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6901 > Neurosurgery > Flashcards

Neurosurgery Flashcards

1
Q

unmyelinated neurons appear _____ and conduct _____ signals at a _____ speed; myelinated neurons appear _____ and conduct _____ signals at a _____ speed;

A

grey, action potential, slower

white, saltatory conduction, faster

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2
Q

saltatory conduction

A

action potential that moves in jumps on myelinated neurons at the nodes of Ranvier

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3
Q

astrocytes

A
  • provide support to neurons

- blood brain barrier

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4
Q

ependymal

A

-CSF production

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5
Q

microglia

A

-phagocytosis within the CNS

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6
Q

oligodendrocytes

A

-provide the myelin sheath in the CNS

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7
Q

Schwann cells

A

-provide the myelin sheath outside the CNS

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8
Q

inhibitory neurotransmitter

A

GABA - opens Cl channels which hyperpolarizes the cell

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9
Q

excitatory neurotransmitter

A

glutamate - opens Na channels which hypopolarizes the cell

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10
Q

gyri

A

-outer 3 mm of cerebral cortex that is convoluted to increase surface area

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11
Q

brainstem (3 components)

A
  • midbrain (RAS - consciousness, arousal, alertness)
  • pons
  • medulla (respiratory and cardiovascular control)
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12
Q

meninges spaces and layers (out to in)

A
  • epidural
  • dura (tough)
  • subdural space
  • arachnoid (web-like, BBB, avascular)
  • subarachnoid (CSF)
  • pia (soft)
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13
Q

mnemonics for cranial nerve - sensory versus motor

A

some say money matters, but my brother says big brains matter more

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14
Q

CNS vasculature

A
  • anterior = carotid artery
  • posterior = vertebral artery

*meet at Circle of Willis

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15
Q

cerebral blood flow rate and percentage of CO

A
  • 50mL/100g/min of brain tissue

- 15-20% of CO

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16
Q

cerebral perfusion pressure (CPP)

A

CPP = MAP - ICP (or CVP)

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17
Q

neurology = ATP stores are depleted and cellular injury can occur within _____

A

3-8 minutes

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18
Q

CBF relationship with CMRO2

A

CBF is directly influenced by cerebral metabolic rate of oxygen (CMRO2) which parallels
glucose consumption

  • 20% of body’s O2 consumption
  • 3-3.8mL/100g/min
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19
Q

CBF relationship with CPP

A

CBF remains constant with CPP between 50-150 mmHg

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20
Q

CBF - PaCO2 and PaO2 effects

A

PaCO2 - increased produces vasoconstriction, decreased produces vasodilation, controls between 20-80 mmHg, 3% for each 1 mmHg **most important regulator

PaO2 - little effect until below 50 mmHg

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21
Q

CBF relationship with ICP

A

CBF decreases when ICP >30 mmHg

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22
Q

CBF relationship with temperature

A

CBF decreases 5-7%

with 1 degree Celsius decrease of temperature

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23
Q

Cerebral Spinal Fluid

A
  • produced in choroid plexus in ventricles at 30 mL/hr; reabsorbed in arachnoid villi
  • total volume = 150 mL
  • CSF pressure 5-15 mmHg
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24
Q

intracranial components

A
  • brain matter=80%
  • blood=12%
  • CSF=8%
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25
normal ICP
5-15 mmHg
26
Cushing Reflex
- HTN, bradycardia, respiratory irregularities | - occurs in response to acute increased ICP
27
types of brain herniation
- uncal - central: transtentorial - cingulate - transcalvarial: moves out hole in skull - upward: cerebellar - tonsillar: cerebellar down
28
how does edema appear on a CT of the brain
hypodensity
29
what is the gold standard for ICP monitoring
intraventricular catheter **also allows for drainage
30
neurology: volatile anesthetics autoregulation
-autoregulation (coupling) is impaired in concentrations exceeding 1 MAC (uncoupling=CMR the same, CBF increased)
31
Robin Hood Phenomenon
only normal tissue can vasoconstrict, ischemic brain tissue cannot constrict
32
neurology: volatile anesthetics CMR
-decreased with all, nitrous may increase
33
neurology: volatile anesthetics CBF
-increased with all
34
neurology: volatile anesthetics CBV
-increased with iso
35
neurology: volatile anesthetics ICP
-increased with all
36
neurology: Propofol
-dose dependent decrease in CBF and CMROs
37
neurology: etomidate
-decrease in CMRO2, CBF, ICP
38
neurology: ketamine
- dilates cerebral vasculature | - increases CBF, ICP, CBV
39
neurology: opioids
-minimal effect
40
neurology: benzodiazepines
- decrease CBF and CMR to a lesser extent than barbiturates | - interfere with electrocorticography
41
neurology: precedex
-decrease in CBF WITHOUT decrease in CMRO2 = can produce ischemia
42
neurology: succinylcholine
- increase ICP, CBF, CMRO2 - usually not avoided if rapid paralysis is needed - avoid after 48 hours from stroke or spinal cord injury due to up-regulation of acetylcholine receptor causes hyperkalemia
43
neurology: muscle relaxants
- no effect on ICP, CBF, CMRO2 - histamine (atracurium) produces vasodilation which increases ICP - interaction with other anti-seizure medications: increased dose with decreased duration of action due hepatic enzyme induction
44
neurology: labetalol and esmolol
-no effect **preferred for the control of HTN
45
neurology: nipride, nitroglycerin, hydralazine
- dilates cerebral vessels | - increases CBV, ICP
46
neurology: steroids
- reduce edema | - most common decadron
47
neurology: diuretics
- loop: general diuresis, decrease CSF production, decrease cerebral edema - osmotic: decrease intra and extra cellular water: Mannitol -- slow administration (fast produces vasodilation, rise in CBF, ICP, CBV), 0.25-1.0 g/kg over 10-15 min
48
neurology: diuretics
- loop: general diuresis, decrease CSF production, decrease cerebral edema - osmotic: decrease intra and extra cellular water: Mannitol -- slow administration (fast produces vasodilation, rise in CBF, ICP, CBV), 0.25-1.0 g/kg over 10-15 min
49
neurology: fluid goal
- euvolemia | - avoid dextrose-containing fluids
50
neurology: target blood sugar
140-180
51
venous air embolism versus paradoxic air embolism
- venous=stays within right ride of heart | - paradoxic=enters arterial circulation through patent foramen ovale
52
venous air embolism signs
- increase in expired nitrogen, EtCO2 | - decrease in SaO2
53
most sensitive monitor to detect venous air embolism
transesophageal echocardiography
54
pituitary neoplasms
- rarely metastatic - neurologic, hormonal, visual changes - common for loss of ADH: treat with DDAVP 0.5-1 ug
55
classification for cerebral aneurysms
Hunt & Hess: 0-5 0=unruptured aneurysm 5=deep coma, decerebrate rigidity
56
subarachnoid hemorrhage risks
- cardiac dysfunction - neurogenic or cardiogenic pulmonary edema - hydrocephalus - rebleeding: 50% chance - vasospasm
57
aneurysm clipping
- removes the risk of recurrent hemorrhage | - should not be postponed
58
neurology: vasospasm
- occurs 4-9 days after in 1:4 - leading cause of m/m - treatment: hypertension, hypervolemia, hemodilution, - nimodipine or nicardipine decrease incidence
59
aneurysms: endovascular treatment
- coil in aneurysm clots blood - avoid hyperventilation which causes vasoconstriction makes access difficult - heparin/protamine
60
carotid artery stenting concerns
-bradycardia or asystole with angioplasty - do not pretreat with atropine

6901 (18 decks)

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