Neuro Pathophys

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Antieplieptic drugs act in which ways decrease neuronal
Only Sz med that is NOT metabolized in LIVER and EXCRETED in renal Gabapentin
Defined as recurrent sz resulting from CONGENITAL or ACQUIRED factor EPILEPSY
FOCAL sz may be localized to specific area of the BRAIN FOCAL LOCAL
type of SZ characteristically produce bilaterally symmetric electrical activity, resulting in ABNORMAL motor activity, loss of consciousness or BOTH GENERALIZED sz
Preferred method of studying brain structure MRI
used to ID the locations of sz foci as well as to characterize electrical properties Standard EEG
First line of tx for Sz SINGLE DRUG therapy with ANTIEPILEPTIC Drug (drug combo ok if mono therapy fails)
antiepiletpic drugs either ____ neuronal excitability or _____ neuronal inhibition DECREASE/ENHANCE
Partial Sz drugs (PECV) PECV (phenytoin, esilcarbazepine, carbamazepine, valproate)
Generalized Sz drugs (CPBG LLV) Carbamazepine, Phenytoin, Barbs, Gabapentin, Levitracetam, lamotrigine, valproate
All anitepileptic drugs are METABOLIZED in LIVER and EXCRETED in the KIDNEYS except….. GABAPENTIN
what should you give is SZ occurs INTRA OP Propofol (50-100mg), Phenytoin (500-1000mg SLOWLY), Diazepam (5-10mg)
Which drugs can precipitate SZ activity (EVEN in SMALL doses) & should be avoided KETAMINE & METHOHEXITAL
What drugs are contraindicated r/t to metabolites (laudanosine & normeperidine) have epileptogenic potential Atracurium & Meperidine
an INCREASE in NDMBs may be req'd if a pt is taking what 2 anti epileptic drugs PHENYTOIN & TEGRETOL
Placement of electrodes directly on the CEREBRAL CORTEX ELECTRO-CORTICO-GRAPHY
3rd lead cause of death in US and which is greater ISCHEMIC or HEMORRHAGIC STROKE –> ISCHEMIC
Incidence of STROKE have decreased r/t Better control of co-existing conditions, SMOKE cessation & greater awareness of stroke & risk factors
INTERNAL CAROTID arteries & VERTEBRAL arteries form what structure in the brain circulation CIRCLE of WILLIS
INTERNAL CAROTIDS –> ANTERIOR CEREBRAL artery –> MIDDLE CEREBRAL artery = ANTERIOR CIRCULATION that provides blood to what? Frontal, Parietal, Lateral temporal lobes, basal ganglia & most of internal capsule
VERTEBRAL artery –> BASILAR artery –>2 ANTERIOR -INFERIOR/2 SUPERIOR CEREBELLAR arteries –> PAIRED POSTERIOR CEREBRAL arteries that supply blood to what? Brainstem, Occipital lobes, cerebellum, medial portions of temporal lobes & most of thalamus
Sudden onset of neurologic dysfunction or describe neuro s/s evolving over MINUTES to HOURS STROKE!!!
sudden vascular-related focal neuro deficit that resolves promptly with 24hrs TIA
Most significant risk factor for STROKE SYSTEMIC HTN
CT scan more sensitive to ISCHEMIA or HEMORRHAGE Hemorrhage
Most reliable predictors of outcome for HEMORRHAGIC stroke EXTRAVASATED blood & LOC
Administration of _____ within 4 HOURS of ONSET of symptoms have been shown to DECREASE hematoma & improve outcome RECOMBINANT ACTIVATED FACTOR VII (7)
Which side do you monitor neuromuscular blockade PARETIC/PARALYZED or NON-PARETIC NON-PARETIC/NON PARALYZED
Avoid with PARALYTIC with patients with recent stroke HX SUCC
Most common place for ANEURYSM Circle of Willis (near a bifurcation) –> Anterior artery (40%) & Middle Cerebral Bifurcation (34%)
Risk of rupture of aneurysm depends on ______ DIAMETER (<10mm FOLLOW/>10mm SURGERY)
HTN, Oral Contraception, Female, Cocaine, Smoking RISK FACTORS for ANEURYSM
An expanding aneurysm that compresses normal neuro structures MASS effect
Distal cerebral circulation from thrombus contained with the aneurysm SMALL emboli
Outcome is OPTIMAL when surgical tx is performed within ____ after bleed 72 hours
Tx methods to DECREASE ICP Mild hyperventilation (hypocarpnea), Optimize sedation & analgesia, Diuretics (mannitol or hypertonic saline), drain CS, elevated HOB, Cerebral vasoconstrictor (Propofol), Corticosteroids
Occurs with a SUSTAINED increase in ICP above 20-25 mmHG INTRACRANIAL HTN
HA, N/V, Papilledma, focal neuro deficits, altered ventilatory function, decreased consciousness, sz, and coma are S/S of? INTRACRANIAL HTN
