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Physiology II > Neuropathophysiology > Flashcards

Neuropathophysiology Flashcards

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1
Q

What are some of the areas through which the brain may herniate?

A

fibrous structures separating lobes of the brain, foramen magnum

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2
Q

How is CPP calculated?

A

MAP - (ICP + CVP)

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3
Q

ICP and CPP are _____ related

A

inversely

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4
Q

What are two methods for monitoring ICP?

A

“bolt” method and ventriculostomy

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5
Q

What major advantage does a ventriculostomy have over an intracranial bolt?

A

ventriculostomy allows drainage of CSF

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6
Q

What is the equation for CMRO2?

A

CMRO2 = CBF x OEF x SaO2

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7
Q

When calculating CMRO2, how might SaO2 be determined?

A

Using a cerebral oximeter

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8
Q

What is the equation for SjO2?

A

SjO2 = SaO2 - (Oxygen Consumption / Cardiac Output x Hb x 1.39)

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9
Q

HTN has what effect on O2 extraction?

A

Increases O2 extraction

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10
Q

Where is the trans-cranial doppler placed and why?

A

Across the temporal bones because they are thin

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11
Q

How would a vasospasm shown on a transcranial Doppler?

A

the waveform would be blunted

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12
Q

What may happen to the arteriole after the rupture of an aneurysm?

A

vasospasm

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13
Q

What happens to ICP when the brain herniates?

A

ICP decreases

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14
Q

A tumor would have what effect on CMRO2?

A

increase

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15
Q

How might chronic HTN affect CPP?

A

CPP should not be affected because the autoregulation curve shifts

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16
Q

What is the minimum CPP value to keep a patient at?

A

50mmHg

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17
Q

At what MAP and CPP should a head injury patient be kept in?

A

MAP >90mmHg, CPP >70mmHg

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18
Q

What are ways to treat elevated ICP?

A

head elevation, hyperventilation, paralysis, diuretics, dexamethasone, CSF drainage, control BP, limit fluids, hypothermia, drugs (Pentothal, propofol, etomidate)

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19
Q

When controlling high ICP, what temperature range should the patient be kept at? Why?

A

33-35°C; each degree decrease in temperature decreases CBF 5-7% but below 33°C arrhythmias occur

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20
Q

When controlling high ICP, how much should the patient’s head be elevated? Why?

A

30°; above 30° arterial blood flow to the brain is compromised

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21
Q

When controlling high ICP, to what SaCO2 should the patient be hyperventilated? Why?

A

25-30mmHg; below this narrows cerebral vasculature too much and compromises blood flow

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22
Q

When controlling high ICP, why is important to use NMBD?

A

NMBD limit O2 consumption by skeletal muscles, allowing more for the brain

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23
Q

Why would Pentothal, Propofol and etomidate be useful in the treatment of high ICP?

A

They decrease CBF and CMRO2

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24
Q

Why would dexamethasone be useful in the treatment of high ICP?

