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Icm > Neurology > Flashcards

Neurology Flashcards

1
Q

Give me an explanation of brain death

A

Irreversible damage to the brain stem leading to loss of the ability to ever regain consciousness or breath for themselves

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2
Q

What are the NiCE Guillermo for BP control within the first 24 hours of acute ischaemic stroke

A

Do not lower bp

Unless preggo, ThrombolySis, dissection, cardiac failure

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3
Q

What are the nice guidelines for bP control in thrombolysis

A

BP

Systolic <180
Diastolic < 110

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4
Q

Eligibility time criteria for thrombectomy and thrombolysis

A

Thrombectomy - 6 hour

Thrombolysis- 4. 5 hours

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5
Q

Evidence for craniotomy in malignant MCA infarct

A

Destiny trial: patients > 60 had high chance of survival but with severe functional debilitation

Hamlet: SH with 48 hours associated with reduction in mortality and increased function al independence

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6
Q

What are the risk factors for vasospasm post SAH

A 
Smoking
Htn 
Low GCS
High blood volume
Cocaine
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7
Q

What strategies are used for vasospasm post SAH

A

Nimodipine
Statins
Increased Map

Avoid - hypotension hypoxia hypothermia hypovolaemia

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8
Q

What colour and T is fluid on MRI

A

White - T2

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9
Q

How is an mri generated

A

Powerful magnet is applied to align protons in tissue water
Protons are displaced from their alignment by radio frequency pulse and when this finishes the protons realign. This realignment releases radio frequency signals which are detected, processed and turned into an image

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10
Q

What are the contraindications to MRI

A 
Cochlear implants
Pacemaker
Some metallic heart valves
Metallic foreign bodies in eye 
Ferromagnetic clips
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11
Q

What monitoring considerations are needed for mri

A 
Mri compatible equipment 
Fibre optic or carbon fibre cable
Visual alarms used as noisy 
Braided short mri compatible ecg leads in a small triangle 
et- co2 delay due to length of tubing
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12
Q

What is the difference between a lundgberg A and B wave

A

Lundgberg A waves are sustained waves due to reflex cerebral vasodilation in response to reduce MAP and usually reflect seizure activity.
B waves occurs in cycles and are present in health

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13
Q

Define MND

A

A group of progressive neurological diseases that destroy motor neurones. This includes Amyotrophic lateral sclerosis, progressive bulbar palsy, spinal muscular atrophy etc and are inherited or sporadic

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14
Q

Management of mND

A

Riluzole- reduce the release of gluatamate and live 10% longer

Gene therapy for SMA

Botox and bacflofen

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15
Q

What pathologies cause intensive care associated weakness

A

Critical Illness polyneuropathy
Critical illness myopathy
Critical illness neuromyopathy

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16
Q

What medications are associated with iCU related weakness

A

Corticosteroids
Paralysis agents
High dose vasopressors
Aminoglycosides

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17
Q

What features of weakness are used to diagnose iCU related illness

A

Onset after critical illness
Generalised symmetrical flaccid weakness sparing cranial
Dependant on mechanical ventilation with failure to mobilise
Critical Illness not Related to the weakness

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18
Q

What would you see on electromyography with cip and cim

A

Cip: spontaneous fibrillation potentials with long duration and high amplitude

Cim: spont fibrillation potentials with short and low amplitude

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19
Q

What would you see on ncs with cip and cim

A

Cip: reduced motor and reduced sensory amplitude action potentials with normal conduction

Cim: reduced motor with normal sensory action potential amplitude action potentials with normal conduction

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20
Q

WhAt drug should be avoided with iCU related weakness

A

Suxamethonium

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21
Q

Methods of measuring ICP

A

Intra ventricular catheter
Subdural pressure transducer
Intraparenchymal monitor

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22
Q

What is a raised ICP

A

22 mmhg

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23
Q

What determines A and B on an ICP wave form

A

A arterial pressure

B intracranial compliance

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24
Q

What would be an explanation for an ICP waveform having reduced amplitude but unchanged morphology

A

Reduced CSF

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25
Q

What causes a sinosidal slow waveform on icp

A

Respiration

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26
Q

What causes a lundgberg a wave on an ICP trace

A

Increase in cerebral blood flow in response to reduced cerebral perfusion

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27
Q

How do lundberg a waves on an icp waveform differ from lundberg b

A

A > 50 mmhg in amplitude
B 20-50
A 5-20 mins
B 1 min

B is unstable icp from vasospasm or REM

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28
Q

Scoring systems for SAH

A

Fischer scale

World federation of neurosurgeons

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29
Q

Benefit of coiling over clipping for SAH

A

Reduction in death
Lower rate of epilepsy
Increased bleeding in 1st yr

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30
Q

Target systolic BP and CPP after a TRaumatic brain injury

A

SBP >100 50-70 years old
>110 if <50 or > 70

CPP of 60-70

31
Q

What are the 4 non radiological early predictors of poor prognosis in TBI

A

GCS
Age
Absent pupillary reflexes
Hypotension

32
Q

Preconditions for brain stem testing

A

deeply unconscious, mechanically ventilated and not making respiratory effort

Irreversible brain damage of known aetiology

Not due to reversible influences - drugs, hypothermia etc

33
Q

State the afferent and efferent cranial nerve for the pupillary response

A

2 afferent

3 efferent

34
Q

State the afferent and efferent cranial nerve for the corneal reflex

A

5

7

35
Q

State the afferent and efferent cranial nerve for the occulovestivular reflex

A

8

3 4 6

36
Q

State the afferent and efferent cranial nerve for the response to painful stimuli

