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NeuroTech Intro To IONM > The Basics > Flashcards

The Basics Flashcards

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1
Q

The Central Nervous System (CNS) consists of

A

The brain & the spinal cord

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2
Q

List the 3 CNS systems of the brain & their functions

A

Cerebrum - cognitive functions
Cerebellum - coordination
Brainstem - vital functions

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3
Q

All nerves outside the CNS make up the:

A

Peripheral Nervous System (PNS)

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4
Q

Describe 2 types of nerves in the PNS:

A

Cranial Nerves: 12 pairs that emerge directly from the brain
Spinal Nerves: 31 pairs that exit the spinal cord (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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5
Q

List 2 types of Neural pathways & their function

A

Motor pathways: carry signals from the brain to muscles (descending)
Sensory pathways: carry signals from body to brain (ascending)

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6
Q

List 3 structures monitored during surgery

A

Dorsal columns
Corticospinal tracts
Cranial nerve nuclei

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7
Q

What is the function of Dorsal columns

A

Sensory pathway carrying proprioception, vibration and fine touch sensory info to the brain

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8
Q

What are the functions of
Corticospinal tracts

A

Main motor pathway for voluntary movement of limbs & trunk

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9
Q

What are the functions of cranial nerve nuclei

A

Control functions like hearing, facial movement, swallowing

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10
Q

From the neck down, name the sections of the spine

A

Cervical, thoracic, lumbar, sacral, coccygeal

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11
Q

How many pairs of nerves are in each of the spinal sections & how many in total

A

31 total: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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12
Q

What is the casual term for the sympathetic division of the autonomic nervous system?

A

Fight or flight

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13
Q

What is the casual term for the parasympathetic division of the autonomic nervous system?

A

Rest or digest

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14
Q

What are ganglia

A

Clusters of nerve cell bodies outside the CNS in the PNS (peripheral nervous system) found throughout the body which carry nerve signals to & from the CNS (central nervous system)

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15
Q

What are 2 broad categories of ganglia?

A

Motor ganglia & sensory ganglia

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16
Q

What 3 parts make up the brainstem?

A

Midbrain, Pons, Medulla Oblongata

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17
Q

What are MEPs

A

Motor evoked potentials, transcranial electrodes stimulate the primary motor cortex to assess the integrity of descending Corticospinal tracts.

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18
Q

What major tract carries motor information down the spinal cord

A

Corticospinal tract

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19
Q

What is the dorsal column-medial lemniscus pathway?

A

Sensory pathway carrying info to the brain about fine touch, vibration sensation, & proprioception (body position/joint direction)

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20
Q

What neural pathway is monitored during MEPs?

A

Corticospinal tract, main motor pathway for voluntary movement of trunk & limbs

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21
Q

Which pathway carries pain and temperature sensation?

A

Spinothalamic tract

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22
Q

How many cranial nerve pairs are there?

A

12

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23
Q

What neural pathways do SSEPs monitor?

A

Dorsal column-medial lemniscus pathway

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24
Q

What is the typical stimulation site for upper extremity SSEPs?

