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6901 > 6901 Neuro Part I > Flashcards

6901 Neuro Part I Flashcards

1
Q

Which structure has more space to expand, the brain or sc?

A

sc

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2
Q

How do unmyelinated versus myelinated nerves travel?

A

unmyelinated= AP; myelinated= saltatory

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3
Q

What do dendrites and axons do?

A

dendrites carry impulses to cell body and axons carry nerve impulses away from cell body

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4
Q

What part of neuron is unmyelinated/gray?

A

cell body and some axons

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5
Q

This provides support for neurons and has nutritive and metabolic functions. Has feet that project from cell and sometimes terminate on blood vessels and not other neurons? May play role in BBB?

A

astrocytes

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6
Q

Type of brain cell that has role in CSF production?

A

ependymal cell

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7
Q

Type of brain cell which participates in phagocytosis with CNS?

A

microglia

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8
Q

Type of brain cell which provides insulation, by forming the myelin sheath around the brain and sc?

A

oligodendrites

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9
Q

This type of cell provides insulation as forms myelin sheath in peripheral nerves?

A

Schwann cell

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10
Q

How do neurons communicate with each other?

A

by means of NTs across synpases

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11
Q

Inhibitory and excitatory NT?

A

major inhibitory is GABA; major excitatory is glutamate

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12
Q

How does a GABA NT work?

A

(hyperpolarizing); it opens neuronal membrane Cl channels and produces hyperpolarization

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13
Q

How does a glutamate NT work?

A

activation depolarizes neurons which makes it more likely that they will fire APs

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14
Q

Where is GABA concentrated?

A

cerebral cortex, cerebellum, basal ganglia, spinal cord

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15
Q

This NT is important in antagonizing the excitatory effects of amino acid NTs?

A

GABA

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16
Q

This NT plays a large role in learning and memory and perhaps interactive and memory formation in awareness under anesthesia and the appreciation of pain?

A

glutamate

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17
Q

Where is glutamate concentrated?

A

cerebral cortex, hippocampus, substantial gelatinosa of the sc

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18
Q

This NT is released in excitatoxic neuronal injury after TBI or ischemic injury?

A

glutatmate

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19
Q

How is glutamate formed?

A

deamination of glutamine supplied by Kreb’s cycle

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20
Q

What are 3 categories of NTs?

A

monoamines (epi, dopa), amino acids (GABA, glutamate), neuropeptides (substance P, pituitary and endocrine hormones)

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21
Q

How does glutamate work?

A

activates NMDA (ligand gated inotropic receptor) that cause conformational change in receptor and opens Na channel which results in depol of post synpatic membrane

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22
Q

Neurons are classified according to and what are 3?

A

specific function; sensory, motor, interneuron

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23
Q

Afferent part of neuron goes in what direction and is what type of neuron?

A

goes towards posterior root, is sensory

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24
Q

Efferent part of neuron goes in what direction and is what type of neuron?

A

away from anterior root and is motor

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25
Q

What do interneurons do?

A

connect adjacent neurons

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26
Q

How much intracellular transport takes place in CNS and why?

A

very little bc lack transport mechanisms

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27
Q

What type of cells form tight junctions between adjacent cells to prevent transport of polar substances from intravascular to extravascular cerebral dept?

A

endothelial

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28
Q

What separates the 2 cerebral hemispheres?

A

longitudinal fissure

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29
Q

Describe the gyri?

A

is elevated and outer 3 mm area which is convoluted and increases the surface area

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30
Q

What do the sulci do?

A

grooves which separate the gyri

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31
Q

4 lobes of the brain?

A

frontal, parietal, temporal, occipital

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32
Q

Lobe of brain which is responsible for motor and thought?

A

frontal

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33
Q

Lobe of brain which is responsible for sense of pain, pressure, temp, and touch?

A

parietal

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34
Q

Lobe of brain which is responsible for hearing and smelling, recognition, and memory?

A

temporal

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35
Q

Lobe of brain whose function is vision?

A

occipital

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36
Q

Brainstem consists of?

A

midbrain, pons, and medulla

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37
Q

Part of brainstem that maintains consciousness, arousal, and alertness?

A

RAS

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38
Q

What does pons connect?

A

midbrain and medulla oblongata

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39
Q

This part of brain contains the respiratory and CV centers?

A

medulla

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40
Q

How many meningeal layers and spaces are there that cover the brain and spinal cord?

A

3 and 3

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41
Q

Meningeal layers going from outside to inside?