A

5

7

37
Q

State the afferent and efferent cranial nerve for the gag reflex

A

9

10

38
Q

State the afferent and efferent cranial nerve for the cough reflex

A

10

10

39
Q

How is the apnoea test performed in brain stem testing

A

The patient is pre oxygenated and minute ventilation is reduced to give Pco2 6.0 - 7.4
Disconnect vent and attach to waters circuit
Observe for >5 mins for resp effort and at the end, abg to look for a 0.5 rise in pco2

40
Q

What is the Bamford/ Oxford classification

A

Posterior circulation syndrome
- 1 of loc/ homo hemi/ cerebella

Partial anterior circ syndrome
- 2 of weak/ homo hemi/ high cerebral

Total anterior circ syndrome
- weak/ homo hemi/ high cerebral

41
Q

Treatment of stroke

And Bp

A

200mg aspirin 2/52
Then statin at 2/52

Treat BP > 200/120

42
Q

When thrombolyse stroke

A

<4.5 hours

Treat HTN >185/110

43
Q

When vasospasm after a sah

A

4-14 days

44
Q

Diagnosis of vasospasm on TCD

A

> 120 or ratio >3

MCA to Ica

45
Q

When does hydrocephalus occur after SAH

A

<3 days

46
Q

Signs of a venous sinus thrombosis

A

3rd and 6th nerve palsy

47
Q

Who benefits from decompression after a stroke

A 
<48hrs of symptoms
< 60
Large MCA 
Low GCS 
>15 nihss
48
Q

What is the Asia classification

A 
A Complete
B Incomplete - no motor
C Incomplete - MRC <3
D Incomplete - MRC > 3
E Normal
49
Q

3 ligaments of the spine from skin to bone

A

Anterior longitudinal
Posterior longitudinal
Ligamentum flavum

50
Q

What dose the posterior / dorsal column do

A

Light tough vibration and proprioception

51
Q

What does the corticospinal column do

A

Motor control

52
Q

What does the spinothalamic column do

A

Pain and temperature

53
Q

Transection of the spine at which level gives autonomic dysfunction
And what symptoms occur

A

T6

Uninhibited sympathetic response
Vasoconstriction below
Vasodilation above
Brady

54
Q

Transaction at which spinal level means you need ventilation

A

C3- diaphragm

C3-5 gives partial phrenic 80% need ventilation

T8 does cough from intercostal

55
Q

3 types of herniation

A

Subfalcine (under falx cerebri)

Transtentorial (through tentorial cerebelli)

Tonsilar (through foramum magnum) I

56
Q

Stage 1 therapy for raised icp

A 
Head elevation 15-30
Optimise ventilation and lower pco2
Sedation and paralysis 
Analgesia
Cpp 50-70
Euvolaemia
57
Q

Stage 2 therapy for raised icp

A 
Inotropes
Manitol
Hypertonic na
Loop diuretics 
Hypothermia 
Increase sedation 
CSF drainage 
CPP >60
58
Q

What I a raised icp

A

> 22

59
Q

Stage 3 therapy for raised icp

A

Barbiturates

Decompression.

60
Q

SAH map and BP targets

A

100- 160 systolic BP

Map <110

61
Q

How long do you give nimodipine for

A

60mg 4 hourly 21 days

62
Q

Complications and time frames of SAH

A

Obstructive Hydrocephalus - first 3 days

Re bleeding - 72 hours

Seizures - suggest re-bleed

Vasospasm - 4-10 days

63
Q

What should the pco2 and ph be prior to Brains stem testing

A

> 6

Ph <7.4

64
Q

Define GBS

A

Acute inflammatory demyelinating polyneuropathy

Autoimmune response to preceding illness (campylobacter, hsv, cmv)

65
Q

Worrying spirometry in GBS

A

<15mls \kg

66
Q

Features GBS

A

Areflexia
Progressive distal weakness
Autonomic dysfunction

67
Q

BP treatment in inter cerebral haemorrhage

A

< 6 hours aim 130-150

> 6 hours treat if >200

68
Q

What is the antibody test in GBS

A

Anti GM1 antibodies

69
Q

Normal ICP pressure

A

5-15

70
Q

Indications for icp monitoring

A

Tbi
Hydrocephalus
High risk hydrocephalus (SAH/ tumour)
Idiopathic intracranial HTN

71
Q

Types of icp monitor

A

Intraventricular catheter
Subdural pressure transducer
Intraparenchymal monitor

72
Q

Icp waves

A

P1 - arterial pulsation
P2 - intracranial compliance
P3- aortic closure

73
Q

Define myasthenia Gravis

A

Autoimmune disease with antibodies against the post synaptic ach receptors on the NM junction

Icm (16 decks)

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