A

Median or ulnar nerve at the wrist

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25
What is the typical stimulation site for lower extremity SSEPs
Posterior tibial nerve at the ankle
26
What does spontaneous EEG monitor during surgery?
Using electrodes on the scalp (or brain if ECoG/iEEG) EEG monitors cortical function/brain electrical activity & depth of anesthesia, best known for ability to detect seizure
27
What EEG change indicates cerebral ischemia?
Decrease in fast activity & increase in slow activity; ultimately suppression of EEG activity
28
What is the 10-20 International System?
Standardized method for electrode placement on the scalp for EEG recording
29
What is EMG?
Electromyography, monitoring muscles, spontaneous activity or activity triggered via electrical stimulation
30
What is spontaneous EMG used to detect?
Mechanical irritation of nerve roots during surgical manipulation
31
What is the difference between free-running & triggered EMG?
Free-running EMG continuously monitors nerve activity; triggered EMG uses electrical stimulation to elicit a response
32
What is SSEP?
Somatosensory Evoked Potentials, recording of ascending sensory signals with stimulating electrodes on limbs & recording electrodes on scalp, can be continuously monitored during surgery
33
What muscles would you monitor during a lumbar spine procedure?
Typically bilateral quadriceps, tibialis anterior, gastrocnemius, & external anal sphincter
34
What are the main components of the Cadwell Cascade Pro?
Base unit, stimulator box, amplifier/s(headbox), isolation transformer, surface electrodes, probes, needle electrodes
35
What muscles are good to use for EMG for C5, C6 & C7?
Deltiod, bicep, tricep respectively
36
What does EEG stand for?
Electroencephalography
37
How do we evaluate SSEPs?
Time & size
38
How do we evaluate MEPs
Size and shape
39
How do we evaluate EMG
Looking for any activity that is not a flat line, flat line = good
40
How do we evaluate EMGs
By looking for any activity that is a flat line, flat line = bad
41
What do differential amplifiers do?
Amplify the difference, common signals are rejected
42
Generally where would you place cathode & anode for stimulation
Cathode over the area you want to stimulate Anode over a bony area
43
What does s neurotech do?
Provide live feedback during surgery on the functional integrity of the spinal cord, the brain & the blood supply to it, back to the surgeon so they are aware of how the patient is handling the procedure
44
What is a neuromuscular junction?
Aka myoneural junction, the connection between motor neurons & muscle fibers, the site where the neuron transmits a signal from the brain to the muscle fiber.
45
In neurology what does cortical refer to?
Anything that is related to, consisting of, or derived from the cortex/cerebral cortex/cerebrum
46
What are mMEPs?
Muscle MEPs record muscle contractions from needle electrodes inserted into muscles, can only be used intermittently during surgery as they may cause significant patient movement.
47
Describe method for monitoring SSEPs
Recording via scalp electrodes by stimulating* peripheral afferent nerves with ascending impulses traveling through the dorsal column to the sensory cortex. *usually with electrodes at the median or ulnar nerve at the wrist for upper limb monitoring & posterior tibial nerve at the ankle for lower limb
48
What are the two main categories of bioelectric signals recorded during IONM?
Spontaneous activity & evoked responses
49
What are 2 examples of spontaneous activity recorded during IONM? And what do they monitor?
EEG - spontaneous activity of the brain EMG - spontaneous activity of muscles (there is also triggered EMG)
50
What are the 2 main types of nerve damage caused by the surgical manipulation itself?
Ischemia & mechanical injury
51
What are 5 perisurgical factors that affect IONM recordings during surgery?
Blood pressure, body temp, anesthesia, noise, technical difficulties,
52
What is IONM? Describe
Electrophysiological recordings during orthopedic, neurological & vascular surgery which provide information about the functional integrity of the nervous system during surgery
53
What are the most common types of electrophysiological signals recorded intraoperatively?
Spontaneous activity: EEG & EMG (not triggered EMG) & evoked responses using external stimulation
54
What is the purpose of IONM
To avoid damage to nerves during surgery and/or to identify specific neuronic structures & landmarks
55
What is the goal of IONM with regard to preventing damage to nerves during surgery?
To detect & quantify, instant by instant, changes in the functional status of neurological structures early enough so that actions can be taken to reverse the effects if ischemia, prevent permanent mechanical injury, & restore normal function.
56
What are the 2 primary risks to the nervous system associated with surgery?
Mechanical injury & ischemia
57
What kind of changes are seen in physiological recordings after an ischemic attack of, or mechanic insult to, neuronal structures? From an electrophysiological point of view, how are these changes detected?
1- Decrease in the number of neurons responding to stimulation 2 - desynchronization of neuronal firing Detected as a reduction in the amplitude, an increase in the latency, & an overall change in the morphology of a wave form
58
What are the 3 most common ions found in the intracellular & extracellular fluids?
Sodium Na+ Potassium K+ Chloride C1-
59
The membrane of a cell is known to be selectively permeable to ions. What is the overall effect of this property?
The cell membrane is polarized, with the inside of the cell being negative with respect to the outside, referred to as Resting Membrane Potential & is approx 70uV
60
Neuronal denndrites are carrying a signal toward what?
Toward the cell body/soma of a neuron
61
The axon of a neuron are carries signals away from what & toward what?
Away from the cell body/soma & toward the axon terminals
62
Describe the phenomenon of membrane depolarization
When a stimulus arrives at a neuron it causes change in the permeability of the cell membrance that results in a net current flow from the outside to the inside of the cell, which causes a change in membrane potential - the potential reverses & the inside of the cell becomes positive with respect to the outside.
63
What is an action potential?
Each neuron receives signals from thousands of other neurons. If these signals exceed a certain threshold a very large depolarization occurs that causes a complete reversal of the voltage across the cell membrane which generates an electric pulse (known as an action potential) which is self propagated

NeuroTech Intro To IONM (3 decks)

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