CNS Part 1 And 2 Flashcards

Question

How many stacked bony vertebrae are in the vertebral column?

Answer 1

The vertebral column contains 25 stacked bony vertebrae. ## Footnote Example sentence: The vertebral column provides structural support and protection for the spinal cord.

Answer 2

Each vertebra has 8 cervical nerves. ## Footnote Example sentence: The cervical nerves control movement and sensation in the neck and upper limbs.

Answer 3

Each vertebra has 12 thoracic nerves. ## Footnote Example sentence: The thoracic nerves innervate the chest and abdominal regions.

Answer 4

Each vertebra has 5 lumbar nerves. ## Footnote Example sentence: The lumbar nerves control movement and sensation in the lower back and legs.

Answer 5

The sacrum has 5 bones and 5 pairs of nerves. ## Footnote Example sentence: The sacrum connects the spine to the pelvis and supports the weight of the upper body.

Answer 6

The coccyx has 1 bone and 1 pair of nerves. ## Footnote Example sentence: The coccyx is commonly referred to as the tailbone and provides attachment for muscles and ligaments.

Answer 7

Spinal cord ## Footnote The spinal cord runs in the middle of the vertebral column

Answer 8

T-12 ## Footnote It extends to T-12

Answer 9

Between L-2 and L-3 ## Footnote A spinal tap will be performed between L-2 and L-3 usually to make sure you don't nick the spinal cord

Answer 10

Nerve impulse conduction ## Footnote It's the main highway for nerve impulse conduction

Answer 11

Cavities within the brain that produce cerebral Spinal Fluid (CSF) ## Footnote The ventricular system consist of cavities within the brain that produce cerebral Spinal Fluid (CSF)

Answer 12

Ventricles ## Footnote The cavities are called ventricles

Answer 13

4 ventricles ## Footnote There are 4 ventricles within the brain

Answer 14

Choroid Plexus ## Footnote The choroid Plexus of each ventricle secretes CSF

Answer 15

CSF is a clear colorless fluid. ## Footnote CSF circulates through sub-arachnoid spaces around the brain.

Answer 16

CSF protects the brain from shock, delivers nutritive substances (like gloucose proteins), and removes waste (lactic acid + urea)

Answer 17

The whole system contains between 80 - 150 ml of CSF. It's produced at a rate of 20ml/hr.

Answer 18

CSF in the ventricular system produces a pressure of 50-180 mm H2o. Similar to blood pressure but remains fairly constant.

Answer 19

Reabsorption takes place in the Arachnoid Villi. CSF should be reabsorbed at the same rate it is produced.

Answer 20

Method used to insert a needle into the spinal cavity. Pressure of CSF can be determined and a sample can be taken.

Answer 21

The brain composes of 2% of body weight ## Footnote However it consumes 20% of oxygen in the body at rest (brain needs a lot of oxygen)

Answer 22

The majority of blood vessels that enter the brain form the cerebral arterial circle. (Circle of Willis)

Answer 23

The brain uses glucose as its main nutrient for energy

Answer 24

The degree of mental activity determines the amount of oxygen and glucose

Answer 25

The BBB acts like a filter to keep certain substances out of the brain

Answer 26

Functions to protect the brain cells from harmful substances and pathogens

Answer 27

However, it makes it difficult for medicines to enter the brain ## Footnote It's hard to treat brain disorders

Answer 28

The brain composes of 2% of body weight ## Footnote However it consumes 20% of oxygen in the body at rest (brain needs a lot of oxygen)

Answer 29

The majority of blood vessels that enter the brain form the cerebral arterial circle. (Circle of Willis)

Answer 30

The brain uses glucose as its main nutrient for energy

Answer 31

The degree of mental activity determines the amount of oxygen and glucose

Answer 32

The BBB acts like a filter to keep certain substances out of the brain

Answer 33

Functions to protect the brain cells from harmful substances and pathogens

Answer 34

However, it makes it difficult for medicines to enter the brain ## Footnote It's hard to treat brain disorders

Answer 35

It can be altered or broken down. ## Footnote Substances that normally do not pass, can breach the barrier. Toxins may enter the brain. This could be due to trauma, inflammation, or toxins.