What should be avoided with INTRACRANIAL HTN r/t exacerbation of efx of brain ischemia DEXTROSE
excessive accumulation of CSF due to obstruction in normal CSF flow obstructive/non-communicating
impaired reabsorption of CSFat ARACHNOID VILLI Communicating
3 ways to cause hydrocephalus EXCESSIVE production/OBSTRUCTION of pathways/DECREASED ABSORPTION
More common in PEDS SUPRAtentorial tumor or INFRAtentorial tumor INFRATENTORIAL –>occlude 4th ventricle/Obstructive/ataxia
Most prevalent neuroglia cells in CNS & give rise to infratenorial and supratentorial tumors/make up the GLUE-LIKE tissue of brain/well differentiated ASTROCYTOMA (surpa>infra)
GRADE IV glioma/imaging shows RING-enchancing lesion (central necrosis & edema)/very POOR prognosis GLIOBLASTOMA MULTIFORME
Poor differentiated/CONTRAST-enhancing lesion/TX: resection/radiation/chemo, PROGNOSIS: intermediate ANAPLASTIC astrocytoma
Arise from myelin-producing cells/TX; resection since cells are RADIORESISTANT/act was astrocytoma or glioblastoma OLIGODENDROGLIOMA
Arise from cells lining the VENTRICLES & CENTRAL Canal of SPINAL CORD/Common location: 4th VENTRICLE/Tx: resection & radiation, OBSTRUCTIVE, HA, N/V, ataxia EPENDYMOMA
Arise EXTRAAXIAL (outside brain) & Arachnoid cap cells, slow growing, BENIGN, Tx: resection, Prognosis: excellent, MALIGNANCY is RARE MENINGIOMA
Arise from ANT. Pituitary gland & w/tumors from Parathyroid/Pancreatic cells as part of ENDOCRINE neoplasm type I, Functional (secret hormones) vs non-functional, compress CRANIAL NERVES, Tx: transphenoidal/craniotomy PITUITARY TUMOR
what are the MICROadenoma (secreting) pituitary tumors (PCA) Prolactinoma (inc PRL), Cushing Dx (incr. ACTH), Acromegaly (incr. GH)
what are the MACROadenoma (mass lesions) PIB PANhypopituitarism, Increased ICP, Bi-termporal hemianopsia
Results of BENIGN SCHWANNOMA in vestibular component of CN VIII, single mass or bilateral w/neurofibromatosis type 2, S/S: hearing loss, tinnitus, disequilibrium, Tx: resection w/wo radiation, PROGNOSIS: good but my reoccur ACOUSTIC NEUROMA
Originate most from primary site in LUNG & BREAST, bleed more during resection & likely more than one METASTATIC TUMOR
2/3 of intracranial tumors in PEDS, Tx: removal/debulking, Radiotherapy, Ventric or shunt, steroids, Gamma Knife POSTERIOR FOSSA
MOST common POSTERIOR FOSSA tumors (BAM) Brainstem glioma, Astrocytoma, medulloblastoma
Degenerative dz of EXTRAPYRAMIDAL system, symptoms worse on EMERGENCE, S/S: bradykinesia, mm rigidity, resting tenor, postural instability, Sx tx: Deep Brain Stimulators PARKINSON's
in Parkinson's there is a LOSS of ______ fibers in the basal ganglia leading to regional concentration depletions DOPAMINERGIC
DOPAMINE is presumed to inhibit rate of firing of neurons that control the extrapyradimal motor system & depletion of DOPAMINE = diminished inhibition and unopposed stimulation by ACH FYI
TX for PARKINSONs: INCREASE concentration of DOPAMINE & DECREASE efx of ACH with what DRUGS? LEVODOPA combo w/ DECARBOXYLASE inhibitor (prevents peripheral conversion of LEVODOPA to dopamine so more is available in the CNS)
Dyskinesia, psych props, INCREASED contractility & HR, Orthstatics, N/V are side EFX of what? LEVODOPA
Continue LEVODOPA day of sx –> abrupt withdrawal can lead to mm rigidity FYI
ANTIPSYCHOTICS, PHEOTHIAZINE (thorazine/compazine), BUTYROPHENONES (droperidol) & METOCLOPRAMIDE can exacerbate symtpoms FYI
what DRUGS should be avoid during induction of PARKINSONs pt r/t cardiac irritability KETAMINE & locals containing EPI
Parkinson's INTRAop: what MUSCLE relaxant should be avoided & what opioid should be used SUCCs r/t hyperkalemia & REMI r/t rapid recovery
Tremors from PARKINSONS mimic VFIB FYI
Autoimmune dz affecting the CNS initiated by VIRAL infection, high rate among twins, increased with 1st degree relative, follow unpredictable, TX: not curative just symptom control with CORTICOSTEROIDS, AVOID SUCCs Multiple Sclerosis/ALS
