25 Mar Neuro Disease Assessment (Exam 3) Flashcards
(229 cards)
1
Q
What is the normal range for intracranial pressure (ICP)?
A
5-15 mmHg
2
Q
What is cerebral perfusion pressure (CPP) influenced by?
A
Arterial blood carbon dioxide levels, brain oxygen levels, and intracranial pathologies
3
Q
What is the Monroe-Kelly hypothesis?
A
An increase in one intracranial compartment must be offset by a decrease in another to avoid ICP increase
4
Q
List the herniation syndromes discussed.
A
- Subfalcine herniation
- Transtentorial herniation
- Uncal herniation
- Cerebellar tonsillar herniation
5
Q
What can cause increased intracranial pressure?
A
- Tumors
- Hematomas
- Infections
6
Q
What methods are used to decrease ICP?
A
- Elevating the head of the bed
- Ventilation to reduce PA CO2
- Using external ventricular drains (EVDs)
7
Q
What are hyperosmotic drugs like mannitol used for?
A
To increase serum osmolality and reduce ICP
8
Q
What is multiple sclerosis?
A
A progressive autoimmune demyelination of central nervous system fibers
9
Q
What is myasthenia gravis?
A
An autoimmune disease where antibodies are generated against nicotinic acetylcholine receptors, causing muscle weakness
10
Q
What is Eaton-Lambert syndrome?
A
A syndrome involving antibodies against voltage-gated calcium channels, causing muscle weakness
11
Q
What are the common treatments for hydrocephalus?
A
- Diuretics
- Surgical interventions like VP shunts
12
Q
What types of strokes are there?
A
- Ischemic
- Hemorrhagic
13
Q
What is the Spetzler-Martin AVM grading system used for?
A
To assess arteriovenous malformations based on size and venous drainage patterns
14
Q
What are the symptoms of Chiari malformation?
A
Headaches, neck pain, balance issues, and possibly syringomyelia
15
Q
What is tuberous sclerosis (AKA Bourneville Disease)?
A
A genetic condition with benign tumors in various body regions
16
Q
What anesthesia considerations are important for patients with von Hippel-Lindau disease?
A
Managing exaggerated hypertension and avoiding neuraxial anesthesia
17
Q
What is the Glasgow Coma Scale used for?
A
To categorize the severity of traumatic brain injury
18
Q
What are anti-epileptic drugs used for?
A
To manage seizures by decreasing neuronal excitability
19
Q
Fill in the blank: Cerebral perfusion pressure (CPP) is calculated as _______.
A
MAP - ICP
20
Q
True or False: Hydrocephalus can be treated with serial lumbar punctures.
A
True
21
Q
What is the treatment for cerebral aneurysms?
A
- Coiling
- Stenting
- Bypassing aneurysms
22
Q
What is the impact of increased PA CO2 on cerebral vessels?
A
It leads to cerebral vessel dilation and increased cerebral blood flow
23
Q
What are the effects of transtentorial herniation?
A
Compresses the brainstem, causing altered mental status and respiratory compromise
24
Q
What are the symptoms of Parkinson’s disease?
A
- Tremors
- Rigidity
- Akinesia
25
What is the role of corticosteroids in managing increased ICP?
To increase blood-brain barrier integrity and reduce intracranial swelling
26
What is the primary treatment for ischemic strokes?
Thrombolytics and revascularization within 90 minutes
27
What is the main reason for increased intracranial pressure (ICP)?
Increased ICP can occur due to:
* Tumors
* Intracranial hematomas
* Obstruction of cerebrospinal fluid (CSF) flow
* Infectious processes
28
What is the primary function of the intracranial vault?
The intracranial vault is compartmentalized to protect the brain by containing increases in ICP regionally.
29
What is the function of the faux Cerebri?
The faux Cerebri is a fold of dura that separates the two cerebral hemispheres.
30
What is transnatorial herniation?
Transnatorial herniation occurs when supratentorial contents push down against the tentorium cerebelli, potentially compressing the brainstem.
31
What are the symptoms of uncus herniation?
Symptoms of uncus herniation include:
* Ipsilateral ocular motor nerve dysfunction
* Pupillary dilation
* Ptosis
* Lateral deviation of the affected eye
32
What is the outcome of cerebellar tonsil herniation?
Cerebellar tonsil herniation can lead to medullary dysfunction, cardio instability, and death.
