Neuro Shelf

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  1. Rate CSF is produced

    total volume

    time to replace 100%
    0.5 mL per minute

    150 mL

    every 5 hours
  2. Area of LP

    Contraindications for LP
    L3-L4 (level of ASIS)

    any space occupying mass or increased ICP, local infection
  3. Spinal cord ends at
  4. Protein content of CSF

    Normal opening pressure
    40-50 mg/dL

    60-150 mm H2O
  5. define xanthochromia
    yellow discoloration of the supernatant of spun CSF. Indicates intrathecal hemorrhage (vs traumatic tap)
  6. Interpretation of CSF findings...

    bacterial or early viral infection
  7. Interpretation of CSF findings...

    • infection (viral, fungal, mycobacterial)
    • demyelination
    • CNS lymphoma
  8. Interpretation of CSF findings...

    elevated protien
    • infection (fungal, mycobacterial)
    • demyelination
    • tumor (meningioma, carcinomatous meningitis)
    • sarcoidosis
    • age
  9. Interpretation of CSF findings...

    low glucose
    bacterial infection
  10. Interpretation of CSF findings...

    oligoclonal bands
    • demyelination (MS)
    • CNS infections (Lyme disease)
    • noninfectious inflammatory processes (SLE)
  11. Interpretation of CSF findings...

    positive EBV PCR
    CNS lymphoma in patients with AIDS or other immunosuppressed states
  12. Interpretation of CSF findings...

    Creutzfeldt-Jakob disease
  13. When is CT before LP contraindicated
    when pt has meningitis
  14. Most common complication of LP
    low-pressure headache

    tx with pt lying flat, increase intake of fluids and caffeine
  15. CT measures...
    degree of x-ray attenuation by tissue

    best for demonstrating fresh blood (ex - contrast enhancement indicates disruption of local BBB), acute intracranial bleeding

    contraindicated in pregnancy
  16. MRI measures...
    radiofrequency (RF) pulses instead of x-rays

    especially good for seeing contents of posterior fossa and craniocervical junction

    ok in pregnancy or in pts with contrast sensitivity (gadolinium is not nephrotoxic)
  17. MRI...

    Fat is bright, myelinated white matter is bright

    water is dark

    usually used with contrast (gadolinium)
  18. MRI...

    water is bright

    useful for examining spinal cord
  19. MRI...

    T2 weighted but CSF signal has been inverted so it's dark. Best for almost everything...
  20. MRI...

    diffusion-weighted image (DWI)
    demonstrates cellular toxicity with high sensitivity, so good for acute stroke
  21. MRA
    uses blood flow as contrast agent, so safer than angiogram, but not as sensitive or specific
  22. PET scan
    measures regional brain metabolism (good for seeing seizures)
  23. SPECT scan
    demonstrates increased blood flow during seizures
  24. EEG normal frequencies
    -alpha: 8-13 Hz. over posterior head regions in the relaxed awake state with eyes closed

    -beta: 14-30 Hz. in frontal regions

    -theta: 4-7 Hz. during drowsiness and sleep

    -delta: 0.5-3.0 Hz. during drowsiness and sleep
  25. EEG...

    diffuse theta or delta activity during awake state...
    suggests encephalopathy
  26. EEG...

    records the activity of...
    cortical neurons
  27. EEG...

    interictal epileptiform EEG findings in how many pts with epilepsy
  28. definition of coma
    unarousable unresponsiveness
  29. use to reverse common etiologies of coma
    • naloxone
    • thiamine
    • dextrose

    Note: use thiamine BEFORE glucose bc otherwise it will precipitate Wernicke's encephalopathy
  30. Brainstem reflexes and associated CNs
    • -pupillary (II, III)
    • -oculocephalic (aka dolls eyes) (VIII - afferent - III, IV, VI - efferent)
    • -corneal - (V1, VII)
    • -gag - (IX, X, XI)
  31. caloric testing can replace what brainstem reflex
  32. two main ways in which consciousness can be depressed
    • -brainstem dysfunction
    • -both cerebral hemispheres dysfunctional simultaneously
  33. how to lower ICP
    raise head of bed, hyperventilate, use mannitol
  34. cause of locked in syndrome
    large lesions in base of pons
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