Acute Neuropathologies Flashcards
(174 cards)
1
Q
Brain Tumors: What is it ?
A
Space-occupying lesions – cause ↑ ICP.
2
Q
Can be life-threatening.
A
Both benign & malignant tumors
Unless accessible and removable
3
Q
The largest category of primary malignant tumors.
A
Gliomas
4
Q
Brain tumors classified based on
A
Cell derivation & location of tumor
5
Q
Brain Tumors
Tumors can also arise from
A
meninges or pituitary
6
Q
Primary malignant tumors rarely
A
metastasize outside CNS
7
Q
Secondary brain tumors
A
Metastasized from breast or lung
Effects are similar to primary tumors
8
Q
Brain Tumors
Primary malignant tumors (PID)
A
- Poorly defined margins
- Invasive, have irregular projections into adjacent tissue (T1)
- Inflammation develops around the tumor (T2)
9
Q
Difficult to totally remove
A
Primary Malignant tumors
10
Q
Brain Tumors Supratentorial mostly in
A
Adults; more frequently in cerebral hemispheres
11
Q
Brain tumors: Infratentorial: mostly in
A
Children; more frequently in brainstem / cerebellum
12
Q
Brain Tumors Signs and symptoms : determines focal signs
Usually no systemic signs of malignancy
Will cause death before they cause general effects
A
Site of tumor
13
Q
Often first sign of brain tumors
A
Seizures
14
Q
Brain tumors Signs and symptoms HVILPB
A
HA (↑ ICP); vomiting lethargy Irritability Personality and Behavioral changes; possible unilateral facial paralysis or visual problems
15
Q
What are the treatment of Brain tumors?
A
Treatment – may cause damage to normal CNS tissue
Surgery if accessible
Chemotherapy and radiation (many are radio resistant)
16
Q
Glomus Tumors of Head and Neck
“Paragangliomas” –Form where?
A
form within neuroendocrine tissue lying along carotid artery, C.N. IX+ and middle ear
17
Q
Paragangliomas” – What determines signs/symptoms:
A
Location of tumor
18
Q
Glomus Tumors of Head and Neck
“Paragangliomas” Middle ear tumor (UCA)
A
Unilateral pulsatile tinnitus
Conductive hearing loss
Aural fullness
19
Q
Glomus Tumors of Head and Neck : “Paragangliomas”
C.N. tumor symptoms
A
Facial paralysis
Dysphonia/Dysarthria
20
Q
Glomus Tumors of Head and Neck can
A
Secrete hormones
21
Q
Glomus Tumors of Head and Neck can Norepi –
Serotonin – mimics carcinoid syndrome
A
mimics Pheochromocytoma
22
Q
Glomus Tumors of Head and Neck -> CCK –
A
causes post-op. ileus
23
Q
Glomus Tumors of Head & Neck Serotonin –
A
mimics carcinoid syndrome Bronchoconstriction HA Flushing HTN
24
Q
Possible Anesthesia Complications Brain tumors Pre-op (if C.N. (VAL)
A
9, 10, 12 affected):
Airway obstruction
Vocal cord paralysis
Laryngeal distortion
25
Possible Anesthesia Complications Brain tumors Intra-op
(if norepi or histamine released during surgery)
| Profound Hyper or Hypotension
26
Possible Anesthesia Complications Post-op
(if C.N. or vessel damage)
↑ risk aspiration with impaired gastric emptying
Venous air embolism
Massive blood loss
27
Vascular disorders Ischemia (TIA) or Infarct (CVA) 2o to:
Occlusion
| Aneurysm with resultant ↑ICP
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TIA and CVA Extent of damage & manifestations depend on
artery involved
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TIA and CVA Ischemia can be
Focal or Global
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Temporary ischemia caused by:
| PASVL
```
Partial occlusion of an artery
Atherosclerosis
Small embolus
Vascular spasm
Local loss of autoregulation
```
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May occur singly or in series
TIA
32
Difficult to diagnose
TIA
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TIA manifest as (weakness)
Intermittent short episodes of impaired function ex. muscle weakness in arm or leg
34
TIA signs TFV
Visual disturbances
Facial numbness / paresthesias
Transient aphasia, confusion or dizziness
35
CVA Infarction caused by:
Occlusion or Aneurysm of cerebral blood vessel
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Irreversible damage
5 Minutes of ischemia
Central area of necrosis develops; all function lost
Surrounding inflammation later heals.
37
Test used to determine whether a stroke is ischemic or hemorrhagic.
Non-contrast CT
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CT reliably detects
intracranial bleeding, but is insensitive to ischemic changes during first few hours of a stroke.
39
% of CVA hemorrhagic
Approx. 20% of CVAs are hemorrhagic.
