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APEX Review > Apex Neuro (Brain) > Flashcards

Apex Neuro (Brain) Flashcards

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1
Q

Normal ICP

A

5-15mmHg

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2
Q

Monroe-Kellie Hypothesis

A

Pressure volume with brain, blood, and CSF. As one increases there must be a decrease in others in order to prevent pressure increase inside the cranium

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3
Q

Cushing’s Triad

A

Sign of intracranial hypertension
-hypertension
-bradycardia
-irregular respirations

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4
Q

The most common site of transtentorial herniation

A

Temporal Uncus

Pressure is applied to the Oculomotor nerve causing ischemia presenting as fixed and dilated pupils

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5
Q

ICP measurement is indicated with a glasgow coma scale of

A

less than or equal to 7

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6
Q

S/S of intracranial hypertension

A

-headache
-nausea and vomiting
-papilledema
-pupil dilation and non reactivity
-focal neuro deficit
-seizure
-coma

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7
Q

Related to increased ICP…compression of the medulla results in what

A

irregular respirations

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8
Q

Pseudotumor cerebri

A

a condition where ICP increases for no apparent reason

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9
Q

Diagnostic criteria for intracranial hypertension

A

ICP greater than 20mmHg

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10
Q

Strategies to reduce cerebral blood volume

A

1.) provide mild hyperventilation
2.) avoid hypoxemia
3.) avoid vasodilators and employ cerebral vasoconstrictors
4.) elevate head > 30 degrees and avoid neck flexion
5.) reduce intrathoracic pressure

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11
Q

Strategies to reduce cerebrospinal fluid

A

1.) drain with an intraventricular drain or VP shunt
2.) give acetazolamide or furosemide

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12
Q

strategies to reduce cerebral edema

A

give diuretics and stroids

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13
Q

strategies to reduce cerebral mass

A

surgical debulking or evacuation of a hematoma

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14
Q

Lowering PaCO2 less than 30mmHg

A

increases the risk of cerebral ischemia due to vasocontriction and shifting the oxyhemoglobin dissociation curve to the left

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15
Q

The effect of hyperventilation only lasts

A

6-20 hours

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16
Q

PaO2 less than 50-60

A

greatly increases CBF and ICP

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17
Q

Cerebrovasodilators

A

nitroglycerine
nitroprusside

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18
Q

Dose of Mannitol

A

0.25-1.0 g/kg

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19
Q

Steroids should not be used for

A

traumatic brain injury
functional pituitary adenoma

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20
Q

Most common type of stroke

A

ischemic

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21
Q

FIrst therapy in patients with acute ischemic stroke

A

PO aspirin

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22
Q

Eligible window to give TPA

A

4.5 hours of symptom onset

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23
Q

Although hypertension is common side effect of ischemic CVA what are the parameters to keep the BP under?

A

Under 185/110

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24
Q

Cerebral hypoxia leads to conversion of glucose to Lactic acid resulting in what?

A

Cerebral acidosis which destroys brain tissue and leads to poor outcomes. Monitor serum glucose and treat hyperglycemia.

