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Cavities inside the skull correct answers >> Anterior/middle/posterior fossa Cranial bones correct answers >> Frontal, occipital, sphenoid, ethmoid (unpaired). Parietal & temporal (paired). Mental protuberance correct answers >> chin bone MCA supply of the cerebral cortex correct answers >> Hand + face/mouth/auditory Cranial nerves correct answers >> -12 pairs (Mixed fibers: sensory/motor/both). -Emerge @ irregular intervals from the brain. -Nuclei displacement:
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Cavities inside the skull correct answers >> Anterior/middle/posterior fossa Cranial bones correct answers >> Frontal, occipital, sphenoid, ethmoid (unpaired). Parietal & temporal (paired). Mental protuberance correct answers >> chin bone MCA supply of the cerebral cortex correct answers
Hand + face/mouth/auditory
Cranial nerves correct answers >> -12 pairs (Mixed fibers: sensory/motor/both). -Emerge @ irregular intervals from the brain. -Nuclei displacement: Motor = medial Sensory = lateral Meckle's Cave correct answers >> Depression in the medial middle fossa where CN V ganglion sits Low frequency sounds correct answers >> @ apex of cochlea Area of spine w/ small pedicles, long spinous process, large inter-vertebral foramen correct answers >> Thoracic Neuroforamen correct answers >> Opening w/in the spinal canal for nerve roots to enter the SC
Glia cell correct answers >> Comes from the Greek word "glue" Large diameter nerve fiber (vs. small diameter) correct answers >> -Recruited 1st w/ INC'd stim intensity -Higher conduction velocity -More vulnerable to hypoxia & pressure Δ's Synaptic transmission, and/or Δ's in thalamocortical projections, produce correct answers >> Cortical potentials Peripheral nerve sensitivity correct answers >> Least sensitive to injury (more sensitive = SC grey/white mater, cortical grey matter) Cavernous angiomas correct answers >> Multi- lobulated lesions containing hemorrhage
Geriatric population: prevalence of temporal bone hyperostosis correct answers >> 10-15% Presbycusis correct answers >> High freq hearing loss; gradually occurs in older individuals Most commonly injured CN correct answers >> Facial nerve (VII) Burst fracture correct answers >> -Break in the vertebra -Failure of anterior & middle vertebral columns -Caused by violent compressive event (fall, MVA) Excessive neck flexion in sitting position correct answers >> Quadraparesis (due to ischemia in upper T-spine)
Scoliosis progression in peds correct answers >> More likely in girls > boys Apraxia correct answers >> Difficulty w/ skilled mvmnts Neurapraxia correct answers >> PNS disorder: blockage of sensory + motor nerve conduction (w/o axonal damage) INC venous pressure leads to correct answers >> - venous congestion; DEC drainage of nml veins; chronic hypoxia -NOT hypotension common source of air embolism introduction into the blood supply correct answers >> Superior sagittal sinus MAC is approximated by the effect of anesthesia on correct answers >> H-reflex (mvmnt when stimulated)
Sevo/Des/N2O correct answers >> DO NOT act on the same neuronal receptors On an equi-MAC basis (w/ equivalent doses of anes), which has the greatest effect on MEPs of recorded mm's? correct answers >> N2O N2O correct answers >> -synergistic IONM effects when mixed w/ Iso --> depressed IONM -weak anesthetic agent -causes ~75% DEC in SSEP amplitudes Desflurane correct answers >> -affects NMJ --> enhances effect of NMBs -no effect on MEP CMAPs -eliminates most rapidly Isoflurane 1.7% correct answers >> may result in burst suppression
-EEG = slowing Etomidate correct answers >> (GABA agonist) -SSEP/MEP: INC amp -EEG: slowing dexmeditomidine (Precedex) correct answers >> (α2-adrenergic antagonist) -mimics nml sleep; awakening --> most nml neuro exam -associated w/ unconsciousness (NOT amnesia) -DEC MEP ampmlitudes Fentanyl correct answers >> (μ-opioid agonist) -SSEP: mild effect on lat/amp -EEG: slowing, diffuse Δ -high dose maintenance --> may not result in EEG burst depression
