Kristine's Neuro Pat 2

Front 1

Clinical features of Basilar artery occlusion

Back 1

Oculomotor deficits and or ataxia with "crossed" sensory and motor dficits

Front 2

Clinical features of Vertebral Artery occlusion.

Back 2

Lower cranial nerve deficits and/or ataxia with crossed sensory deficits.

Front 3

Unilateral Visual Impairment Numbness or weakness of an extremeit or aphasia Symptoms of a stroke mean...

Back 3

They have CAROTOID dz (usually just one of the cartoid).

Front 4

Bilateral Vision impairment, bilat weakness, ataxia (weak gait) or amensia

Back 4

Global problems, These suggest veterbral basilar dz.

Front 5

TIAs give a pt a higher risk for....

Back 5

Stroke

Front 6

A pt who has a stroke, you should consider...

Back 6

-They have alerations in CO2 responsivness in the BBB 4-6 weeks after surgery.
-Elective surgery should be delayed 6 wks after a CVA.
-Very careful with muscle relaxants.
-Nerve stimulation or normal side
-If you put on weak side, you will overdose muscle relaxant.

Front 7

CVA's and NDMB

Back 7

Be sure to judge twiches on non-paralyzed side because of up regulation. More receptors present and pt will be resistant to NDMB. Sch given to these pts with marked up regulation will have hyperk+.

Front 8

Conditions associated with AchR upregulation

Back 8

Spinal cord injury
Stoke
Burns
Prolonged immobility
Prolonged exposure to NMB
MS
GBS

Front 9

Conditions associated with AchR Down regulation

Back 9

Myasthenia Grvavis
Anticholinesterase poisoning
Organophosphate

Front 10

Where does CSF start?

Back 10

At the choroid plexus and goes to be absorbed in the villi of the arachnoid membrane in the brain.

Front 11

Hydrocephalus can be caused by...

Back 11

obstructive outflow of csf pathway.
Can be caused by cancer, trauama, mennigitis, subarachnoid hemmorrage.

Front 12

Pathway of normal CSF flow...

Back 12

Choroid plexus->formen of Monro->Third ventricle-> Aqueduct of sylvius-> 4th ventricle->foramen of luschka OR formaen of Magendie-> into cisterna magna->pool of CSF at base of brain.

Front 13

What is the Foramen of Luschka?

Back 13

One of the two possible ways CSF can travel to the base of the brain.

Front 14

What is the Foramen of Magendie?

Back 14

Where the CSF travels from the 4th ventricle down through either these pathways (either magendie or luschka) and into the cisterna magna and then into the subarachnoid space.

Front 15

Where is CSF reabsorbed?

Back 15

From the subarchnoid space CSF is reabsorbed in the arachnoid villa and enters the venous blood.

Front 16

Generalized sz's

Back 16

Involves the neurons bilaterally.
Subcortical or deep sz focus in the brain. Conciousness is always impaired. Deep in brain (subcortical)= generalized sz

Front 17

Partial Sz or focal Sz

Back 17

usually unilateral and conciousness is usually maintained.

Front 18

Anesthetic management of people who have sz...

Back 18

Pt w/ sz are at risk for having post-op sz.
Barbs, benzos, propofol...increase the sz threshold.
Avoid: ketamine, reglan, methohexital. etomidate can cause spikes in EEG
Dilantin-need more NMB
Metabolite of atricurium and cis: Laudanosine has CNS stim effects...avoid in pt w/sz
Manage the airway.

Front 19

Complications with pts with sz

Back 19

Sz increase 250% in ATP usage and cerebral O2 demand by 60%. A deficient of glucose and ATP can occur and then lactate accumulates in the brain.
-Sz pts can run out of ATP or O2 and can have ischemic brain injury

Front 20

What can cause sz like activity other than sz?

Back 20

Propofol-myoclonus
Etomidate-jerking movements
Sch-fasiculations
Inadequate reversal-floppy fish like movements
LA toxicity can cause actual sz (intravenous or overdose).

Front 21

Avoid sch in.....

Back 21

Marked muscle atrophy, marked up regulation, children under 18 (bc of MD possib)

Front 22

LMN dz

Back 22

Progressive muscular atrophy
Muscular dystrophys
MG
Bulbar palsies

Front 23

UMN ...other name

Back 23

pyramidal tract (brain and 1st synapse)

Front 24

LMN other name

Back 24

Extrapyramidal tract

Front 25

Bulbar palsies...CN nerves affected>? And what part of the body is affected?

Back 25

CN 9, 10, 12 injury
Injury to the myencephalon
Extra-pyramidal tract...causes injury to the face, jaw, pharynx and tongue. Pts have difficulty swallowing

Front 26

Extrapyramidal motor syndromes-Cerebellar disorders

Back 26

Loss of muscle tone, difficulty coordinating movement, muscle weakness on the ipslateral side.

Front 27

Extrapyramidal Motor syndromes-
Basal ganglia

Back 27

Too much dopamine- causes hyperkinesia. Imbalance of dopaminergic and choinergic activity. Ach and dopamine are usually in balance in the basal ganglia.

Front 28

Increased Ach in the basal ganglia causes....

Back 28

out of balance, causes Akinesia in basal ganglia

Front 29

Increased Dopamine in the basal ganglia causes...

Back 29

too much causes hyperkinesia.

Front 30

marked upregulation happens in ...

Back 30

Muscle atrophy. Worry about muscle relaxants w/ people who have neuromuscular disorders, respiratory insuffiency (no deep breath and cough).

Front 31

People with NMD and respiratory insufficiency

Back 31

major cause of death

Front 32

Progressive resp insufficency/dz

Back 32

ALS

Front 33

Reversible resp insufficiency/dz

Back 33

GBS...can resolve

Front 34

Reversible w/ therapy resp insufficiency/dz

Back 34

MG

Front 35

Relapsing resp insufficiency/dz

Back 35

MS...comes and goes...

Front 36

Muscular disorders as associated with

Back 36

cardiac dysfuct
Autonomic nervous system dysfct.

Front 37

S/sx of dysautonomia

Back 37

resting tachycardia
orthostatic hypotension
venous pooling
hypovolemia
decreased contractility
-use phenylephrine to treat hypotension (direct acting vasopressor).

Front 38

UMN diseases

Back 38

MS,
Parkinsons dz
CVA
Trauma

Front 39

LMN dz occur at what level?

Back 39

Below T12...flaccid paralysis below level of injury

Front 40

UMN occur

Back 40

in the anterior horn...
Spastic paralysis and hyperreflexia.