A

Dexamethasone is a steroid that can help reduce swelling

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25
Why is it dangerous to drain CSF from the spinal cord when ICP is elevated?
Can cause herniation since CSF drops below ICP
26
What types of mass lesions are there?
tumor, infection, hematoma, congenital
27
If a small lesion caused respiratory arrest, where was the lesion likely located?
near the brainstem (compressing on it?)
28
What are some symptoms of elevated ICP?
N/V, headaches, dizzines, memory loss, personality changes, hi BP/bradycardia (Cushing's Response), papilledema (optic disk swelling), seizures
29
What are some things to look for in a CT scan or MRI when evaluating for brain tumor?
Are lateral ventrals smaller than normal? Could brain be injured by trying to remove the tumor? What position will the patient need to be in during surgery?
30
What are things to look for pre-operatively when evaluating a patient with neurological dysfunction?
Get CT or MRI scans if available, look for signs of elevated ICP, find out what medications they're taking, what is baseline neurologic function
31
What is a consideration for a patient on anti-epleptics?
these patients may metabolize drugs quicker, especially NMBD
32
Patients with brain tumors are likely to have what electrolyte imbalance?
hypokalemia
33
Changes in personality necessitate what?
CT scan
34
Number one goal in managing a patient with an intracranial mass lesion?
preventing changes in CBF
35
Types of intracranial bleeds?
subdural hematoma, epidural hematoma, intraparenchymal hematoma, subarachnoid hemorrhage
36
Paranchyma of brain are made of what?
neurons and glial cells
37
Three coverings of the brain?
pia, arachnoid, dura mater
38
Layers covering brain from outside in?
skull, epidural space, dura mater, subdural space, arachnoid, subarchnoid space, pia mater
39
What are the differences between acute, sub-acute and chronic subdural hematomas?
Acute hematoma is still bleeding, sub-acute hematoma stopped bleeding but blood is still present, chronic subdural hematoma stopped bleeding and now blood is breaking down
40
Regarding intracranial bleeds, where are arterial bleeds and venous bleeds generally located?
arterial - generally in epidural space, venous - generally in sundural space
41
What is a lucid interval? In what kind of hematomas do they generally occur?
Occur with epidural hematomas. Patient is asymptomatic (lucid) following trauma, then when enough blood accumulates, they become comatose.
42
Epidural hematomas are often present with what injury?
skull fracture
43
Most common site of epidural hematoma? What artery?
temporal bone and middle menningeal artery
44
What is the most common cause of sub-arachnoid hemorrhage not related to trauma?
rupture of aneurysm
45
What is an arterial-venous malformation and why is it relevant?
An abnormal connection between arteries and veins; they sometimes rupture and cause sub-arachnoid hemorrhage.
46
Age of typicaly patient with intracranial tumor?
40-60 y/o
47
What EKG changes are associated with sub-arachnoid hemorrhage?
P wave changes, development of U waves, ST elevation or depression, T wave changes, PVC's
48
How might a ruptured aneurysm cause hydroencephalus?
Blood getting into the 4th ventricle then clotting, causing an accumulation of CSF
49
Most common arteries associated with intracranial aneurysms?
Internal carotid/posterier communicating bifurcation (30-35%); anterior communicating artery (30-35%); middle cerebral artery (20%)
50
What could happen to an aneurysm when MAP gets too high or low?
too high - rupture, too low - spasm or hypoperfusion
51
What is SIADH? What does it lead to?
Syndrome of inappropriate antidiuretic hormone (seen in 1/3 pts w/ aneurysmal rupture); leads to hyponatremia/hyperkalemia
52
General treatment for vasospasm?
"three H's" - hypervolemia, hypertension, hemodilution (makes blood less viscous so it can flow through vessels easier)
53
What is the incidence of venous air embolism with sitting craniotomies?
20-40%!
54
How does venous air embolism present?
Decrease in ETCO2, HoTn, coronary ischemia
55
What is the treatment for venous air embolism?
turn off N2O, increase PEEP, head down and to right side, flood field with saline, bilateral IJ compression, aspirate entrained air
56
What is the purpose of bilateral IJ compression when treating venous air embolism?
To stop air from entering venous circulation
57
What is the purpose of increasing PEEP when treating venous air embolism?
To increase CVP
58
Apply 1-6 that corresponds with the Glasgow coma scale for "best motor response:" (a) flexion to pain (b) obeys verbal commands (c) localizes pain (d) no response (e) withdraws to pain (f) extension to pain
1 - d, 2 - f, 3 - a, 4 - e, 5 - c, 6 - b
59
What is a normal Glasgow coma scale value?
15
60
Patients with a Glasgow coma scale below ____ are often intubated.
6-7
61
What is a countrecoup injury?
An injury that occurs on the side of the brain opposite that which was impacted (occurs when brain bounces back in skull).
62
Why might a patient with a head injury have HoTN?
bleeding from coup or countrecoup injury
63
What is a distracting injury?
An injury that distracts a patient from another injury they have
64
What head injury is associated with hyponatremia?
Aneurysm and SIADH

Physiology II (3 decks)

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