40
Hemorrhagic strokes are
4x more likely to result in death.
41
Test to determine cause
MRA useful in determining cause
42
Risk factors for CVA
| 4S DEHAIOH
```
Systemic HTN
Systemic lupus
Smoking
Sedentary lifestyle
Diabetes
Erythematosus
Hyperlipidemia
Alcohol abuse,
Increasing age
Obstructive sleep apnea
Heart disease
```
43
This combination can lead to stroke->
Combination of oral contraceptives & cigarette
| smoking
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CVA and congenital
Congenital malformation of blood vessels
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Signs and symptoms of CVA
| Depend on
location & size of artery involved (Collateral circulation may diminish size of affected area)
46
IN CVA, Weakness signs and symptoms
Lack of voluntary movement or sensation on opposite side of body
Initially flaccid paralysis
Spastic paralysis develops weeks later
47
NIH Stroke Scale
Developed by the National Institutes of Health
| Designed to assist with rapid diagnosis in an emergency situation
48
CVA Treatments:
| Rehabilitation
Surgery
Medical - Thrombolytics for clot
Glucocorticoids
Supportive treatment
49
IV TPA – must be initiated within
3 hours from the onset of symptoms
50
CVA rehab
Occupational and physical therapy; speech-language
| pathologists
51
Treat underlying problem to prevent recurrence
CVA
52
What is an aneurysm?is
|
Localized weakness in wall of an artery
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Cerebral aneurysms frequently
multiple.
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Cerebral aneurysm Usually in
subarachnoid space, or at points of bifurcation on circle of Willis “Berry” aneurysms
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Aneurysm aggravated by
Often aggravated by HTN
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Aneurysm is initially ____and _______
| Slow bleed cause_______
Initially small and asymptomatic
| Slow bleed causes vascular headache
57
Aneurysm rupture
Rupture = fatal ↑ICP and death
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Aneurysms Signs and symptoms of subarachnoid hemorrhage (LSND)
Loss of vision or visual disturbances
Sudden severe HA & photophobia
Nuchal rigidity due to meningeal irritation
Decreased level of consciousness
59
ECG changes often seen following subarachnoid
| hemorrhage:
ST-segment depression, and inverted T waves.
60
Aneurysm Treatment
Treatment
Surgical treatment before rupture
Antihypertensives
61
Moyamoya Japanese word – means
“puff of smoke” – refers to angiographic findings.
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Moyamoya is progressie
| TIAs/ischemia seen in children; Hemorrhage in adults
Progressive stenosis of intracranial vessels with 2o
| development of anastomotic capillaries.
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Moyamoya genetic
Familial tendency
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Intracranial aneurysms occur with
increased frequency
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Medical Treatment of Moyamoya
Vasodilators
| Anticoagulants
66
Surgical Treatment of Mayamoya
Anastomosis STA to MCA
| Prognosis Poor
67
Moyamoya – (Anesthesia Considerations)
| FIA
Intra-arterial catheterization for rapid BP assessment should be placed prior to induction.
Avoid hyperventilation to reduce risk of cerebral
vascoconstriction.
Facilitate rapid emergence from anesthesia for neurologic
function assessment.
68
BP control of Moyamoya
Dopamine and ephedrine control hypotension with less
| adverse effects on cerebral vasculature than vasoconstrictor drugs
69
Infections - meningitis
Different age groups are susceptible to different causative
organisms.
May be 2o to other infections
70
Children and young adults Meningitis
Neisseria Meningitis or meningococci
Frequently carried in nasopharynx of asymptomatic carriers
Spread by respiratory droplets
71
Neonates Meningitis
Escherichia coli most common causative organism
| Usually in conjunction with a neural tube defect, premature rupture of the amniotic membranes, difficult delivery
72
Young children Meningitis
Most often due to
More often in the
H. influenzae
| autumn or winter
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Older adults and Meningitis
Streptococcus pneumoniae – major caus
74
Signs and symptoms of Meningitis
| SSBNP
```
Sudden onset
Severe HA
Nuchal rigidity
Back pain
Photophobia
```
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Sign with Meningitis
Kernig sign
| Brudzinski sign
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Symptoms of Meningitis
Vomiting
Irritability
Lethargy, fever, and chills with leukocytosis
Progressing to stupor or seizures
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Meningitis Diagnostic tests
Lumbar puncture to examine CSF
| Identify causative organism
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Treatment of Meningitis
| AGRV
Aggressive antimicrobial therapy
Glucocorticoids
Reduction of cerebral inflammation & edema
Vaccines available for some types of meningitis
79
Infections - Brain Abscess
| LUF
Localized infection
Usually necrosis of brain tissue and a surrounding area of
edema
Frequently in frontal or temporal lobes
80
Brain Abscess spread?