Answer 36

Studies are being done to breach the barrier to allow certain drugs to enter the brain. This can help in the treatment of the brain. ## Footnote No example sentence provided.

Answer 37

It is a stroke when there is a compromised blood supply to the brain for ≥ 24 hrs. ## Footnote No example sentence provided.

Answer 38

Ischemia - decreased blood supply (due to blockage). Hemorrhage - rupture of blood vessel. ## Footnote No example sentence provided.

Answer 39

Dizzy, weak, numb, paralysis, drooping of side of the face, headache or slurred speech. ## Footnote No example sentence provided.

Answer 40

Intracerebral hemorrhage, emboli, atherosclerosis, compression of a tumor on a blood vessel. ## Footnote No example sentence provided.

Answer 41

High BP, high cholesterol, TIA, diabetes, smoking, obesity, alcohol, family history, or age. ## Footnote No example sentence provided.

Answer 42

Perfusion defects ## Footnote Show blood flow and metabolic abnormalities

Answer 43

Anatomic lesions ## Footnote There has to be anatomic changes to show a CVA

Answer 44

Medications that dissolve blood clots or prevent new ones from forming ## Footnote A surgery to remove blood clots, prevent bicecling or, in some cases, to re-open the blocked arteries Endarterectomy - surgery done to remove a clot or plaque A rehabilitation program at a social facility or in the patient's home to help recovery

Answer 45

A temporary impaired blood supply to the brain for less than 24 hrs ## Footnote TIA usually subsides within a few mins to hours

Answer 46

Dizzy, weak, numb, paralysis, drooping of one side of face, headache and slurred speech

Answer 47

Most are caused from atherosclerosis or emboli ## Footnote Example sentence: A TIA can be caused by a blood clot traveling to the brain.

Answer 48

Same as stroke ## Footnote Example sentence: High blood pressure and smoking are common risk factors for both TIA and stroke.

Answer 49

43% ## Footnote Example sentence: Nearly half of patients who experience a TIA will go on to have a stroke within 5 years.

Answer 50

A disabling neurological disorder affecting 11% of the population over the age of 65 ## Footnote Symptoms are characterized by loss of memory and cognitive skills.

Answer 51

Unknown ## Footnote There is currently no known cause for Alzheimer's Disease.

Answer 52

No cure, but drugs can help contain it and slow down progression ## Footnote Effects of Alzheimer's Disease are irreversible.

Answer 53

A motor disorder resulting in muscular incoordination ## Footnote There is damage to motor areas of the brain.

Answer 54

Lack of oxygen during birth, hydrocephalus ## Footnote Cerebral Palsy usually occurs before or during birth.

Answer 55

No cure, but training and therapy can help improve function ## Footnote Example sentence: Physical therapy and occupational therapy can help individuals with Cerebral Palsy lead more independent lives.

Answer 56

Most are caused from atherosclerosis or emboli ## Footnote Example sentence: A TIA can be caused by a blood clot traveling to the brain.

Answer 57

Same as stroke ## Footnote Example sentence: High blood pressure and smoking are common risk factors for both TIA and stroke.

Answer 58

43% ## Footnote Example sentence: Nearly half of patients who experience a TIA will go on to have a stroke within 5 years.

Answer 59

A disabling neurological disorder affecting 11% of the population over the age of 65 ## Footnote Symptoms are characterized by loss of memory and cognitive skills.

Answer 60

Unknown ## Footnote There is currently no known cause for Alzheimer's Disease.

Answer 61

No cure, but drugs can help contain it and slow down progression ## Footnote Effects of Alzheimer's Disease are irreversible.

Answer 62

A motor disorder resulting in muscular incoordination ## Footnote There is damage to motor areas of the brain.

Answer 63

Lack of oxygen during birth, hydrocephalus ## Footnote Cerebral Palsy usually occurs before or during birth.

Answer 64

No cure, but training and therapy can help improve function ## Footnote Example sentence: Physical therapy and occupational therapy can help individuals with Cerebral Palsy lead more independent lives.

Answer 65

Is a neurological disorder it effects 1 out of 100 people ## Footnote Epilepsy causes sudden, uncontrollable electrical surges in the brain.

