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Brain Flashcards

1
Q

Oculomotor

A
  • CN III
  • Motor
  • Bedside test = eye movement, pupil constriction
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2
Q

Trochlear

A
  • CN IV
  • Motor
  • Bedside test = eye movement
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3
Q

Trigeminal

A
  • CN V
  • Motor & Sensory
  • Bedside test =
    V1- Opthalamic = somatic sensation to face
    V2 - Maxillary = somatic sensation to
    anterior 2/3 tongue
    V3- Mandibular = muscles of mastication
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4
Q

Abducens

A
  • CN VI
  • Motor
  • Bedside test = Eye movement
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5
Q

Facial

A
  • CN VII
  • Motor & Sensory
  • Branches: temporal, zygomatic, buccal,
    mandibular, cervical
  • Bedside test =
    facial movement except mastication
    eyelid closing
    taste anterior 2/3 tongue
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6
Q

Vestibulocochlear

A
  • CN VIII
  • Sensory
  • Bedside test = hearing & balance
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7
Q

Glossopharyngeal

A
  • CN IX
  • Both
  • Bedside test = somatic sensation & taste to
    posterior 1/3 tongue
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8
Q

Vagus

A
  • CN X
  • Both
  • Bedside test = swallowing
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9
Q

Accessory

A
  • CN XI
  • Motor
  • Bedside test = shoulder shrug
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10
Q

Hypoglossal

A
  • CN XII
  • Motor
  • Bedside test = tongue movement
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11
Q

How does hyperventilation affect CBF?

A
  • CO2 dilates cerebral vessels, decreases CVR, increases CBF, increases ICP
  • Hyperventilation constricts cerebral vessels, increases CVR, decreases CBF, decreases ICP

Goal: PaCO2 30-35 mmHg

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12
Q

How do NTG & nitroprusside affect ICP?

A
  • cerebral vasodilators
  • increase CBF
  • increase ICP
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13
Q

How does head position affect ICP?

A
  • HOB > 30 degrees facilitates venous drainage away from brain
  • Neck flexion/extension compresses jugular veins, reduces venous outflow, increases CBV, increases ICP
  • Head down increases CBV & ICP
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14
Q

How does mannitol reduce ICP?

A
  • osmotic diuretic
  • increases serum osmolarity
  • “pulls” water across BBB toward IV space
  • problems:
    1. if BBB disrupted, manitol can cause
      cerebral edema
    2. transiently increases blood volume,
      increase ICP & stress a failing heart
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15
Q

Anterior circulation of brain

A
  • supplied by internal carotids
  • aorta –> carotid a. –> internal carotid a. –> circle of willis –> cerebral hemispheres
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16
Q

Posterior circulation of brain

A
  • supplied by vertebral arteries
  • aorta –> subclavian a. –> vertebral a. –> basilar a. –> posterior fossa structures & cervical spinal cord
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17
Q

Circle of Willis

A
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18
Q

When should tPA be given?

A

< 4.5 hours after symptom onset

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19
Q

Relationship b/t cerebral hypoxia & hyperglycemia

A

During cerebral hypoxia, glucose is converted to lactic acid. Cerebral acidosis destroys brain tissue & is associated w/ worse outcomes.

20
Q

In context of cerebral aneurysm, how is transmural pressure calculated?

A

transmural pressure (TP) = MAP - ICP

increased TP –> risk of rupture

21
Q

S/S SAH

A
  • intense HA “worse of my life” (most common)
  • LOC (50%)
  • focal neuro deficit
  • N/V
  • photophobia
  • fever
    -Meningismus
22
Q

incidence of cerebral vasospasm

A

25% of patients w/ SAH

23
Q

When is cerebral vasospasm following SAH most likely to occur?