May spread from organisms in ear, throat, lung, sinuses
May result from septic emboli, acute bacterial
endocarditis, site of injury or surgery
81
Treatment of brain abscess
Surgical drainage and antimicrobial therapy
82
Infections – Viral Encephalitis
Infection of the parenchymal or connective tx. of Brain/SC Inflammation & Necrosis develop
Results in some permanent damage
83
Viral Encephalitis infection Early signs
Severe HA, stiff neck, lethargy, fever, vomiting, seizures
84
Infection may include
meninges
85
Western equine encephalitis
Arboviral infection spread by mosquitoes
More frequent in summer
Common in children
86
St. Louis encephalitis
Affects older persons more seriously than young
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West Nile fever
Caused by a flavivirus
| Spread by mosquitoes
88
Encephalitis Herpes simplex encephalitis
Occurs occasionally
Spread from herpes simplex I
Extensive necrosis and hemorrhage in the brain
89
Tetanus
| Caused by _________
Caused by Clostridium tetani
90
Botulism caused by
Caused by Clostridium botulinum
91
WIth botulism exotoxin
blocks acetylcholine @NMJ causing FLACCID Paralysis, respiratory failure
92
With Tetanus exotoxin
Exotoxin blocks inhibitory glycine & GABA @NMJ
Spastic paralysis
Respiratory failure
93
Rabies
Viral, transmitted by bite of a rabid animal, or
| transplant of contaminated tissues
94
Virus travels along peripheral nerves to CNS causing
HA, fever, nervous hyperirritability, sensitivity to
| touch, seizures
95
Virus also travels to salivary glands.
Difficulty swallowing
Fear of fluids
Respiratory failure – death
96
Neuroborreliosis ( from Lyme disease)
| Caused by
Borrelia burgdoferi
97
Transmitted by ticks
Neuroborreliosis ( from Lyme disease)
98
Neuroborreliosis Typical
“bull’s eye” lesion – sore throat, dry cough, fever, headache, cardiac arrhythmias, neurologic abnormalities
99
Lyme disease need this therapy
Antimicrobial therapy
100
Poliomyelitis (infantile paralysis)
| Endemic in_______
Polio virus
| Immunization available
101
Polio is Endemic in
West and Central Africa
102
Highly contagious
Poliomyelitis
103
Transmission of polio
Direct contact or oral droplet
104
What does polio do?
Attacks motor neurons of the spinal cord and medulla
105
Polio signs and symptoms
Fever, headache, vomiting, stiff neck, pain, flaccid paralysis
106
```
Herpes zoster (shingles)
Caused by
```
varicella-zoster virus
107
Herpes zoster develop when ?
Years after varicella (chickenpox)
108
Herpes zoster Usual affect on
cranial nerve or one dermatome
109
HERPES Pain, paresthesia, vesicular rash
If antiviral drugs started within 48 hours of onset, pain is
| significantly reduced.
110
Lesions and pain persist for several weeks.
Herpes Zoster
| Post-herpetic pain may persist for months to years in some cases.
111
Vaccine available for those 60 years or older
Herpes Zoster
112
Linked to viral infection in children treated with
Aspirin
113
Reye syndrome
| Cause
not fully determined
114
Reye syndrome is linked to
Linked to viral infection in children treated with aspirin
115
Reye Syndrome and fluid
Hepatomegaly with acute failure
| Cerebral edema
116
No immediate cure
Reye syndrome
117
Infection-Related Syndromes - Guillain-Barre
Post-infection polyneuritis
118
GBS is inflammatory
Inflammatory condition of PNS
119
GBS Precise cause is
unknown, but usually follows viral infection
120
Local inflammation with ______
accumulated lymphocytes, demyelination, axon destruction
121
GBS Changes cause
impaired nerve conduction.
122
Guillain-Barre Muscle weakness PATTERN
Ascending paralysis involves diaphragm
| and respiratory muscles
123
GBS respiratory
C – Respiratory failure
124
Guillain-Barre – Anesthesia Considerations functions altered
ANS and lower motor neuron
125
Guillain-Barre – Anesthesia Considerations functions altered- CV
Compensatory cardiovascular responses absent,
with unpredictable changes in systemic BP.
– Intra-arterial catheter to monitor changes.
126
GBS and NMB
Avoid succinylcholine - ↑risk of excessive K+ release
from denervated muscle.
