von Hippel-Lindau disease may present with
pheochromocytoma
What would limit Neuraxial anesthesia in patients with Von Hipple-Lindau Disease
co-existing spinal cord tumor
Name the (3) types of Neurofibromatosis
- Type 1
- Type 2
- Schwannomatosis (rare)
Anesthesia consideration for ________ include increased scoliosis, possibility of pheochromocytoma, ICP, and airway issues
Neurofibromatosis
T/F: Neurofibromatosis patients are good candiates for Neuraxial anesthesia.
- False
- Avoid NA d/t high likelihood of spinal tumors
_______ is a disorder of CSF accumulation, causing increased ICP, that results in ventricular dilation.
Hydrocephalus
Accumulation of CSF in Hydrocephalus is due to
- an imbalance between CSF production and absorption
_____ can be congenital or acquired d/t meningitis, tumors, head injuries, or strokes
Hydrocephalus
Name the treatments for Hydrocephalus
- diuretics - controversial in children
- serial lumbar punctures - temporary
- VP shunt/Endoscopic third ventriculostomy (ETV)
This is placed in the ventricle of the brain and empties into peritoneum to treat Hydrocephalus
VP Shunt
This is a catheter placed into the lateral ventricle that drains into the perironeal space, right atrium or more rarely into pleural space to treat Hydrocephalus.
- ETV
Shunt malfunction most frequently occurs in the ______ year of placement.
first
These can be categorized by:
* penetrating
* non-penetrating
* d/o breech of dura
Traumatic Brain Injury (TBI)
Primary Injury of a TBI occurs as a result of __________.
- as a result of time
______ injuries of a TBI can include: neuroinglammation, cerebral edema, hypoxia, anemia, electrolyte imbalances, and neurologic shock.
Secondary
________ is required in severe TBI w/ GSC <9, AW trauma and respiratory distress
Intubation
With TBIs, mild __________ can control increased ICP
mild hyperventilation
Name the imaging that needs to be obtained ASAP for TBIs
- CT head/neck
T/F: You can delay emergent surgery for TBI for complete Pre-Op testing
False
C-spine stabilization, adequate IV access, CVC, A-line, and uncrossed blood are Anesthetic considerations for_______.
TBI
T/F: You can place an NGT/OGT for potential basal skull fractures
False
Intra-Op considerations for TBIs
- I-stat labs
- Pressors
- BiCarb
- Calcium
- Blood Products
_______ is defined as transient, paroxysomal, synchronous discharge of neurons in the brain.
Seizures
To cure seizures, you have to treat the ______ _________.
treat the underlying condition
Hypoglycemia, hyponatremia, hyperthermia and intoxication are _______ abnormalties that can cause seizures.
- transcient abnormalities
______ is defined as recurrent seizures d/t congentital or acquired factors
Epilepsy
_______ drugs decrease neuronal excitability/enhance inhibition
Antiepileptic
What medication do you want onboard before incision in patients with seizure disorders?
Anti-seizures drugs
Phenytoins, Tegretol, Barbituates are enzyme - ________.
inducers
What needs to be applies when intubating (RSI) patient’s post-seizure?
cricoid pressure