A

4 - 9 days following SAH

24
Q

Cerebral vasospasm treatment

A

Triple H therapy
1. Hypervolemia
2. HTN
3. Hemodilution (Hct 27-32%)

Hydration supports BP & CPP, while also reducing blood viscosity & CVR

Nimodipine shown to reduce M&M–increases collateral flow

25
Q

Aneurysm ruptures while undergoing endovascular coil placement. What do you do?

A
  • Patient is heparinized
  • If aneurysm ruptures, give protamine 1 mg per 100 U heparin
    -lower MAP to low/normal range
26
Q

GCS

A
27
Q

Tx for pt w/ intracerebral bleed on warfarin

A
  • FFP
  • prothrombin complex concentrate
  • recombinant factor VIIa
28
Q

Tx for pt w/ intracerebral bleed on plavix

A
  • platelets
  • recombinant factor VIIa
29
Q

2 common ways of reducing ICP that should be avoided in pt w/ TBI

A
  • Hyperventilation (worsen ischemia)
  • Steroids (worsen neuro outcome)
30
Q

Is N2O safe in pt w/ TBI?

A

No, pt may have other injuries-pneumothorax . N2O can rapidly expand pnemo

31
Q

Grand Mal SZ

A
  • Generalized tonic-clonic
  • tonic = whole body rigid
  • clonic = repetitive jerking
  • respiratory arrest & hypoxia
    -Tx: propofol, diazepam, thiopental
32
Q

Focal Cortical SZ

A

Localized to a particular cortical region
- motor or sensory
- no LOC

33
Q

Absence (Petit mal) SZ

A
  • loss of awareness but remains awake
  • common in children
34
Q

Akinetic SZ

A

Temporary LOC & postural tone
- fall, head injury can result

more common in children

35
Q

Status Epilepticus

A

-SZ activity last > 30 min or 2 grand mal SZ w/o regaining consciousness b/t
- resp arrest
- Tx:
1. phenobarbital
2. thiopental
3. phenytoin
4. benzos
5. propofol
6. GA

36
Q

Etomidate & SZ

A
  • Causes myoclonus
  • not associated w/ increased EEG activity in pt w/o epilepsy
  • increases EEG activity in pt w/ SZ d/o
37
Q

Alzheimer’s dz patho

A
  • development of diffuse beta amyloid-rich plaques & neurofibrillary tangles in brain
  • dysfunctional synaptic transmission (nicotinic Ach)
  • apoptosis
38
Q

Alzheimer tx

A

Cholinesterase inhibitors
1. Tacrine
2. Donepezil
3. Rivastigmine
4. Galantamine

39
Q

How do cholinesterase inhibitors interact w/ sux?

A

increase DOA

40
Q

Parkinson’s dz patho

A
  • destruction of dopaminergic neurons in basal ganglia
  • decreased dopamine + normal Ach = increase Ach
  • suppression of corticospinal motor system
  • overactivity of extrapyramidal motor system
41
Q

What drugs increase extrapyramidal s/s in Parkinson’s pt?

A

Drugs that antagonize dopamine:
1. metoclopramide
2. butyrophenones (haloperidol, droperidol)
3. phenothiazines (promethazine)

AVOID

42
Q

Most common eye complication in the perioperative period

A

Corneal abrasion

43
Q

Most common cause of vision loss in the perioperative period

A

Ischemic optic neuropathy (ION)

44
Q

Ischemic optic neuropathy patho

A
  • ischemia of optic nerve
  • venous congestion in optic canal reduces perfusion
  • central retinal & posterior ciliary arteries high risk
  • increased IOP can compress vessels & reduce O2 to retina

Ocular perfusion pressure = MAP - IOP

45
Q

Surgical procedure that presents most risk of ION?

A

**Spinal surgery in prone position

Other risk factors:
prone
wilson frame
long anesthesia time
large blood loss
low ratio of colloid to crystalloid resuscitation
hypotension
male
obese
DM
HTN
smoking
old
atherosclerosis

APEX: Flashcards (13 decks)

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