33
How can tumors increase ICP directly?
Tumors can increase ICP directly by occupying space and increasing volume.
34
What is one way that tumors can increase ICP indirectly?
Tumors can cause cerebral edema, leading to increased pressure in the cranial vault.
35
What is an external ventricular drain (EVD)?
An EVD is a device used to relieve intracranial pressure by draining cerebrospinal fluid.
36
What is the initial non-invasive method to decrease ICP?
Elevating the head of the bed.
37
What role do corticosteroids play in managing ICP?
Corticosteroids increase the integrity of the blood-brain barrier and decrease intracranial swelling.
38
What is multiple sclerosis (MS)?
Multiple sclerosis is a progressive autoimmune demyelination of central nervous fibers.
39
What age range is commonly associated with the onset of multiple sclerosis?
The onset of multiple sclerosis typically occurs between 20 to 40 years of age.
40
What factors can trigger an exacerbation of multiple sclerosis symptoms?
Triggers for exacerbation can include:
* Stress
* Temperature swings
* Postpartum period
41
What are common symptoms experienced by patients with multiple sclerosis?
Common symptoms include:
* Motor weakness
* Sensory disorders
* Visual impairments
* Autonomic instability
42
True or False: All patients with multiple sclerosis experience the same severity of symptoms.
False
43
What is the purpose of a ventriculostomy?
A ventriculostomy is performed to relieve increased intracranial pressure by draining cerebrospinal fluid.
44
Fill in the blank: Increased intracranial pressure can be caused by _______.
tumors, hematomas, or infection
45
What is the significance of the Centurion cerebelli?
The Centurion cerebelli separates supratentorial and infratentorial spaces.
46
What can happen if an external ventricular drain (EVD) is ineffective?
If ineffective, the patient may require a surgical procedure called a VP shunt.
47
What is delayed hydrocephalus?
Delayed hydrocephalus is a condition where fluid buildup occurs weeks after initial treatment.
48
What are the main symptoms of Multiple Sclerosis?
Motor weakness, sensory disorders, visual impairments, autonomic instability
## Footnote
Autonomic instability can include heart rate changes and postural hypotension.
49
What is the current treatment approach for Multiple Sclerosis?
Corticosteroids, immunomodulators, targeted antibodies, IVIG
## Footnote
IVIG stands for intravenous immunoglobulins.
50
What assessments are needed for pre-anesthetic consideration in Multiple Sclerosis patients?
Assess existing deficits, pulmonary function testing, general labs (BMP, CBC), liver function testing, glucose levels, electrolytes
## Footnote
Liver function testing is crucial due to the heavy liver load from certain medications.
51
Why is temperature management critical in Multiple Sclerosis patients during surgery?
Temperature swings can exacerbate the disease process
## Footnote
Maintaining normothermia is essential to avoid triggering exacerbations.
52
What anesthetic options are acceptable for patients with Multiple Sclerosis?
Regional anesthesia, peripheral nerve blocks
## Footnote
Avoid succinylcholine due to the risk of hyperkalemia.
53
What is Myasthenia Gravis?
An autoimmune disease with antibodies against nicotinic acetylcholine receptors
## Footnote
It causes muscle weakness, particularly in cranial nerves.
54
What are common triggers for exacerbations in Myasthenia Gravis?
Stress, pain, insomnia, infection, surgery
## Footnote
These factors can worsen muscle weakness.
55
What is the primary treatment for Myasthenia Gravis?
Acetylcholinesterase inhibitors (e.g., pyridostigmine)
## Footnote
Pyridostigmine increases circulating acetylcholine levels.
56
What is Eaton Lambert Syndrome and its association with cancer?
A syndrome with antibodies against voltage-gated calcium channels, highly associated with small cell lung carcinoma
## Footnote
Over 60% of patients with Eaton Lambert have this type of lung cancer.
57
What are the primary symptoms of Eaton Lambert Syndrome?
Progressive weakness, dysautonomia, ocular involvement
## Footnote
Similar symptoms to Myasthenia Gravis but with a different underlying mechanism.
58
What is Muscular Dystrophy?
A disorder of muscle fiber degeneration caused by the breakdown of the dystrophin glycoprotein complex
## Footnote
Duchenne muscular dystrophy is the most common and severe form.
59
What are common symptoms of Duchenne Muscular Dystrophy?