A

dura, arachnoid, pia

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42
Q

Meningeal spaces going from outside to inside?

A

epidural, subdural, subarachnoid

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43
Q

This meningeal layer is thin and avascular and serves as a major pharmacologic barrier?

A

arachnoid

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44
Q

This meningeal layer is thin, soft, highly vascular, and provides nourishment to spinal cord and brain

A

pia mater

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45
Q

This meningeal layer is thick and provides structural support to spinal cord?

A

dura mater

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46
Q

This meningeal layer forms a good portion of the BBB?

A

arachnoid

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47
Q

What is the space called above the dura mater?

A

epidural space

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48
Q

What is the space called between the arachnoid and pia?

A

subarachnoid space

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49
Q

What is the space called between the dura and arachnoid?

A

subdural

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50
Q

Which space contains the CSF?

A

subarachnoid

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51
Q

Pneumonic for memorizing CN names?

A

On Old Olympus Towering Top A Fin A(V)nd German Viewed S(A)ome Hops

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52
Q

Sensory/motor/both CN pneumonic?

A

Some Say Money Matters, But My Brother Says Big Brains Matter More

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53
Q

Angostroms between tight junctions in BBB and then in rest of body?

A

8; 65

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54
Q

Movement across BBB is governed by what 4 things?

A

size, charge, solubility, degree of protein binding

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55
Q

4 substances that struggle to pass thru BBB?

A

large molecules, high electrical charge, low fat soluble, polar molecules

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56
Q

Water, lipid soluble molecules such as (3) can pass thru BBB?

A

O2, CO2, anesthetics

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57
Q

Some problems which can cause a disruption in BBB?

A

HTN, TBI, subarachnoid or cerebral hemorrhage, ishcemia, mass or lesions

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58
Q

2 main arteries which supply blood to brain? Which supplies the anterior portion and which supplies the posterior portion?

A

internal carotid arteries and vertebral arteries; anterior: internal carotid; posterior: vertebral

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59
Q

Where does carotid bifurcate in to internal and external carotid arteries?

A

level of 3rd cervical vertebrae

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60
Q

CN whose motor control is of the face and salivation. Sensory is taste and cutaneous sensations

A

facial

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61
Q

CN which has motor control of some eye muscles and eyelid?

A

oculomotor

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62
Q

CN which has motor control of some eye muscles?

A

trochlear or abducent

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63
Q

CN which is responsible for chewing muscles and facial sensation?

A

trigeminal

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64
Q

CN which is responsible for motor impulses to pharynx and shoulder?

A

accessory

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65
Q

CN which is responsible for salivation, sensation of skin, taste, and viscera?

A

glossopharyngeal

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66
Q

CN which has motor control of tongue, some skeletal muscles, some viscera, and sensation from skin and viscera?

A

hypoglossal

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67
Q

8 ways in which CBF can be manipulated?

A

CMRO2, PaO2, PaCO2, autoregulation, temp, viscosity, ANS, anesthetics/meds

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68
Q

Normal rate of CBF?

A

50mL/100g/min of brain tissue

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69
Q

What percentage of CO is CBF?

A

15-20

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70
Q

As CBF changes so does?

A

CBV

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71
Q

Why does brain get disproportionately high part of CO?

A

high metabolic rate and inability to store energy

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72
Q

CMR is directly r/t?

A

of neurons and rate of depol

73
Q

Gray matter gets what % of CBF and why?

A

80%, higher metabolic rate

74
Q

How many mL/min is CBF?

A

700-750 mL/min

75
Q

Too little CBF leads to? And too much CBF leads to?

A

ischemia; edema, bleeding

76
Q

CPP=?

A

MAP- ICP or CVP (whichever is higher)

77
Q

Where do you measure CVP?

A

at ear canal/meatus

78
Q

Normal ICP?

A
79
Q

Pressure that drives blood flow to the brain?

A

CPP

80
Q

CPP is primarily dependent on? What’s the exception?

A

MAP; increased ICP

81
Q

When ICP> 30, what is compromised even with a normal MAP?

A

CBF CPP

82
Q

A CPP of what can show flat EEG and result in irreversible brain damage?

A

25-40

83
Q

Brain uses what % of total body O2 consumption?

A

20

84
Q

CBF is tightly coupled to?

A

metabolism

85
Q

High O2 consumption of brain is roughly what mL/min in adult?

A

50 mL/min

86
Q

Neuronal activity in brain accounts for what % of energy use?