Answer 66

Effects - seizures, brief interruptions in brain activity, periods of unawareness, may involve changes of consciousness, involuntary movement, muscle spasms or convulsions. ## Footnote Treatment for epilepsy includes medications, special diets, or surgery.

Answer 67

Epilepsy can be caused by head trauma, infection, neurological disorders, and hereditary factors. People cannot swallow their tongues as epilepsy is not contagious.

Answer 68

Is a progressive disorder of the CNS. Certain neurons are destroyed in the brain, which produce dopamine. An imbalance of neurotransmitter activity occurs. ## Footnote The cause of Parkinson's is unknown, but a defective gene has been found in some cases.

Answer 69

Occurs when fluid spaces in the brain are enlarged ## Footnote The fluid spaces are the ventricles

Answer 70

1. Communicating - CSF inside the ventricles 'communicates' or is open to the fluid spaces around the brain 2. Non-communicating - obstruction in a ventricle 3. Normal Pressure Hydrocephalus (NPH) - enlargement of a ventricle without increased pressure

Answer 71

CSF flows normally throughout the CNS but is not being reabsorbed Causes build up in the ventricles Usually caused by an infection (meningitis) that forms an obstruction Can be treated with a shunt ## Footnote Usually caused by an infection (meningitis) that forms an obstruction

Answer 72

CSF can't 'communicate' outside the ventricle CSF builds up within the ventricle The ventricle doesn't expand and pressure of CSF increases (usually caused by a tumor) ## Footnote Usually caused by a tumor

Answer 73

Enlargement of a ventricle without increased pressure CSF within a ventricle increases

Answer 74

Could be due to reabsorption problem or blockage with increased CSF the ventricles expanding, the ventricle expands the pressure of the CSF remains normal

Answer 75

Mainly due to the availability of CT + MRI ## Footnote This answer highlights that the availability of CT and MRI has led to a decrease in Nuclear Medicine imaging of the brain.

Answer 76

Function and perfusion of cerebral abnormalities CSF imaging ## Footnote Nuclear Medicine imaging can be used for assessing function and perfusion of cerebral abnormalities, as well as for CSF imaging.

Answer 77

Planar Brain Imaging & SPECT Brain Imaging ## Footnote Brain imaging can be divided into Planar Brain Imaging and SPECT Brain Imaging.

Answer 78

They do not cross a normal (intact) BBB ## Footnote Radiopharmaceuticals used in planar brain imaging do not cross a normal (intact) BBB.

Answer 79

99mTc accumulates in the choroid plexus of the brain ## Footnote 99mTc accumulates in the choroid plexus of the brain, making imaging difficult in some situations.

Answer 80

Oral Potassium Perchlorate ## Footnote Oral Potassium Perchlorate can be administered to block the accumulation of 99mTc in the choroid plexus of the brain.

Answer 81

30-60 minutes before the scan ## Footnote Example sentence: Dose 15-25 mCi of Tc-99m DTPA in a brain scan by injection

Answer 82

0-4 hours, with 0 hours being for flow and 4 hours for brain lesions

Answer 83

Does not cross the BBB ## Footnote Example sentence: Dose of 15-20 mCi of Tc-99m DTPA will allow us to image at 0-60 minutes

Answer 84

Good target/nontarget ratio ## Footnote Reasons: - Tc-99m DTPA clears the blood and into the brain rapidly - Tc-99mDTPA will also leave the body via urine quickly

Answer 85

Dose of 10-20 mCi, and image from 0-4 hours ## Footnote Example sentence: Going out 4 hours gives more time for accumulation in tumors

Answer 86

They all use 99mTc ## Footnote Good for perfusion Give similar imaging results Give higher doses

Answer 87

GH are more expensive They are all good for flow studies but the time it takes for them to localize and allow for delayed images is different. DTPA is the quickest -0-60 mins Then GH -0-4 hours like regular Tc Finally Tc-99m

Answer 88

Dose - 2-3 mCi Imaging time - 0-60 mins. Not especially good for flow studies but localizes fairly well in METS ## Footnote Example sentence: Thallium-201 is commonly used for myocardial perfusion imaging.

