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40 Cards in this Set
- Front
- Back
Clinical features of Basilar artery occlusion
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Oculomotor deficits and or ataxia with "crossed" sensory and motor dficits
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Clinical features of Vertebral Artery occlusion.
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Lower cranial nerve deficits and/or ataxia with crossed sensory deficits.
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Unilateral Visual Impairment Numbness or weakness of an extremeit or aphasia Symptoms of a stroke mean...
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They have CAROTOID dz (usually just one of the cartoid).
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Bilateral Vision impairment, bilat weakness, ataxia (weak gait) or amensia
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Global problems, These suggest veterbral basilar dz.
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TIAs give a pt a higher risk for....
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Stroke
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A pt who has a stroke, you should consider...
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-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. |
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CVA's and NDMB
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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+.
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Conditions associated with AchR upregulation
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Spinal cord injury
Stoke Burns Prolonged immobility Prolonged exposure to NMB MS GBS |
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Conditions associated with AchR Down regulation
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Myasthenia Grvavis
Anticholinesterase poisoning Organophosphate |
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Where does CSF start?
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At the choroid plexus and goes to be absorbed in the villi of the arachnoid membrane in the brain.
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Hydrocephalus can be caused by...
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obstructive outflow of csf pathway.
Can be caused by cancer, trauama, mennigitis, subarachnoid hemmorrage. |
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Pathway of normal CSF flow...
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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.
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What is the Foramen of Luschka?
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One of the two possible ways CSF can travel to the base of the brain.
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What is the Foramen of Magendie?
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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.
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Where is CSF reabsorbed?
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From the subarchnoid space CSF is reabsorbed in the arachnoid villa and enters the venous blood.
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Generalized sz's
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Involves the neurons bilaterally.
Subcortical or deep sz focus in the brain. Conciousness is always impaired. Deep in brain (subcortical)= generalized sz |
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Partial Sz or focal Sz
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usually unilateral and conciousness is usually maintained.
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Anesthetic management of people who have sz...
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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. |
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Complications with pts with sz
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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 |
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What can cause sz like activity other than sz?
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Propofol-myoclonus
Etomidate-jerking movements Sch-fasiculations Inadequate reversal-floppy fish like movements LA toxicity can cause actual sz (intravenous or overdose). |
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Avoid sch in.....
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Marked muscle atrophy, marked up regulation, children under 18 (bc of MD possib)
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LMN dz
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Progressive muscular atrophy
Muscular dystrophys MG Bulbar palsies |
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UMN ...other name
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pyramidal tract (brain and 1st synapse)
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LMN other name
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Extrapyramidal tract
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Bulbar palsies...CN nerves affected>? And what part of the body is affected?
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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 |
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Extrapyramidal motor syndromes-Cerebellar disorders
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Loss of muscle tone, difficulty coordinating movement, muscle weakness on the ipslateral side.
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Extrapyramidal Motor syndromes-
Basal ganglia |
Too much dopamine- causes hyperkinesia. Imbalance of dopaminergic and choinergic activity. Ach and dopamine are usually in balance in the basal ganglia.
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Increased Ach in the basal ganglia causes....
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out of balance, causes Akinesia in basal ganglia
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Increased Dopamine in the basal ganglia causes...
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too much causes hyperkinesia.
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marked upregulation happens in ...
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Muscle atrophy. Worry about muscle relaxants w/ people who have neuromuscular disorders, respiratory insuffiency (no deep breath and cough).
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People with NMD and respiratory insufficiency
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major cause of death
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Progressive resp insufficency/dz
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ALS
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Reversible resp insufficiency/dz
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GBS...can resolve
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Reversible w/ therapy resp insufficiency/dz
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MG
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Relapsing resp insufficiency/dz
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MS...comes and goes...
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Muscular disorders as associated with
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cardiac dysfuct
Autonomic nervous system dysfct. |
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S/sx of dysautonomia
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resting tachycardia
orthostatic hypotension venous pooling hypovolemia decreased contractility -use phenylephrine to treat hypotension (direct acting vasopressor). |
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UMN diseases
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MS,
Parkinsons dz CVA Trauma |
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LMN dz occur at what level?
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Below T12...flaccid paralysis below level of injury
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UMN occur
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in the anterior horn...
Spastic paralysis and hyperreflexia. |