Progressive muscle wasting, kyphoscoliosis, respiratory weakness
## Footnote
Average lifespan is about 20-25 years, primarily due to cardiopulmonary complications.
60
What key anesthetic considerations are necessary for patients with Muscular Dystrophy?
Baseline labs including pulmonary function testing and CK levels, pre-op EKG, echocardiogram, caution with neuromuscular blockers
## Footnote
Monitoring is essential to avoid over-dosing on paralytics.
61
True or False: Patients with Myasthenia Gravis are at risk for prolonged muscle weakness from neuromuscular blockers.
True
## Footnote
Careful dosing is required to avoid exacerbating their condition.
62
Fill in the blank: The drug _______ is used to increase circulating acetylcholine in Myasthenia Gravis patients.
[pyridostigmine]
63
What is the significance of IVIG in treating autoimmune diseases like Myasthenia Gravis?
It provides healthy antibodies to replace dysfunctional autoimmune antibodies
## Footnote
However, it is very expensive and has a risk of blood-borne infections.
64
What is hyper metabolic syndrome and how does it relate to muscular dystrophy?
A syndrome similar to malignant hyperthermia, presenting with muscle symptoms
## Footnote
It is not generally as deadly as malignant hyperthermia.
65
What is hyper metabolic syndrome?
A syndrome similar to malignant hyperthermia, presenting with fever, tachycardia, and can progress to severe complications like V fib and cardiac arrest
## Footnote
Triggered by certain anesthetics, it requires careful management to avoid exacerbation.
66
What should be avoided in patients with hyper metabolic syndrome?
Volatile anesthetics and succinylcholine
## Footnote
These agents can exacerbate muscle membrane instability.
67
What is myotonic dystrophy?
The most common form of myotonia, characterized by prolonged muscle contractions post-stimulation
## Footnote
Onset is typically in early adulthood, affecting various muscle groups and potentially leading to aspiration risks.
68
What are the symptoms of myotonic dystrophy?
Muscle wasting, especially in the face, hands, and respiratory muscles
## Footnote
It can also affect the cardiac conduction system, with about 20% of patients having mitral valve prolapse.
69
What is the treatment for myotonic dystrophy?
Managed with quinine, propanolol for arrhythmias, and steroids
## Footnote
There is no cure for myotonic dystrophies.
70
What are the three major dementia syndromes?
* Alzheimer's (70% of cases)
* Vascular dementia (25%)
* Parkinson's dementia (5%)
## Footnote
These syndromes require careful assessment of cognitive dysfunction and may involve advanced directives for medical decision-making.
71
What is the primary treatment for Parkinson's disease?
Levodopa, which converts to dopamine and crosses the blood-brain barrier
## Footnote
Other treatments may include anticholinergics and deep brain stimulators.
72
What are the common symptoms of Parkinson's disease?
* Tremors
* Rigidity
* Akinesia
## Footnote
Patients often exhibit a 'pill rolling' maneuver with their hands and may experience cognitive decline.
73
What is the preferred anesthesia type for dementia patients?
Regional anesthesia
## Footnote
This is to minimize opioid requirements and reduce complications in older populations.
74
What are the common symptoms of brain tumors related to increased intracranial pressure?
* Headaches
* Confusion
* Mobility impairment
* Autonomic dysfunction
## Footnote
Vomiting can also occur, further increasing intracranial pressure.
75
What type of brain tumor is an astrocytoma?
A tumor of astrocytes, which are the most common glial cells in the central nervous system
## Footnote
Astrocytomas can vary in aggressiveness and prognosis.
76
What is a common benign brain tumor?
Meningioma
## Footnote
Usually has a good prognosis if surgically resected.
77
What is the management for patients with brain tumors undergoing surgery?
Monitor glucose and electrolytes, assess neurological status, and administer stress doses of steroids
## Footnote
Patients are often on anti-seizure medications due to the risk of seizures.
78
What is the role of deep brain stimulators in Parkinson's disease?
To stimulate dopaminergic fibers and increase dopamine release
## Footnote
It may require disabling during surgery to avoid interaction with cautery.
79
What are the potential risks for patients with Parkinson's disease during anesthesia?
Aspiration risk and respiratory compromise
## Footnote
Special attention should be given to their pulmonary status and medication interactions.
80
Fill in the blank: Myotonic dystrophy can lead to an increased risk of _______.
aspiration
## Footnote
Due to muscle weakness affecting respiratory and swallowing functions.
