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neuro Flashcards

1
Q

autoregulation fails when? x2

A

MAP
under 60
greater than 150

(cerebral flow depends on SBP)

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2
Q

cerebral perfusion pressure equation

A

CPP = MAP - ICP

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3
Q

circle of willis

A

compensates for decreased bloodflow in order to maintain perfusion

  • posterior cerebral arteries
  • posterior communicating arteries
  • internal carotid arteries
  • anterior cerebral arteries
  • anterior communicating artery
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4
Q

subarachnoid hemorrhage is

A

caused by bleeding in arachnoid space, between pia & arachnoid membrane
- blood mixes w CSF around brain/spinal cord
- results:
↑ ICP
↓CPP
meningeal irritation
↓ CSF reabs into venous sys

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5
Q

SAH causes

A

traumatic

non-traumatic: ruptured aneurysm (85%), ruptured AVM, tumor

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6
Q

“worst headache of my life”

A

think SAH!

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7
Q

SAH: s/s

A
  • “worst hHA of my life”
  • n/v/projectile
  • seizure/LOC
  • unilateral pupil dilation
  • photophobia, visual ∆s
  • nuchal rigidity (4-6 hrs later)
  • CN III, IV, VI deficits (eyes do tricks)
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8
Q

Hunt Hess Score for?

A

SAH mortality

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9
Q

SAH imaging

A

non-con head CT + head CTA /OR/ LP

- usually CTA esp if higher susp SAH vs meningitis

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10
Q

blood in LP classic for

A

SAH

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11
Q

SAH tx: SBP goal, htn, hypotn (rx x4)

A

SBP goal 120 - 130

htn: IV labetalol, nicardipine
hypo: levophed (↑MAP), dopamine works too

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12
Q

SAH tx traumatic vs aneurysmal tx

A

traumatic: neurosurg intervention
aneurysmal: coiling, clipping

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13
Q

why are vasospasms + SAH bad?

A

decreases perfusion

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14
Q

SAH tx total

A
  • SBP 120 - 130 (maintain perfusion)
  • intervention: neurosurg, coil, clip
  • avoid hyperthermia (38+C) & hypoglycemia (BG 60+)
  • monitor
    • rebleed (ICU 2-3 wk for monitor)
    • aseptic fever r/t central reg of hypothalamus
    • SIADH r/t pituitary malfxn
    • vasospasm, ↑ ICP, cerebral ischemia
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15
Q

aseptic fever + SAH

A

r/t central regulation of hypothalamus

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16
Q

SIADH + SAH

A

r/t pituitary malfxn

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17
Q

cushing reflex

A

aka vasopressor response aka cushing effect aka phenomenon etc

physiological nervous system response to increased ICP that results in cushing’s triad

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18
Q

cushing’s triad

A

indicative of increased ICP - late stages, brain herniation imminent

  • ↑ BP
  • cheyne stokes breathing
  • ↓ HR
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19
Q

CTA vs head CT with contrast

A

angiogram: specific type of CT w contrast - timed so it will highlight arteries or veins of interest

CT will be timed to show capillary beds of soft tissues

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20
Q

arteriovenous malformation

A

congenital defect of circulatory system, tangled arteries & veins bypass capillary beds

21
Q

AVM s/s

A

progressive neuro sx: seizure, vertigo, HA, dysarthria, memory deficits, risk for rupture

22
Q

AVM tx

A

endovascular embolization, surgical resection, radiosurgery, combo

23
Q

linear skull fracture

A

no bone depression

24
Q

depressed skull fracture

A

outer table of skull depressed below inner table

25
basilar skull fracture types x3 + 1 associated
anterior fossa: raccoon eyes + rhinorhea middle fossa: battle sign + CSF (tympanic membrane) posterior fossa associated dural tear results in rhinorrhea, otorrhea, increased risk infection1
26
raccoon eyes sign of
anterior fossa basilar skull fracture
27
battle sign indicative of
middle fossa basilar skull fracture
28
supratentorial (uncal) herniation
Shifting of lateral temporal lobe (uncas) → tentorial notch = compression of lateral midbrain, third cranial nerve, & posterior cerebral artery
29
supratentorial (uncal) herniation: s/s
Sluggish to dilated pupils Contralateral hemiparesis/hemiplegia Restlessness deteriorating to loss of consciousness Respiratory changes: Cheyne-stokes, ataxic pressure Decorticate & decerebrate posturing Dilated fixed pupils, flaccidity, & respiratory arrest
30
concussion
Diffuse brain injury assoc w general or widespread neurological dysfxn Temporary LOC (seconds to minutes to hrs) Retrograde amnesia/Anterograde amnesia Cognitive abilities impaired s/t neuronal injury: twisted/ stretched
31
contusion
Bruising of brain @ site of impact or distal (contra coup forces) Freq: frontal/temporal lobes, or brain stem involved Assoc w prolonged LOC Implications: monitor closely for edema, ↑ ICP, possible herniation
32
types of cerebral hematoma
epidural - arterial -- rapid deterioration/LOC + herniation subdural - venous -- most common intracranial - into parenchyma d/t direct trauma or shearing forces -- poor prognosis d/t assoc injuries
33
epidural hematoma
Bleeding btw inner table & dura mater Freq occurs w linear skull fracture ARTERIAL BLEED: middle meningeal art, assoc w temporal/parietal injury Rapid deterioration w LOC & herniation
34
subdural hematoma
Bleed btw dura mater & arachnoid meninges MOST COMMON - venous bleed Assoc w other injuries (contusions) sx r/t area of injury, degree ↑ ICP
35
intracranial hematoma
Bleeding into brain parenchyma from direct injury or shearing of small vessels MOI: trauma, GSW Poor prog d/t assoc injuries (↑ mortality)
36
migraine headache s/s
premonitory sx (aura), photophobia, N, V
37
cluster headache s/s
ipsilateral lacrimation, rhinorrhea, ptosis, 30 - 180 min long
38
migraine tx x3
sumatriptan (Imitrex) midrin (non-opioid analgesic, has APAP in it, sympathomimetic) rizatriptan (Maxalt)
39
cluster headache tx
indomethacin (NSAID) | nifedipine, nimodipine
40
ergots & triptans: nota bene!!
do not use these drug types within 24 hours of each other - serotonin syndrome risk! (class: abortive migraine meds)
41
visceral pain
organs, body cavities | C fibers
42
somatic pain
alpha & delta fibers | body tissue injury: skin, SQ tissue, bones, blood vessels, muscles
43
neuropathic pain
d/t primary lesion in nervous system sustained by aberrant somatosensory processing in PNS or CNS - not related to nociceptor stimulation central (ex: phantom limb) vs peripheral (ex: neuralgia)
44
cancer pain treatment steps x3
1. mild: non-opioid analgesics 2. moderate pain or no relief from #1 - opioids (codeine or hydrocodone), hydrocodone w APAP, or lortab adjuvant 3. severe or no relief from #2: - morphine, hydromorphone, methadone, fentanyl, oxycodone - combo w non-opioid or h
45
short acting opioids WHO Step 1 or 2
codeine hydrocodone oxycodone
46
short acting opioids WHO Step 2 or 3
morphine (IR) hydromorphone (Dilaudid) oxycodone
47
long acting opioids
MS Contin Fentanyl Methadone
48
no ceiling dosage for?
MS

monster management (29 decks)

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