Hemorrhagic Strokes
Ischemic Strokes
Seizures
OR Cases
IR Procedures
Neuromuscular/
Autoimmune
Autoimmune
Random
100
what type of stroke is commonly caused by ruptured aneurysms?
SAH
100
What are three major things we consider before giving a patient TNK?
1. Symptom onset (within 4.5 hrs)
2. Are they on anticoags
3. are the symptoms debilitating to the patients lifestyle
100
What does a seizure look like on EEG? What does burst suppression look like on EEG?
Seizure-rapid spiking waves
burst suppression- flat lines
100
Explain the difference between a craniotomy and craniectomy
-Otomy: flap gets put back on
-ectomy: piece removed and not replaced (no bone flap)
100
What is an AVM?
arteriovenous malformation, or a tangle of arteries and veins
100
How does Guillian Barre Syndrome present? What typically causes it?
the body attacks peripheral nerves, ascending numbness/weakness. usually caused by a viral infection
100
When transitioning off an Integrillin drip, what meds and typically given and at what time interval.
loading dose aspirin (325mg) and tricagrelor (brilinta 180mg) and then stop the IV drip 2 hrs after
200
What aneurysm treatment requires OR intervention? What interventions can be done in IR?
clipping has to be done in OR- and requires a hemi crani
stent, coil, and flow diversion can be done in IR
200
What symptoms would a patient present with, if they had an occlusion of the vertebral or basilar artery?
Dizziness, ataxia, and visual deficits
200
What is the gold standard for treating seizures?
ativan
200
What is a pneumocephalus? How do we treat it?
air in the intercranial space after resection or evacuation
- 100% O2 and to lay flat
- (15L) via a nonrebreather facemask or 100% on vent
to increase the nitrogen gradient that facilitates air absorption, and entrapped air gradually gets absorbed as pneumocephalus resolves
200
What is the frequency of post IR checks for a planned procedure?
q15x4, q30x2, q1x4 (groin site, vitals, neuro, neurovascular)
200
What is ALS?
progressive degeneration of nerve cells in the spinal cord and brain. Eventually lose control of the ability to move, speak, eat, and breathe. There is no cure.
200
Why is ENT strict about avoiding pressors on their flap patients?
pressors cause vasoconstriction and reduce blood flow to flap
300
What is vasospasming? What are three things we do to prevent and catch vasospasm early?
constrictive narrowing of an artery causing decreased perfusion of brain tissue distal to the hemorrhage
1. nimodipine (30mg q2 or 60mg q4)
2. 1:1 fluid replacements
3. TCDs
300
What does TICI score represent and what are the scores you can get in order from worst to best?
Thrombolysis in Cerebral Infarction- It is the grading system used to describe revascularization post thrombectomy
0,1,2c,2b,2a,3
300
What are 3 precautions we take with seizures patients?
always a high fall risk, seizure pads on bed, door open, linens off bed, seizure button and call light within reach
300
What is a microvascular decompression?
- what is the biggest post op issue
relives compression of the trigeminal nerve (compression usually causes pain and muscle twitching)
- patients are in a lot of pain post op- expect a lot of treating pain
300
What are 4 ways to stop a groin site from bleeding?
manual pressure, d-stat block/quick clot powder, hydrogen peroxide soak gauze, and in severe cases fem stop
300
What electrolyte can MG patients not receive and why?
Magnesium because it causes worsening of their exacerbations
300
What is the PRIMARY use of bromocriptine?
primarily used to treat neuro storming
- secondarily it improves shivering
400
What are three late signs of impending herniation?