Answer 89

Localizes in inflammatory and infectious areas

Answer 90

Dose - 3-6mCi ## Footnote No additional information

Answer 91

Imaging - 24-72 hrs ## Footnote No additional information

Answer 92

Good for differentiating cerebral infarcts Dose:15-20 mCi Imaging :0-4 hours

Answer 93

Evaluate Brain: Perfusion, Brain Death, Evaluate stroke (CVA)

Answer 94

RP→ Depends on the indications There is: Patient Prep → No Prep for these studies

Answer 95

Metastatic brain tumors Cerebral infection Cerebral inflammation

Answer 96

Metastatic brain tumors Cerebral infection Cerebral inflammation

Answer 97

To keep brain function normal (not over-functioning) ## Footnote Always use an IV and start the IV at least 20 min pre-injection. Have patient lie supine and still for at least 20 min pre-injection.

Answer 98

The Imaging room should be quiet and dimly lit. Keep the patient calm and still for at least 20 min pre-injection. ## Footnote This helps in maintaining normal brain function.

Answer 99

The Procedure consists of 2 phases: A dynamic study of rapid sequential images (Flow Study) and Immediate brain perfusion. Measures Regional Cerebral blood Flow. Delayed static images taken when the activity settles in the brain. Represents the distribution of the activity in the cerebral regions. ## Footnote Usually 1-4 hours when using Tc based tracers.

Answer 100

Patient should be positioned supine ## Footnote Head strap may be used if necessary

Answer 101

Camera is usually positioned for an ANT image. ## Footnote A bolus injection of 15-20 mci of imaging agent

Answer 102

Use the oldendorf technique for your injection

Answer 103

2-3 second images are obtained for 60 seconds

Answer 104

Patient is again supine and should remain as still as possible Static images will start 20-60mins post injection

Answer 105

Static images can be taken out to 3-4 hours using the same agent

Answer 106

Images will be taken for 500,000 counts ## Footnote ANT, POST, R, +L LAT

Answer 107

Remain consistent with your counts and views if delays at different times are taken

Answer 108

Determines if any blood flow is going to the brain Positive flow will show tracer in the carotids, but nothing in the cerebral arteries Positive delay images will continue to not show activity in the brain A positive scan will show some extracerebral activity

Answer 109

Will show as a single focus of activity May or may not show on the flow Depends on the blood flow to the tumor Should show on delays Depends on the rate of blood flow

Answer 110

Usually shows as multiple small focal hot spots Will show on flow and delayed views depending on blood flow to the METS

Answer 111

Will show an asymmetric flow (uneven) Delays will show a wedge-shaped defect

Answer 112

Focal area of increased uptake with an area of decreased activity in the center Called a Doughnut sign

Answer 113

Rp used for SPECT imaging cross the BBB BBB stands for blood-brain barrier.

Answer 114

They actually enter the brain substances ## Footnote No additional information provided.

Answer 115

They remain in the brain in proportion to the regional cerebral blood flow ## Footnote Cerebral blood flow is abbreviated as CBF.

Answer 116

The good: this agent also has rapid first pass uptake - The use of 99mTc enables a 20 mCi dose and is great for SPECT dose -Once it is the brain it will not diffuse out it will remain until it decays

Answer 117

Unstable in-vitro( outside the body) Should be injected 30 mins after preparation

Answer 118

More rapid clearance of the blood pool than Ceretec Reducing background activity Increasing target to non target ratio More stable than ceretec Longer post injection time

Answer 119

It can be inhaled or dissolved in saline and injected either way it goes into the blood stream and goes to the brain. -It localizes quickly in the brain and then washes out quickly allows us to measure rCBF

Answer 120

1-10 mCi which is an average dose for SPECT the low energy of Xe-133 creates limitation for detection especially behind the skull.