81
True or False: All myotonic disorders are triggered by stress and extremes of temperature.
True
## Footnote
Particularly cold temperatures can exacerbate symptoms.
82
What is the significance of a patient's advanced directives in surgical decisions?
Guides medical decision-making and intervention preferences
## Footnote
Especially important for dementia patients who may not provide informed consent.
83
What is a common risk associated with autonomic dysfunction?
Risk and manifestation on EKG, postural tachycardia, labile heart rates, labile blood pressures
84
What should be monitored before a craniotomy?
Fresh labs, EKG, CT, and MRI trends
85
What is the purpose of administering mannitol preoperatively?
To reduce intracranial volume and pressure on the brain
86
What are the two main types of strokes?
* Ischemic strokes
* Hemorrhagic strokes
87
What percentage of strokes are ischemic?
88%
88
What is the leading cause of death and disability worldwide?
Stroke
89
What are the major arteries supplying blood to the brain?
* Internal carotid arteries
* Vertebral arteries
90
What is the Circle of Willis?
A structure that provides collateral circulation to multiple areas of the brain
91
What are the neurological deficits associated with anterior cerebral artery occlusion?
Contralateral leg weakness
92
What symptoms are associated with middle cerebral artery occlusion?
* Contralateral hemiparesis
* Aphasia
* Contralateral visual deficits
93
What is a transient ischemic attack (TIA)?
A focal neurological deficit that resolves generally within 24 hours
94
What is the first step if a stroke is suspected?
Obtain a non-contrast CT
95
What does the prognosis of an ischemic stroke depend on?
The time of treatment from the onset of symptoms
96
What is the TOAST classification used for?
Classifying different types of ischemic strokes based on the originating factor
97
What is the first-line treatment for ischemic stroke?
Oral aspirin
98
What is the time frame for administering TPA for ischemic stroke?
3 to 4.5 hours post onset
99
What is revascularization in the context of stroke treatment?
A procedure performed to remove a clot using interventional radiology
100
What is required for patients undergoing surgery after starting a new anticoagulant?
Elective cases must be canceled for three months
101
What is a hemorrhagic stroke?
Bleeding inside the intracranial vault that impairs brain perfusion
102
What are the subtypes of hemorrhagic strokes?
* Intracerebral hemorrhage
* Epidural hematoma
* Subdural hematoma
* Subarachnoid hematoma
* Intraventricular hemorrhage
103
What is the most reliable predictor of outcomes in hemorrhagic stroke?
Blood volume in the hemorrhage and change in level of consciousness
104
What does conservative treatment for hemorrhagic stroke include?
* Reducing intracranial pressure
* Controlling blood pressure
* Seizure precautions
* Careful monitoring
105
What are common symptoms of cerebral aneurysms?
* Photophobia
* Confusion
* Hemiparesis
* Coma
106
What are the risk factors for cerebral aneurysms?
* Hypertension
* Smoking
* Female gender
* Cocaine use
107
How can a cerebral aneurysm be diagnosed?
* CT
* MRI
* Lumbar puncture for CSF analysis
108
What is photophobia?
Sensitivity to light
109
What is hemiparesis?
Weakness on one side of the body
110
What are some risk factors for aneurysms?
* Hypertension
* Smoking
* Female gender
* Cocaine use
111
How is an aneurysm diagnosed?
* CT scan
* MRI
* Lumbar puncture for CSF analysis
112
What is the recommended timeframe for intervention after an aneurysm rupture?
Within 72 hours
113
What medications are patients with an aneurysm generally placed on?
Steroids
114
What is Triple H therapy for subarachnoid hemorrhage vasospasm?
* Hypertension
* Hypervolemia
* Hemodilution
115
What is the initial treatment in Triple H therapy?
Hypertension
116
What is the Hunt and Hess classification used for?
To gauge the mortality of patients with aneurysms
117
What are AVMs?
Arteriovenous malformations, direct arterial to venous connections
118
How are AVMs typically diagnosed?
* Angiograms
* MRIs
119
What are the treatment options for AVMs?
* Radiation
* Embolization
* Surgical resection
120
What is Chiari malformation?
Congenital displacement of the cerebellum downward through the foramen magnum
121
What is the only real treatment for Chiari malformation?
Surgical decompression
122
What are the key anesthesia considerations for tuberous sclerosis?