characterized byt demyelination in the BRAIN & SPINAL cord ONLY, increased body temperature, may be on large doses of corticosteroids Multiple sclerosis
Intramedullary dz of cervical cord suggested by electrical sensation that runs down the back into the legs in response to flexion of the neck LHERMITTE's sign
Choice of treatment of pt with RELAPSING/REMITTING multiple sclerosis INTERFERON-B (sfx: flu like symptoms 24-48 hours after injection)
Autoimmune dz of NMJ mediated by REDUCTION in # of ACH receptor, Characterized by weakness and fatiguability of SkM Myasthenia Gravis
Muscle strength IMPROVES after administration of ANTICHOLINERGIC drugs (atropine/robinul) FYI
FEWER ACH receptors, SIMPLIFIED synaptic folds, WIDENED synaptic spaces Characteristics of MG NMJ
most common INITIAL complaints of MG PTOSIS & DIPLOPIA r/t extra ocular muscle weakness
MG pts are HIGH risk for PULM aspiration FYI
First line of TX for MG patients ANTI CHOLINESTERASE drugs -> increase ACH at NMJ
which ANTICHOLINERGIC drug is used for MG r/t decreased sfx PYRIDOSTIGMINE
Thymectomy (decreased ACH antibodies), Immunosuppressive Tx (corticosteroids), Plasmapheresis (removes antibodies) are tx for MG FYI
Induction of MG pts: consider breath down technique, avoid NDMB, careful w/opioids, steroid maintenance, HOLD anticholinergic meds for 2-4 hrs POSTOP, may need wake up vent FYI
Deficiency in CHOLINE ACETYLTRANSFERASE Alzheimer's Dz
ANESTHESIA MGMT for Alzheimers: NO premed (more confusion), Regional (if cooperative), INH over NARCs, Centrally acting anticholinergic (ROBINOL) FYI
referred to nerve damage that SPECIFICALLY causes PAIN in SHOULDERS, THIGHS, HIPS, OR BUTT PROXIMAL neuropathy
Occurs when any of the 12 CN are damaged CRANIAL neuropathy
Refers to damage or dz of the OPTIC nerve (II) that transmits visual signals from the retina of eye to the brain OPTIC NEUROPATHY (II)
Involves nerve that carries signal from INNER EAR to BRAIN & responsible for HEARING AUDITORY NEUROPATHY (VIII)
Damage to nerves of the INVOLUNTARY NERVOUS SYSTEM (BP, Digestion, Bowel/bladder, sexual response, perspiration) Autonomic NEUROPATHY
Condition most COMMONLY associated with NEUROPATHY DM or DIABETIC Neuropathy
CAUSES of NEUROPATHY includeL Vitamin Deficiencies (B12,Folate), Infection (HIV/AIDS, Lyme Dz, Leprosy, syphilis), Autoimmune (RA, Systemic Lupus, Guillain-Barre) FYI
Damage to SENSORY nerves is common in _____ neuropathy PERIPHERAL
Weakness, loss of reflexes, muscle mass, cramping & loss of dexterity are symptoms of damage to ______ nerves MOTOR
Damage to nerves that control FUNCTION of organs and gland AUTONOMIC neuropathy
ELECTROMYOGRAPHY (EMG) measures function of nerves with needle thru skin into muscles that measures electrical activity
Damage to SENSORY nerves is common in _____ neuropathy PERIPHERAL
Weakness, loss of reflexes, muscle mass, cramping & loss of dexterity are symptoms of damage to ______ nerves MOTOR
Damage to nerves that control FUNCTION of organs and gland AUTONOMIC neuropathy
ELECTROMYOGRAPHY (EMG) measures function of nerves with needle thru skin into muscles that measures electrical activity FYI
Nerve Conduction Velocity Test measures SPEED thru nerves & done with EMG FYI
Surgical removal off small piece of tissue & most COMMON sites NERVE BIOPSY (Sural Nerve & SUPERFICIAL Radial nerve)
Other tx of NEUROPATHY other than MEDS TOPICAL, Trans-cutaneous electrical nerve stimulation (TENS)
refers to clinical disorder of the Skeletal Muscle which may extend to cardiac muscle causing HYPERTROPHY MYOPATHY
two main categories of MYOPATHY INHERITED or ACQUIRED
EARLY age onset with longer duration of dz INHERITED MYOPATHY
Sudden or SUBacute presentation at later age ACQUIRED MYOPATHY
Essential in ID-ing presence of myopathy and narrowing down differential diagnosis CLINICAL HISTORY
ELEVATIONs in Creatine Phophokinase (CPK), Adolase, Lactate Dehydrogenase (LDH), Liver Function enzymes are seen in MYOPATHY FYI
Muscular Dystrophy, Congenital, Metabolic, Mitochondrial are ALL types of _____ myopathies INHERITED
Myopathy PREOP: good HX & physical, NEURO exam FYI

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