4 - Neuro Disorders

Question 1

When are the maximal effects of primary brain injuries seen?

Answer 1

18-36 hours

Question 2

What is the source of bleeding in 85% of epidural hematomas?

Answer 2

Arterial

Almost always a medical emergency

Briefly regain consciousness, then unconscious again

Question 3

Where does epidural bleeding occur?

Answer 3

between the dura and the skull

Question 4

where does subdural bleeding occur?

Answer 4

between the dura and the brain

Question 5

Tears in what veins cause subacute subdural hematomas?

Answer 5

Bridging veins

Question 6

Subdural hematomas are more common in what population?

Why?

Answer 6

older adults and alcoholics

some degree of brain atropy cause increased size of epidural space and more stress on the bridge veins

Question 7

What are the GCS levels for TBI:

Mild

Moderate

Severe

Answer 7

13-15

8-13

<8

Question 8

What is second brain injury?

Answer 8

hypotension, hyperglycemia, anemia, cerebral edema

anything that happens as a result of the brain injury

Question 9

What is chronic traumatic encephalopathy?

Answer 9

progressive dementia r/t repeated brain injury

boxers, soldiers, etc.

Question 10

What is primary and secondary spinal cord injury?

Answer 10

primary: the injury from initial trauma/destruction
secondary: cascade of vascular, cellular, and biochemical events (edema etc)

Question 11

Where do vertebral injuries most often occur in adults?

Answer 11

Most mobile portions of the column:

C1-C2

C4-C7

T10-L2

Question 12

What causes spinal shock?

Answer 12

Loss of continuous tonic discharge from the brain or brainstem

Question 13

What is neurogenic shock?

Answer 13

occurs with cervical or upper thoracic cord injury

may exist with spinal shock

sympathetic nerves pass through the spine and are therefore cut off, but parasympathetic activity passes through the vagus and remains intact

get a massive wave of uninhibited parasympathetic activity

Question 14

With acceleration injuries the greatest stress point is:

Answer 14

C4-C5

Question 15

With deceleration injuries the greatest stress point is:

Answer 15

C5-C6

Question 16

complete quadriplegia results in injury at:

partial quadriplegia:

Answer 16

above C6

at or below C6

Question 17

What is autonomic hyperreflexia?

Answer 17

sudden, life-threatening massive reflex sympathetic discharge

associated with spinal cord injury at T6 or above where descending inhibition is blocked

Question 18

what is the most common cause of autonomic hyperreflexia?

Answer 18

distended bladder or rectum

but can be any sensory stimulation that’s unpleasant

Question 19

What is the cause of most lower back pain?

Answer 19

Usually idiopathic and non-specific

Question 20

What is spondylolysis?

What is spondylolisthesis?

Answer 20

fracture of the pars interarticularis (where the vertebral body meets the posterior structures)

displacement of the pars interarticularis (slides forward)

Question 21

Degenerative Disk Disease pain is caused by:

Answer 21

protrusion of the disk

OR

narrowing of the spinal canal/intervertebral foramen by osteophytes

Question 22

what is radiculopathy?

Answer 22

compression or inflammation of a spinal nerve root causing dermatomal distribution of pain

Question 23

Where do disk herniatons almost never occur?

Answer 23

thoracic

Question 24

What are symptoms of cauda equina syndrome?

Answer 24

saddle anesthesia

decreased or absent reflexes in the lower extremities

neurogenic bowel or bladder dysfunction

Question 25

When does a herniated disk merit surgery?

Answer 25

severe compression cauda equina syndrome requires emergency surgical evaluation

Question 26

What is the difference between embolic and thrombotic strokes?

Answer 26

Thrombotic strokes are caused by clots that originate in the cerebral vessels Embolic strokes are caused by clots that migrate from outside the brain (usually the heart, aorta, or common carotid)

Question 27

What are lacunar strokes?

Answer 27

small vessel disease caused by perivascular edema, thickening and inflammation of the arterial wall Usually in the basal ganglia, pons

Question 28

what is a hemodynamic stroke?

Answer 28

brain hypoperfusion d/t inadequate blood delivery

Question 29

what is the ischemic penumbra?

Answer 29

zone of borderline ischemic tissue that isn't permanently damaged Window of opportunity for protecting the penumbra is 3 hours

Question 30

\_\_\_\_\_\_\_\_ is associated with ruptured aneurysms, AVMs, cavernous angioma, or brain trauma \_\_\_\_\_\_\_\_ is usally just associated with brain trauma

Answer 30

SAH SDH

Question 31

What is an AVM?

Answer 31

mass of dilated vessels between the arterial and venous systems Its an AV fistula in the brain

Question 32

What causes AVMs?

Answer 32

persistent embryonic patterns of blood vessels

Question 33

What percentage of AVMs lead to seizures?

Answer 33

50% The other 50% experience a hemorrhagic stroke

Question 34

Which type of head bleeds often reoccur?

Answer 34

SAH especially if it's due to a ruptured intracranial aneurysm

Question 35

What is the mortality from an SAH?

Answer 35

50%

Question 36

40-60% of patients with SAH also experience:

Answer 36

Delayed cerebral ischemia (DCI) Inflammatory substances from the SAH damage cause cerebral artery vasospasms in adjacent (or nonadjacent) vessels Can prolong cell death in the area up to 3-14 days

Question 37

What is the diagnostic marker of a migraine?

Answer 37

Lasts 4-72 hours

Question 38

What neurosubstances are associated with migraine?

Answer 38

Elevated CGRP Increased glutamate Decreased serotonin

Question 39

What are the most common pathogens to cause bacterial meningitis?

Answer 39

meningococcus pneumococcus

Question 40

How is bacterial meningitis spread?

Answer 40

respiratory droplets and contact with contaminated saliva can be a carrier without exhibiting symptoms

Question 41

Which is worse: bacterial or viral meningitis? Which has a vaccine?

Answer 41

Bacterial Bacterial

Question 43

Guillain Barre is a demyelinating disease of the \_\_\_\_\_ MS is a demyelinating disease of the \_\_\_\_\_

Answer 43

PNS CNS

Question 44

In MS, what is a clinically isolated syndrome?

Answer 44

a demyelinating event that manifests as an acute neurologic episode

Question 45

What happens with botulism poisoning?

Answer 45

inhibited release of Acetylcholine leads to severe flaccid paralysis and death

Question 46

What is myasthenic crisis?

Answer 46

severe muscle weakness with depressed respiratory function danger of respiratory arrest

Question 47

What is a cholinergic crisis?

Answer 47

often caused by anticholinergic drug toxicity Massive amounts of acetylcholine at the NMJ Increased intestinal motility, bradycardia, pupillary constriction, increased salivation, diaphoresis looks like a myasthenic crisis but occurs 30-60 min after taking an anticholinergic med

Question 48

What is the most lethal and common type of primary brain tumor?

Answer 48

Glioblastoma Multiforme (GBM) Grade IV astrocytoma

Question 49

Which is more common: secondary or primary brain cancers?

Answer 49

10x more likely to be from metastasis

Question 50

Describe the anterior and posterior fontanel in infants

Answer 50

anterior is diamond shaped and closes at 18 months posterior is triangular shaped and closes at 2-3 months

Question 51

What usually causes hemorrhagic strokes in children?

Answer 51

congential cerebral AVMs

Question 52

What is moyamoya disease?

Answer 52

chronic, progressive stenosis of anterior circulation (internal carotids or middle cerebral aa) Looks like a "puff of smoke" on CTA