* Airway compromise
* Cardiac involvement
* Kidney involvement
123
What is hydrocephalus?
Accumulation of cerebrospinal fluid leading to increased intracranial pressure
124
What are the preferred diuretics for treating hydrocephalus?
* Furosemide
* Acetazolamide
125
What is the surgical treatment for chronic hydrocephalus?
Insertion of a VP shunt
126
What defines a traumatic brain injury (TBI)?
Injury to the brain from external force, classified as penetrating or non-penetrating
127
What scale is used to categorize the severity of TBI?
Glasgow Coma Scale
128
What is a primary injury in TBI?
Injury occurring at the time of insult
129
What are secondary injuries in TBI?
* Neuroinflammation
* Cerebral edema
* Hypoxia
* Electrolyte imbalances
130
What is the first step in managing a severe TBI in the ER?
Obtain a CT scan
131
What is the significance of a lumbar puncture in diagnosing aneurysms?
Presence of blood in CSF can indicate an aneurysm
132
What is the role of interventional radiology in aneurysm treatment?
Coiling or stenting of the aneurysm
133
What is the significance of vasospasm post subarachnoid hemorrhage?
It occurs due to inflammatory mediators released after the hemorrhage
134
What is the Spetzler-Martin AVM grading system?
Grades AVMs based on size, surrounding brain tissue, and venous drainage patterns
135
What are the four types of Chiari malformation?
* Type I: Downward displacement of cerebellum
* Type II: Arnold Chiari with myelomeningocele
* Type III: Rare, occipital encephalocele
* Type IV: Not compatible with life
136
What are the common symptoms of Chiari malformation?
* Headaches
* Visual disturbances
* Ataxia
137
What is the anesthesia consideration for patients with neurofibromatosis?
Avoid neuraxial anesthesia due to higher likelihood of spinal tumors
138
What should be assessed in patients undergoing anesthesia?
Morbidity, degree of injury, imaging, severity of damage, baseline labs, neuro exam
## Footnote
Important to understand the patient's overall condition and potential complications.
139
What is the preferred type of venous access for emergency surgery?
Essential venous catheter
## Footnote
An a-line may also be necessary for monitoring.
140
What type of blood may be given if there isn't time for typing?
Uncrossmatched blood
## Footnote
This is often critical in emergency situations.
141
Why should an NG tube or OG tube be avoided in trauma cases?
Risk of nasal skull fracture
## Footnote
Insertion could exacerbate injuries.
142
What is the primary focus during surgery for traumatic brain injuries?
Correcting intraoperative issues
## Footnote
Continuous monitoring and adjustments may be necessary.
143
What are common causes of seizures?
* Hypoglycemia
* Hyponatremia
* Hyperthermia
* Intoxication
## Footnote
These conditions can lead to transient seizure activity.
144
What defines epilepsy?
Recurrent seizures due to congenital or acquired factors
## Footnote
Differentiates from single-event seizures.
145
What should be assessed preoperatively in patients with seizure disorders?
Source of seizures, control with medications
## Footnote
Important for planning anesthesia and surgery.
146
What is the role of anti-epileptic drugs?
Decrease neuronal excitability and enhance inhibition
## Footnote
Helps in managing seizure disorders.
147
What may patients on enzyme-inducing drugs require?
Higher doses of hepatically cleared medications
## Footnote
Due to increased metabolism of these drugs.
148
What should be ready when intubating a patient having a seizure?
RSI and suction
## Footnote
Preparedness is crucial for airway management.
149
Fill in the blank: Seizures are a transient, _______ discharge of neurons in the brain.
proximal synchronous
## Footnote
This definition helps in understanding seizure mechanisms.
150
True or False: All patients with seizures should have their anti-seizure medications reviewed preoperatively.
True
## Footnote
Ensures proper management during anesthesia.
151
What factors modulate cerebral blood flow (CBF)?
* Cerebral metabolic rate
* Cerebral perfusion pressure (CPP)
* Arterial blood carbon dioxide (PaCO2)
* Arterial blood oxygen (PaO2)
* Various drugs and intracranial pathologies
152
What is the normal range for intracranial pressure (ICP)?
5-15 mmHg
153
What does the Monro-Kellie hypothesis state?
Any increase in one component of intracranial volume must be offset by a decrease in another component to prevent an elevated ICP
154
What happens when compensatory mechanisms fail due to increased ICP?
