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Flashcards in neuro Deck (48)
1

autoregulation fails when? x2

MAP
under 60
greater than 150

(cerebral flow depends on SBP)

2

cerebral perfusion pressure equation

CPP = MAP - ICP

3

circle of willis

compensates for decreased bloodflow in order to maintain perfusion

- posterior cerebral arteries
- posterior communicating arteries
- internal carotid arteries
- anterior cerebral arteries
- anterior communicating artery

4

subarachnoid hemorrhage is

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

5

SAH causes

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

6

"worst headache of my life"

think SAH!

7

SAH: s/s

- "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)

8

Hunt Hess Score for?

SAH mortality

9

SAH imaging

non-con head CT + head CTA /OR/ LP
- usually CTA esp if higher susp SAH vs meningitis

10

blood in LP classic for

SAH

11

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

SBP goal 120 - 130
htn: IV labetalol, nicardipine
hypo: levophed (↑MAP), dopamine works too

12

SAH tx traumatic vs aneurysmal tx

traumatic: neurosurg intervention
aneurysmal: coiling, clipping

13

why are vasospasms + SAH bad?

decreases perfusion

14

SAH tx total

- 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

15

aseptic fever + SAH

r/t central regulation of hypothalamus

16

SIADH + SAH

r/t pituitary malfxn

17

cushing reflex

aka vasopressor response aka cushing effect aka phenomenon etc

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

18

cushing's triad

indicative of increased ICP - late stages, brain herniation imminent

- ↑ BP
- cheyne stokes breathing
- ↓ HR

19

CTA vs head CT with contrast

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

20

arteriovenous malformation

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

21

AVM s/s

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

22

AVM tx

endovascular embolization, surgical resection, radiosurgery, combo

23

linear skull fracture

no bone depression

24

depressed skull fracture

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