Answer 121

Cut Right to Left

Answer 122

Cut from front to back

Answer 123

Cut from top to bottom

Answer 124

Evaluate Cerebravascular disease( infraction hemorrhage TIA’s) Evaluate dementia Evaluate trauma Locate seizure foci

Answer 125

No patient prep

Answer 126

Inject 20 mCi of 99mTc brain agent IV The flow is optional-Inject a bonus if a flow is desired SPECT images can be obtained 20 mins post injection with a 360 degree rotation Then data is reconstructed to give Transverse/Coronal/Sagittal

Answer 127

Crosses the BBB and localizas proportional to blood flow More blood to gray matter of the brain

Answer 128

Same principle as planar imaging A little more sensitive than planar imaging SPECT is not as dependant on the flow study

Answer 129

Localize a focal defect in both primary and metastatic lesions Using same Tc-agents

Answer 130

Will show as a reduced or no blood supply to a particular area

Answer 131

Temporary hypoperfusion defect TA defects are time dependent The longer you wait, the less sensitive the scan is to detect the effects of a TA Will show as a reduced blood supply to a particular area.

Answer 132

Bilaterally symmetrical activity on the SPECT images • Activity is also high in the regions corresponding to the basal ganglia and thalamus • Regions between the basal ganglia and thalamus • Regions between the basal ganglia and the convexity corresponding anatomically to cortical white matter and the ventricles have less activity • SPECT images can be seen in a number of different color scales

Answer 133

CSF runs around the brain and down the spinal column We can image the fluid pattern in this system as well • CSF imaging • Cisternogram ## Footnote Cerebral Spinal Fluid Imaging

Answer 134

In-111 DTPA ## Footnote It has a longer half-life of 2.8 days images are commonly taken up to 72 hours, has abundant gamma emissions, mixes well, and has a good affinity for CSF.

Answer 135

Diagnose normal pressure hydrocephalus (NPH), identify CSF leaks, verify CSF shunt patency.

Answer 136

0.5 - 1.0 mCi injected intrathecally (lumbar). Indium-111 DTPA can be used for shunt patency.

Answer 137

Injections are done by the doctor, usually the radiologist or neurologist.

Answer 138

No patient prep is necessary.

Answer 139

Procedure with the patient laying on their side, the doctor will inject intrathecal ## Footnote 22 gauge or smaller needle is recommended to minimize leaks

Answer 140

Injection will be between the vertebrae L-2 or lower, and will go into the subarachnoid space ## Footnote The patient needs to stay horizontal for 2 hours post injection. Pt movement can initiate headaches

Answer 141

Images will be taken @ 2, 6, 24, 48, 72 hours if necessary. An initial image can be taken POST to verify the injection site ## Footnote Patient will be positioned supine for the images. Images will be acquired for 100k to 200k counts.

Answer 142

Since In-DTPA is mixed in with CSF, it should not normally flow in the ventricles. We cannot diagnose this using a lumbar puncture. However, if you must use In-DTPA, you can inject it directly into the ventricles. Not very common. ## Footnote Example sentence: Sounds painful but it has been done.

Answer 143

We can localize the site of the leak. Plugs can be placed in the nose or ears. This is a common spot for leaks. Then count the plugs. If activity shows up, there is your leak. This method is not very common either. ## Footnote Additional information: This metrod is not very common either.

Answer 144

Shunt Patency. A shunt will drain CSF from the brain into other areas. By injecting into the shunt, we can watch the flow of the RP. An open shunt will show activity draining. An obstructed shunt will show retention of the tracer. Remember we can use 99mTc-DTPA due to the short duration of the study. 1-3 mCi given. 99mTc-DTPA. Can also be used 500 uCi of In-DTPA

Answer 145

-RP will ascend up the spinal column -At 2-4 hours the RP should be in the basal cisterns -From 6-24 hours the ascent of In-111-DTPA will continue up the Sylvia’s and interhemispheric fissures -Activity will start into subdrachoid spaces (cerebral convexities) -At 24 hours there should be complete ascent of the RP over the cerebral convexities And some if not all activity will clear from the cisterns -48 hours the RP should appear as a cap as it is completely filled into the sinuses -When In-111 DTPA doesn’t follow the normal pattern different clinical applications may apply

Answer 146

-111-In-DTPA should not enter lateral ventricles by 4-6 hours -Persistent activity in the lateral ventricles at 24 -48 hours -Delay in the ascent of activity from the parasagittal region -Possible delayed clearance of activity from the basal cisterns -Remember the CSF is created in the ventricles -CSF should flow out of the lateral ventricles but not back in

CNS Part 1 And 2 Flashcards

(171 cards)