Cerebral ischemia occurs
155
What are the two main types of herniation syndromes?
* Subfalcine Herniation
* Transtentorial Herniation
156
What is a common cause of increased ICP related to tumors?
* Direct size of tumors
* Indirectly causing edema
* Obstructing CSF flow
157
What are methods to decrease ICP?
* Elevation of the head
* Hyperventilation
* CSF drainage
* Hyperosmotic drugs
* Diuretics
* Corticosteroids
* Cerebral vasoconstricting anesthetics
* Surgical decompression
158
What is the typical age of onset for Multiple Sclerosis (MS)?
20-40 years
159
What are common symptoms of Multiple Sclerosis?
* Motor weakness
* Sensory disorders
* Visual impairment
* Autonomic instability
160
What are preanesthetic considerations for patients with Multiple Sclerosis?
* Assess existing deficits
* Pulmonary function tests if respiratory compromise
* Monitor glucose and electrolytes
* Temperature management
161
What triggers exacerbations in Myasthenia Gravis (MG)?
* Pain
* Insomnia
* Infection
* Surgery
162
What is the primary treatment for Myasthenia Gravis?
* Ach-E inhibitors (Pyridostigmine)
* Immunosuppressive agents
* Steroids
* Plasmapheresis
* IVIG
163
What are the effects of Eaton-Lambert Syndrome?
* Progressive limb-girdle weakness
* Dysautonomia
* Oculobulbar palsy
164
What is the most common and severe form of Muscular Dystrophy?
Duchenne Muscular Dystrophy
165
What are pre-anesthetic considerations for patients with Muscular Dystrophy?
* CBC, BMP, PFTs
* Pre-op EKG, echocardiogram
* Caution with ND-NMBs
166
What is myotonia?
Prolonged contraction after muscle stimulation
167
What are common symptoms of Dementia?
* Cognitive dysfunction
* Potential aspiration risk
168
What are the three major dementia syndromes?
* Alzheimer's
* Vascular dementia
* Parkinson's
169
What are common symptoms of brain tumors?
* Increased ICP
* Papilledema
* Headache
* AMS
* Mobility impairment
* Vomiting
* Autonomic dysfunction
* Seizures
170
What is the prognosis for Meningiomas?
Good prognosis with surgical resection
171
What are pre-anesthesia considerations for patients with brain tumors?
* Review history & physical
* Inquiry about previous therapies
* Continue steroids
* Monitor glucose levels
172
What is a common complication associated with prolonged respiratory compromise in Myasthenia Gravis?
Need for post-op respiratory support
173
Fill in the blank: The combined volume of brain tissue, CSF, and intracranial blood is ______ mL.
1200-1500
174
True or False: Hyperosmotic drugs decrease serum osmolarity to decrease ICP.
False
175
What is radiation damage associated with?
Lethargy and AMS
## Footnote
AMS refers to altered mental status.
176
What neurological effects can chemotherapy have?
Neurological effects including cognitive changes and peripheral neuropathy
## Footnote
Patients may experience symptoms like memory issues and nerve pain.
177
Why are patients often on steroids?
To minimize cerebral edema.
178
What must be monitored while continuing steroids?
Glucose levels.
179
What are common medications used for patients with supratentorial lesions?
Anticonvulsants.
180
What may autonomic dysfunction manifest as?
EKG changes, labile heart rate, and blood pressure.
181
What diagnostic tests are commonly performed?
CBC, BMP (glucose), EKG, CT/MRI.
182
What is mannitol used for?
To reduce intracranial volume and pressure.
183
What does CVA stand for?
Cerebral Vascular Accident.
184
What is the leading cause of death and disability worldwide?
Stroke.
185
What are the two main types of strokes?
* Ischemia (88% of cases)
* Hemorrhage (12% of cases).
186
What supplies blood to the brain?
* Internal carotid arteries
* Vertebral arteries.
187
What is the Circle of Willis?
A structure that provides collateral circulation to multiple areas of the brain.
188
What causes an ischemic stroke?
Occlusion of a vessel that perfuses a region of the brain, causing brain cell necrosis.
189
What characterizes a transient ischemic attack (TIA)?
Sudden focal vascular neurologic deficit that resolves within 24 hours.
190
What percentage of patients who experience a TIA will subsequently suffer a stroke?
1/3.
191
What is needed to distinguish ischemic stroke from intracerebral hemorrhage?
A STAT non-contrast CT.