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25
Risk factors for a CVA
-hypertension -smoking -DM -HLD -excessive ETOH intake -Elevated homocysteine level
26
window for large vessel occlusion embolectomy
within 6 hours of symptom onset
27
What is the leading cause of morbidity and mortality after subarachnoid hemorrhage?
vasospasm
28
Prevention of cerebral vasospasm includes
Nimodipine and triple H therapy -hemodilution -hypervolemia -hypertension -frequent neuro exams -daily transcranial doppler exams
29
The most common cause of subarachnoid bleeding is
aneurysm rupture mostly in the circle of willis
30
HCT target for triple H therapy
HCT 27-32%
31
CCB shown to reduce morbidity and mortality associated with vasospasm
Nimodapine Does not relieve the spasm but increases collateral blood flow
32
Cebreal ARTERIAL bleeding usually occurs where
subarachnoid space
33
Cerebral VENOUS bleeding usually occurs where
subdural space
34
Most common sign of SAH
intense headache described as "worst headache of my life"
35
Other S/S of SAH
consciousness is lost about 50% of the time -focal neuro deficits -NV -photophobia -fever
36
Gold standard diagnosing cerebral vasospasm
cerebral angiography
37
MAP goal for cerebral vasospasm
MAP 20-30 mmHg above baseline
38
Most common result of cerebral salt-wasting syndrome
hyponatremia
39
Cerebral Salt-wasting syndrome
Brain releases natriuretic peptide and this leads to volume contraction, hyponatremia, and sodium wasting by the kidney. Treat with isotonic crystalloids.
40
Initial considerations for head trauma
C-spine stabilization, airway protection, optimize hemodynamics, and cerebral protection
41
What GCS score is consistent with TBI
less than 8
42
Warfarin can be reversed with what
-FFP -Prothrombin Complex Concentrate -Recombinant factor 7a
43
Clopidogrel and aspirin can be reversed with what
-platelet transfusion -recombinant factor 7a
44
Anesthetic consideration for TBI
-Maintain CPP >70mmHg -Use hypertonic saline -Glucose solutions worsen outcomes -Albumin linked to poor outcomes -Do not use N20 -Steroids worsen outcomes
45
Memorize GSC
reminder
46
Other anesthesia considerations for trauma
-Full stomach -C spine -intracranial hypertension -Airway, blood, skull base fracture, laryngotracheal injury -volume status -hypoxemia -other injuries elsewhere on the body
47
Prolonged hyperventilation with TBI
Worsen outcomes. Only use temporarily. Mild hyperventilation is key
48
Partial (Focal) seizure
activity is localized to a particular cortical region
49
Generalized seizure
activity affects both hemispheres
50
Partial seizure progressing to a generalized seizure is called
Jacksonian march
51
New onset seziures in adults are usually due to
structural brain lesion or metabolic cause
52
Types of seizures
53
Status Epilepticus
seizure activity lasting longer than 30 minutes or two grand mal seizures without regaining consciousness in between
54
Drugs that effect seizures
Atracurium metabolism yields laudansosine, a proconvulsant (long term infusions) Nimbex produces laudansosine Normeperidine can produce seizure activity Local anesthetics lower seizure threshold but good regional techniques are safe.
55
3 drugs that are useful for locating seizure foci during cortical mapping
etomidate methohexital alfentanil
56
Phenytoin
induces hepatic enzymes which contributes to resistance to nondepolarizing neuromuscular blockers
57
valproic acid
inhibits hepatic enzymes. can cause hepatotoxicity can cause thrombocytopenia
58
carbamazepine
induces hepatic enzymes which contributes to resistance to neuromuscular blockers can cause aplastic anemia, thrombocytopenia, liver dysfunction, and low sodium
59
Gabapentinoids
renal excretion do not induce hepatic enzymes can cause post-op respiratory depression useful for neuopathic pain syndromes
60
Signs and symptoms of Alzheimer's
memory loss apraxia aphasia agnosia
61
Treatment for Alzheimer's
Palliative. Restore concentration of Ach. Cholinesterase inhibitors -Tacrine -Donepezil -Rivastigmine -Galantamine
62
4 side effects of Rivistigmine
1.) increased duration of succinylcholine 2.) Increased N/V 3.)Bradycardia 4.) Syncope
63
Diagnosis of Parkinson's requires 2 of the following 4
1.) resting pill rolling tremor 2.) Skeletal muscle rigidity 3.)Postural instability 4.) Bradykinesia - very slow movement and reflexes
64
Secondary signs of Parkinson's
- Psychosis - Depression - Dementia - Lack of facial -expression - diaphragmatic spasm -oculogyric crisis
65
Risks of Parkinsons
- autonomic instability - orthostatic hypotension - dysrhythmias - aspiration
66
Contraindicated drugs in Parkinson's
- Metoclopramide - Butyrophenones - Phenothiazines
67
Butyrophenones
Haloperidol Droperidol
68
Phenothiazines
Promethazine
69
Anticholinergics and Parkinsons
Can be used to treat acute exacerbation of Parkinsonian symptoms
70
Diphenhydramine and parkinsons
anticholinergic properties. Useful for sedation and reduction of tremors
71
Anesthesia considerations in Parkinsons
Hypotension treated with volume and direct acting agents Alfentanil may cause acute dystonic reaction d/t interruption of central dopaminergic neurotransmission No ketamine No contradindication to succinylcholine or NDMB's Risk for post-op ventilatory failure
72
Deep Brain Stimulation considerations
Head placed in rigid frame Light sedation with opioids or precedex No GABA agonists Risk of VAE in sitting position SBP should not exceed 140mmHg Treat any seziures with small dose of propofol, barbiturate, or benzo
73
The most common cause of perioperative vision loss
Ischemic Optic Neuropathy
74

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