A

60

87
Q

Most cerebral O2 consumption is used to?

A

generate ATP to support neuronal electrical activity

88
Q

Increased ATP/energy leads to increased CMRO2 and therefore?

A

increased blood flow

89
Q

What determines blood flow in the brain?

A

regional metabolism rate of O2

90
Q

Primary fuel for brain is what and at what rate?

A

glucose; 5 mg/100g/min

91
Q

How is ATP generated? And >90% of that is what type of process?

A

glycolysis; aerobic

92
Q

CMRO2 parallels?

A

glucose consumption

93
Q

Since the brain has no O2 stores, ATP stores are depleted and cellular injury can occur how soon?

A

3-8 minutes

94
Q

What does mild hyperthermia do to the CMR and CBF?

A

increases and increases

95
Q

CBF is directly influenced by ____= glucose consumption?

A

CMRO2

96
Q

What is autoregulation?

A

ability of cerebral vasculature to maintain relatively constant blood flow despite large changes in BP

97
Q

CBF maintains constant with CPP (MAP) between?

A

50-150

98
Q

MAP for lower limit of autoregulation is?

A

> 70

99
Q

MAP> what disrupts the BBB and leads to edema and bleeding?

A

150-160

100
Q

What does cerebral autoregulation curve do with chronic HTN?

A

shifts to the right

101
Q

MAP

A

50

102
Q

What does PaCO2 do to CBF and vasculature?

A

dilation and increases blood flow

103
Q

Beyond autoregulation limits CBF is dependent on?

A

perfusion pressure

104
Q

What can alter brain autoregulation?

A

brain injury or intracranial surgery

105
Q

PaO2 has little effect on CBF until it falls below?

A

50

106
Q

Most important regulator of CBF?

A

PaCO2

107
Q

Hypocapnia does what to the vasculature?

A

constricts

108
Q

CBF increases or decreases what % for each 1 mm change in PaCO2?

A

3

109
Q

Do blood vessels in ischemic areas react the normally to changes in CO2?

A

no

110
Q

One way to get a steal phenomenon w PaCO2?

A

hypoventilation with hypercarbia (increased CBF to normal areas)

111
Q

One easy way to relax the brain to change the ICP?

A

hyperventilation

112
Q

How long can hyperventilation relax the brain? And how quickly?

A

acutely (

113
Q

PaCO2

A

30

114
Q

What happens to CBF when PaO2

A

increases

115
Q

ICP > 30 does what to CBF?

A

decreases

116
Q

CPP

A

decreases

117
Q

CPP > 150 does what to CBF?

A

increases

118
Q

A decreased temp does what to neuronal metabolism and CBF?

A

decrease, decrease

119
Q

CBF decreases what percent for every 1 degree Celsius decrease in temp?

A

5-7%

120
Q

Hyperthermia does what to CBF and CMR?

A

increases, increases

121
Q

Hypothermia is used for what and what do you have to monitor for?

A

high risk intraop ischemia; dysrthymias and coagulation dysfunction

122
Q

Most important factor in viscosity?

A

hct

123
Q

What does increased viscosity (increased hct) do to CBF?

A

decrease

124
Q

What does decreased viscosity (decreased hct) do to CBF?

A

increase

125
Q

Suggested optimal hct adequate for O2 delivery is?

A

30%

126
Q

Intracranial vessels are innervated by?

A

SNS, PNS

127
Q

What type of innervation may lead to passing out?

A

SNS

128
Q

What does SNS innervation do to the vasculature and CBF?

A

constriction; decrease in CBF

129
Q

What does PNS innervation do to the vasculature and CBF?

A

dilate; increases CBF

130
Q

3 places where CSF is located?

A

subarachnoid space, cerebral ventricles, cisterns

131
Q

Function of CSF?

A

bathes and cushions brain and spinal cord

132
Q

Where is CSF produced and secreted?

A

produced by choroid plexus in the ventricles; secreted by ependymal cells of choroid plexus

133
Q

CSF is produced at a rate of what? And the total volume at one time is? And how much is produced daily?

A

30 mL/h; 150 mL; 450-500 mL

134
Q

How often does CSF volume replace itself?

A

3-4 hours

135
Q

Normal CSF pressure is between?

A

5-15

136
Q

% of brain, blood, and CSF in cranial vault?

A

80% brain, 12% blood, 8% CSF

137
Q

Brain matter is composed of?

A

neurons, glia, interstitial fluid

138
Q

Blood/fluid part of brain consists of?