–Non-depolarizing muscle relaxants w/ minimal
circulatory effects should be used:
ex. Cisatracurium or vecuronium
127
Most common transmissible spongiform encephalopathy
CJD – Creutzfeldt-Jakob disease
128
CJD is a Formation of
clustered vacuoles that become confluent in brain
129
Rapidly progressive dementia with ataxia and myoclonus
CJD
130
Prions – Anesthesia Precautions
| ______only body fluid shown to result in transmission
CSF
131
LP with PRIONS
Double glove
Protective gown
Protective glasses
Label specimen “Infectious
132
Head injury main issue
Can be severe and life-threatening
Destruction of brain tissue
Massive swelling
133
Types of head Injuries:Concussion
Result of
Recovery
– (minimal brain trauma)mild blow to head or whiplash-type injury
–usually within 24 hours without permanent
damage
134
Types of head Injuries:Contusion
–Bruised brain tissue, rupture of small blood vessels,
and edema
–Blunt blow to the head – possible residual damage
135
Types of Head InjuriesClosed head injury
No Skull fx
| Brain tissue injured, blood vessels may be ruptured
136
Basilar fractures -occurs
at the base of skull
137
What happens with a basilar fracture?
| When might it occur?
Leakage of CSF through ears or nose is possible
| May occur when forehead hits windshield
138
Contrecoup injury
Area of the brain contralateral to the site of direct damage is injured. As brain bounces off the skull
139
Moya Moya
Puff smoked
140
May be secondary to acceleration or deceleration injuries
Contrecoup injury
141
Primary brain injuries is ____
| what rupture?
Direct injury of brain tissue
| Rupture or compression of cerebral blood vessels
142
Secondary injuries
| Result from additional effects of
cerebral edema, hemorrhage, hematoma, vasospasm, infection, ischemia
143
****Epidural hematoma
Results from ruptured WHICH ARTERY ?
meningeal artery
144
****Signs with EPIDURAL HEMATOMA: when does it show?
Signs usually arise within few hours of injury
145
SIGNS and SYMPTOMS of EPIDURAL (BHM)
Mydriasis
Hemiparesis
Bradycardia
146
Subdural hematoma: Results from
| Hematoma may be acute or subacute
Results from torn bridging veins between dura and arachnoid
| -Acute or Subacute
147
Subdural Signs arise
gradually over several days
148
Signs and symptoms of Subdural HHL
HA/Drowsiness
Hemiparesis/Hemianopsia
Language disturbances
149
Head Injuries - Anesthesia
| CPP? Avoid 2 things
Optimize CPP – maintain above 70mmHg if possible
Minimize cerebral ischemia
Avoid drugs/techniques that could increase ICP
Avoid hyperventilation to reduce risk of cerebral ischemia
150
Fracture, dislocation of vertebrae causes:
Compression or tear of spinal cord
151
May result from hyperextension or hyperflexion of neck
Cervical spine injuries
152
injury to cord when force is applied to top of skull or to feet
Compression
153
Complete transection of cord
Flaccid paralysis & loss of sensation at and below the level of injury
154
Common with Complete transection of cord
Loss of temp. regulation and decreased systemic BP common
155
Partial transection of cord
May allow recovery of some function
156
Spinal Cord Injury: Spinal shock
Hypotension with absent ANS reflexes (@T & L-spine level)
Recovery dependent on amount of bleeding and surgical intervention
157
Spinal shock lasts
Typically lasts 1 to 3 weeks in survivors
158
Spinal SHOCK physiologic effects
Alveolar hypoventilation and ↓ability to clear bronchial
secretions (@C & Upper T-spine level)
↑risk of aspiration, pneumonia and PE
159
Tetany what kind of paralysis
Spastic
160
Botulism what kind of paralysis
Flaccid
161
SCI Inflammation gradually subsides
| Damaged tissue removed by__________ what forms?
phagocytes
| Scar tissue forms
162
SCI Reflex activity resumes
below level of injury.
| No communication with higher levels or brain
163
SCI what is lost?
Control of reflexes below the level of damage is lost.
164
****Spinal Cord Injury - Anesthesia
| During airway mgmt, minimize
neck movements.
165
****SCI and compensatory sympathetic NS
Absence of compensatory sympathetic NS can cause
profound hypotension with changes in body position,
blood loss or pos. airway pressure.
166
SCI, If muscle relaxants necessary,
pancuronium or other non-depolarizing drugs can be used
167
Carpal Tunnel Syndrome
Most common nerve entrapment
168
Carpal tunnel syndrome
Compression of Median Nerve btwn. Ligament & bones
169
Treatment of Carpal tunnel syndrome
Immobilization and/or cortisone injection
| Surgical decompression
170
Three times more frequent in women
Carpel tunnel
171
From repetitive movements
Carpal tynosynovitis
172
Symptoms with Carpel tunnel
Pain & paresthesias over thumb, index and middle fingers
173
Cubital Tunnel Entrapment Syndrome
Compression of Ulnar N. passing through condylar groove
| into cubital tunnel
174
Surgical treatment by
decompression carries risk of injuring nerves blood supply which could worsen the condition