192
What factors affect ischemic stroke prognosis?
Time from onset to thrombolytic intervention (<90 min).
193
List the TOAST classification groups for ischemic stroke causes.
* Large artery atherosclerosis
* Small vessel occlusion
* Cardioaortic embolic
* Other etiology
* Undetermined etiology.
194
What is the recommended initial treatment for ischemic stroke?
PO Aspirin.
195
What must be initiated within 3-4.5 hours post-onset for ischemic stroke?
IV or intra-arterial tissue plasminogen activator (TPA).
196
What is revascularization in the context of ischemic stroke treatment?
A procedure in interventional radiology to administer thrombolytics or perform thrombectomy.
197
What are the two most reliable predictors of outcome in hemorrhagic CVA?
* Blood volume
* Change in level of consciousness (LOC).
198
What are the subtypes of hemorrhagic strokes based on blood location?
* Intraparenchymal hemorrhage
* Epidural hematoma
* Subdural hematoma
* Subarachnoid hemorrhage
* Intraventricular hemorrhage.
199
What is the conservative treatment for hemorrhagic stroke?
Reduction of ICP, blood pressure control, seizure precautions, and monitoring.
200
What does surgical treatment for hemorrhagic stroke involve?
Evacuation of the hematoma.
201
What should be assessed pre-operatively in cerebrovascular disease?
History, deficits, imaging, treatments, and co-existing diseases.
202
What imaging techniques are used for cerebrovascular disease assessment?
* Carotid U/S
* CT/MRI head & neck
* Echocardiogram.
203
What is the risk for vasospasm post-subarachnoid hemorrhage (SAH)?
3-15 days.
204
What triggers vasospasm after SAH?
Free hemoglobin (hgb) reduces nitric oxide availability and increases endothelin 1.
205
What is Triple H therapy?
Hypertension, Hypervolemia, Hemodilution.
206
What are congenital brain abnormalities?
Defects in the development or structure of the CNS.
207
What is Chiari Malformation?
Congenital displacement of the cerebellum.
208
What are the types of Neurofibromatosis?
* Type 1 (most common)
* Type 2
* Schwannomatosis (rare).
209
What is hydrocephalus?
Excessive CSF accumulation causing increased ICP.
210
What are the main treatments for hydrocephalus?
* Diuretics (furosemide, acetazolamide)
* Serial lumbar punctures
* Surgical treatment (VP shunt, ETV).
211
What is the Glasco-Coma Scale used for?
Categorizing the severity of traumatic brain injury (TBI).
212
What is the primary injury in TBI?
Injury occurring at the time of the insult.
213
What are secondary injuries in TBI?
* Neuroinflammation
* Cerebral edema
* Hypoxia
* Anemia
* Electrolyte imbalances
* Neurogenic shock.
214
What must be done for severe TBI patients?
Intubation and mild hyperventilation to control ICP.
215
What is a seizure?
Transient, paroxysmal, synchronous discharge of neurons in the brain.
216
What is epilepsy?
Recurrent seizures due to congenital or acquired factors.
217
What is the role of antiepileptic drugs?
Decrease neuronal excitability and enhance inhibition.
218
What should be reviewed pre-anesthesia for seizure patients?
Source of seizures and control level.
219
What is the main concern regarding patients on enzyme-inducing medications?
They require higher doses of hepatically-cleared medications.
220
What is the primary risk factor for Parkinson's Disease?
Advanced age.
221
What is the triad of symptoms for Parkinson's Disease?
* Skeletal muscle tremor
* Rigidity
* Akinesia.
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What are common treatments for Parkinson's Disease?
* Levodopa
* Anticholinergics
* MAOIs
* Deep brain stimulator.
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What is the major risk factor for cerebral aneurysms?
Hypertension.
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What are the symptoms of cerebral aneurysms?
* Headache
* Photophobia
* Confusion
* Hemiparesis
* Coma.
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What is the recommended intervention time for cerebral aneurysms after rupture?
Within 72 hours for best outcomes.
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What is an arteriovenous malformation (AVM)?
An arterial to venous connection without intervening capillaries.
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What are the treatment options for AVMs?
* Radiation
* Angio-guided embolization
* Surgical resection.
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What is Tuberous Sclerosis also known as?
Bourneville Disease.
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What does Tuberous Sclerosis cause?
Benign hamartomas, angiofibromas, and other malformations.