A

blood, vascular space, ICF, ECF

139
Q

Where is CSF reabsorbed?

A

arachnoid villi

140
Q

Where does brain stem turn in to spinal cord and exit CNS in to spinal cord?

A

foramen magnum

141
Q

Cerebral bolt or ventriculostomy in supine position pressure should be?

A

10-15 torr

142
Q

ICP refers to?

A

supratentorial CSF pressure

143
Q

An ICP of what is considered intracranial HTN?

A

15

144
Q

Normal ICP?

A

5-15

145
Q

4 compensatory mechanisms used when ICP is increased?

A

decrease CSF production, increase CSF absorption, displacement of CSF from cranial to spinal compartment, decrease in CBF (venous)

146
Q

As the cranial volume increases, CSF is translocated in to?

A

spinal canal

147
Q

Ischemia leads to?

A

cerebral edema and further increases in ICP

148
Q

Symptoms of increased intracranial HTN?

A

HA (that wakes them up at night), N/V, blurred vision, somnolence and neuro deficits, papilledema, seizures/coma, Cushing reflex

149
Q

3 s/s Cushing’s triad?

A

HTN, bradycardia, respiratory irregularities

150
Q

Some causes of intracranial primary HTN?

A

brain tumor, trauma, nontraumatic intracerebral hemorrhage, ischemic stroke, hydrocephalus, idiopathic or benign intracranial HTN, abscess, infection, cyst

151
Q

Causes of extracranial/secondary HTN?

A

hypercarbia >35, hypoxia

152
Q

Post op causes of intracranial HTN?

A

mass lesion (hematoma), edema, disturbances in CSF, increased CBV

153
Q

What does edema look like on a CT scan?

A

region of hypodensity

154
Q

What does increased airway or intrathoracic pressure do to venous pressure?

A

increased jugular venous pressure

155
Q

6 things which increase CBV?

A

increased PaCO2, decreased PaO2, increased JV pressure, some anesthetics, vasodilators, seizures

156
Q

Intracranial vault concentration is lost when ICP >?

A

30

157
Q

Brain response to ischemia is?

A

edema

158
Q

Increase in ICP and ischemia cause what reflex?

A

Cushing’s

159
Q

Normally cerebral ischemia leads to Cushing’s reflex which will increase?

A

MAP

160
Q

Cushing’s reflex only compensates to a certain point and then what falls leading to further ischemia?

A

CPP

161
Q

Why does a reduction in SBP aggravate ischemia?

A

causes reduction in CPP

162
Q

2 compensatory mechanisms for high ICP?

A

translocation of CSF to spinal CSF space and venous blood to the extracranial veins

163
Q

2 meds that increase ICF or ECF?

A

diuretics or steroids

164
Q

Increases in blood volume are usually associated with increases in CBF. Exception is?

A

ischemia from hypotension or vessel occlusion at which time CBV may increase as cerebral vasculature dilates in response to reduction in CBF

165
Q

3 things we can manipulate in CNS?

A

CSF: drain; blood volume: diuretics, steroids, positioning; cells (surgical removal glia, tumors, extravasated blood)

166
Q

Gold standard for ICP monitoring?

A

intraventricular catheter

167
Q

4 types of drains?

A

subdural bolt, ventriculostomy, epidural transducer, subdural fiberoptic catheter placement

168
Q

Level drain w?

A

right atrium or angle of monroe

169
Q

How do steroids help with CSF/fluid volume reduction?

A

decrease edema

170
Q

4 diuretics to give to decrease CSF/fluid?

A

Lasix, hypertonic saline, Mannitol, Diamox

171
Q

One way to decrease CBF?

A

decrease CBV

172
Q

Decreased CBV and CBF does what to ICP?

A

decreases

173
Q

Anesthesia can provide rapid alteration in which area of the intracranial vault?

A

CBV reduction/CBF reduction

174
Q

3 things which increase CMR?

A

arousal, pain, seizures

175
Q

Arterial blood volume can be reduced by?

A

preventing increase in CMR, barbs, optimizing hemodynamics

176
Q

In hypothermia CBF (CMRO2) is decreased what % for every 1 degree C decrease in body temp below 37?

A

7%

177
Q

Keep hct in what range to maximize O2 transport?

A

30-35%

178
Q

Below what temperature can you not improve intracranial HTN?

A

35

179
Q

Some ways to increase venous outflow and drainage?

A

elevate head, avoid constriction of the neck, avoid PEEP and excess airway pressures

6901 (18 decks)

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