Cushing's Triad- bradycardia, widening pulse pressure, irregular respirations
Change in LOC
Change in pupils
increased ICP
400
Explain the difference/purpose of CT, CTA, and CTP and what each one can help us determine
CT: No contrast- rules out bleeds, can show us old ischemic strokes
CTA: uses contrast to show the vessels in the neck and head, shows us large vessel occlusions and stenosis
CTP: allows us to see the mismatch ration (salvageable tissue, penumbra, to irreversible brain damage), shows us if IR would be beneficial for the patient or if that patient is an extending window stroke if TNK is an option
400
What is a non-epileptic seizure?
not caused by abnormal brain electrical discharges and usually have a psychological cause that manifests as physical symptoms (trauma)
- no seizures seen on EEG
400
What is a CEA and and what do all CEA patients need in their rooms at all times?
surgical removal of plaque inside the carotid artery, all patients need the carotid precautions bag
400
Draw an aneurysm coiling, clipping, and stenting
400
Plex VS IVIG
IVIG: treats bad antibodies but nothing is removed from the body- done by bedside RN
Plex: removes harmful antibodies, replaces donor antibodies- done by dialysis
400
What are the symptoms of menegitis?
sudden high fever, stiff neck, headache, nausea vomiting, confusion, seizures, sensitivity to light.
500
Explain the difference between ICH, IPH, SAH, and IVH
ICH-intercerebral blood vessel bursts leaking into brain tissue
IPH- type of ICH that occurs in functional tissueSAH: blood vessel in the subarachnoid space (space surrounding the brain) ruptures
IVH: blood is in the ventricular space
500
What is malignant MCA syndrome?
rapid patient deterioration due to cerebral edema
500
What type of diet can be used to help prevent seizures in extreme cases and what types of foods does that entail?
Ketogenic diet-
high-fat, very low-carbohydrate eating plan that shifts the body into ketosis, using fat instead of glucose for energy
500
Vestibular Schwannoma
- where is the tumor located
-what are the most common symptoms
benign tumor that grows in the ear and affects hearing and balance
- balance issues/ataxia, post op nausea and vomiting
500
What is a venous stent used to treat?
What are the typical symptoms prior to a venous stent?
treats venous sinus stenosis caused by idiopathic intercranial hypertension- stenting decreases venous sinus pressure
symptoms:headaches, tinnitus, and visual symptoms
500
What RT measurements are important in neuromuscular patients? What do the lab values mean?
NIF- Breath out then how much can they breathe in
–80 to –100 is normal –20cmh2O to 0cmh20 will fail
Vital capacity - big breath in then measure how much they can exhale
normal is 65-75 ml/kg
500
What is PRES?
severe HTN causing interruption of cerebral blood flow (leading to interstitial extravasation of proteins and fluids) causing vasogenic edema
600
Draw a normal ICP waveform and then explain what P2 being greater than P1 on an ICP waveform indicates
poor brain compliance/ at risk for impending herniation and brain code
600
Explain the patho physiology of venous sinus thrombus, what are the early symptoms?
clot in venous sinus leading to a back up of CSF that is unable to drain-->can cause IPHs and increased pressure
early symptoms: headache and blurred vision
600
What is Refractory Status Epilepticus (RSE)? What do we do for those patients?
patients who do not respond to standard treatment regimens
-burst suppression while we adjust medications
600
Explain the hormone changes associated with DI in transsphenoidal patients
How does DDAVP help the patients
ADH: regulates water balance in the body
Desmopressin (DDAVP) is a synthetic form of the vasopressin hormone and regulates the water balance in the body
in a transsphenoidal ADH is low so water reabsorption is altered, causing increased urine output. The salt doesn't follow the water as it is supposed to, causing high serum sodium. (low urine osmo and low specific gravity)
600
What is an angioplasty?
inflating a tiny balloon in the clogged artery to widen the area so blood can flow freely
600
What is CIDP
rare autoimmune disorder in which the body attacks its own tissues, the myelin sheaths which are the fatty coverings on the fibers that insulate and protect the nerves
- chronic version of GBS lasting >8 weeks
600
Explain what the circle of willis is made up of and why it beneficial in stroke patients
Internal carotid, Anterior communicating artery, anterior cerebral artery, posterior communicating artery, posterior cerebral artery
When there is an occlusion in one of the vessels bloods is able to reroute around the circle to still perfuse everything else