Succinylcholine correct answers >> depolarizing muscle relaxant Rocuronium correct answers >> non-depolarizing muscle relaxant Monitoring mm relaxation is done via TOF. How is relaxation measured? correct answers >> By counting the # of mm responses to 4 stimuli @ 2 Hz Barbiturate effect on EEG correct answers >> burst suppression phenytoin (Dilantin) correct answers >> anticonvulsant (NaV channel blocker) -should be excluded before ECoG for inter-ictal discharges Advantages of general anesthesia during CEA correct answers >> -prevents pt mvmnt; provides brain protection & rapid BP control
DEC HCT correct answers >> INC RBC velocity Nitroprusside correct answers >> (breaks down to NO --> vasodilator) DEC's BP Unstable BP effects on cortical SSEPs correct answers >> fluctuating amplitudes Glucose is monitored & treated during surgery bc: correct answers >> -high/low BG levels = associated w/ worsened neurological injury -Glc produces intracellular acidosis during ischemia Pt presentation for acoustic neuroma: correct answers >> hearing loss, HA, unsteady gait Most important step to setting up BAERs? correct answers >> placing foam inserts
Least important considerations during intra-op BAERs correct answers >> Anesthetic considerations < BP, local cooling, core body temp BAER waveforms cannot be recorded in the following conditions: correct answers >> -bone drilling -30 dB pe SPL (intensity levels) -"kinking" of the sound delivery tube BAER stim/RR correct answers >> -<20 Hz (optimal amplitude) -10-19 Hz range -31.1 (acceptable) -NOT divisible by 60 Hz
30 Hz = INC lat + DEC amp BAER troubleshooting: pt w/ conductive hearing loss correct answers >> INC stim intensity
BAERs: 0.9 ms INC latency of both L & R wave V in a 10 min period most likely indicates: correct answers >> Temperature effects (hypothermia) BAER wave V - latency INC rate from temperature correct answers >> 0.2 ms per 1 deg C If the pt's threshold is 25 dB & the stimulator is set to 85 dB, the intensity is: correct answers >> 60 dB SL Masking level for eliminating crossover response correct answers >> 60 dB pe SPL BAER sound stimulus intensity @ the TM depends on the: correct answers >> acoustic coupling btwn the sound stimulus generator and the ear Advantage of direct CN VIII recordings correct answers >> diminishes need for averaging
BAER latency abnormalities - vascular causes correct answers >> vascular malformations in the posterior fossa (associated w/ hemi-facial spasms & facial paresis) Vestibular schwannoma dissection - approach that sacrifices hearing correct answers >> translabyrinthine Most productive electrode placement for ECochG correct answers >> promontory of the cochlea EEG wave frequencies correct answers >> Delta = 0.5-4 Hz Theta = 4-8 Hz Alpha = 8-13 Hz Beta = 13-30 Hz Raw (unprocessed) EEG should always be available for review when monitoring quantitative EEG in order to:
CSA & CDSA correct answers >> processed EEG displays Cardiac activity on the CSA/CDSA appears as correct answers >> delta activity Fast Fourier Transformation (FFT) correct answers
Mathematical transformation: complex waveform --> simpler, uniform waves EEG will most likely disappear at what temp? correct answers >> 16 deg C What EEG Δ's would you expect after intra-carotid injection of sodium amytal? correct answers >> Ipsi DEC in high freq waves EEG filter, time-base, and sensitivity for monitoring cortical ischemia during a CEA: correct answers >> 0.3-70 Hz, 15 mm/s, 3 uV/mm
Most strokes associated w/ a CEA occur: correct answers >> after cross-clamping is released Methods to monitor brain perfusion during CEA: correct answers >> -intra-op: doppler, angiography -measuring residual "stump" (ICA) pressure CEA surgery: 80% of clamp-related EEG Δ's occur w/in: correct answers >> first 1 min Maximum time to expect EEG Δ's following carotid cross-clamping? correct answers >> 2 min Pt w/o collateral blood supply during a CEA can suffer post-op deficits if perfusion isn't resolved w/in: correct answers >> 10 min ECoG: advantage of grid/strip electrodes over "crown of thorns" correct answers >> ability to slide them under dura to unexposed areas
