Kiwon Lee 14 Multimodality Neuromonitoring

Front 1

Where should the probe of neuromonitoring devices be placed in patients with diffuse injury?

Back 1

Frontal lobe of non dominant hemisphere

Front 2

What is the pressure reactivity index?

Back 2

BP and ICP correlation

This is a correlation between the blood pressure and ICP that shows the autoregulatory status of a patient. Negative correlation is seen in patients with vasoreactivity, positive correlation indicates passive pressure response system / absent vasoreactivity.

Front 3

What is the oxygen reactivity index?

Back 3

This is a correlation between CPP and PbtO2.

Front 4

How to interpret ORx / Oxygen reactivity index?

Back 4

Intact reactivity - changes in CPP should not reflect changes in PbtO2 since autoregulation prevents passive variations in CBF

Front 5

What causes increases in lactate in cerebral microdialysis?

Back 5

Anaerobic metabolism

Front 6

What does an increase in LPR or glutamate in cerebral microdialysis indicate?

Back 6

These are markers of ischemia

Front 7

What does an increase in glycerol in cerebral microdialysis indicate?

Back 7

Destruction of cell membranes from energy failure

Front 8

What causes an increase in glucose in cerebral microdialysis? (3)

Back 8

Hypertension

Increased serum glucose

Decreased cellular metabolism

Front 9

Define metabolic distress?

Back 9

LPR>40

Front 10

Define metabolic distress?

Back 10

LPR>40

Front 11

Define metabolic crisis?

Back 11

LPR >40 and brain glucose <0.7mmol/L

Front 12

Define metabolic distress?

Back 12

LPR>40

Front 13

Define metabolic crisis?

Back 13

LPR >40 and brain glucose <0.7mmol/L

Front 14

What causes changes in lactate and pyruvate without changes in LPS?

Back 14

Increases in both metabolites or decreases in both metabolites will not change the ratio

Increases in both indicates increased metabolic activity (rewarming phase, etc.)

Decreased in both indicates decreased metabolic activity (i.e. Sedation)

Front 15

What is AJDo2?

Back 15

Arterial-jugular difference of oxygen content

Front 16

What is the utility of SvjO2 (jugular venous O2 sat) and AJDO2?

Back 16

Both offers a global estimate of balance between O2 delivery and extraction by brain

Front 17

What is the utility of SvjO2 (jugular venous O2 sat) and AJDO2?

Back 17

Both offers a global estimate of balance between O2 delivery and extraction by brain

Front 18

What is a "good" SvjO2 number?

Back 18

low (<50%) and high (>80%) associated with worse outcomes.

So in between?

Front 19

What is the utility of SvjO2 (jugular venous O2 sat) and AJDO2?

Back 19

Both offers a global estimate of balance between O2 delivery and extraction by brain

Front 20

What is a "good" SvjO2 number?

Back 20

low (<50%) and high (>80%) associated with worse outcomes.

So in between?

Front 21

What causes low SvjO2?

Back 21

Cerebral hypoperfusion leading to incresaed O2 extraction

Front 22

What causes high SvjO2?

Back 22

Usually associated with hyperemia after TBI, which may lead to intracranial hypertension

Front 23

What is a cortical spreading depolarization?

Back 23

A 1-5mm per minute wave of depolarization in the gray matter which occur in both healthy and diseased brain under conditions of energy compromise (ischemia, hypoxia, hypoglycemia)

Front 24

What is a peri-infarct depolarization (PID))?

Back 24

CSDs in the peri-ischemic brain tissue