Brain Tumors & Aneurysms
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Questions and Answers

What systemic complication is most commonly associated with decreased intravascular volume in patients with SAH?

  • Thrombocytopenia
  • Bleeding (correct)
  • Hepatic dysfunction
  • Heart failure

    • Which type of cerebral aneurysm is characterized by twisting vascular channels with an entry and exit point

  • Fusiform aneurysm
  • Saccular aneurysm
  • Serpentine aneurysm (correct)
  • Mycotic aneurysm

    • In patients with SAH, which alteration is commonly observed that involves cardiac changes? select all that apply

  • Atrial fibrillation
  • ST elevation and depression (correct)
  • T wave abnormalities (correct)
  • U and Q waves (correct)

    • What percentage of patients may experience hepatic dysfunction following a subarachnoid hemorrhage?

    <p>25%</p> Signup and view all the answers

    Where are the majority of cerebral aneurysms typically located?

    <p>In the anterior circulation</p> Signup and view all the answers

    What primary function does the Windkessel effect serve in the cardiovascular system?

    <p>Dampens the pulsatile nature of blood flow</p> Signup and view all the answers

    Which condition is most likely to contribute to the formation of cerebral aneurysms?

    <p>Loss of elasticity in arterial walls</p> Signup and view all the answers

    How does the Windkessel effect help mitigate the risks associated with cerebral aneurysms?

    <p>By maintaining constant pressure in the vessel</p> Signup and view all the answers

    What are characteristic symptoms of SAH?

    <p>Worst headache of their life with s/s of increased ICP</p> Signup and view all the answers

    Which of the following are considered risk factors for subarachnoid hemorrhage?

    <p>All of the above</p> Signup and view all the answers

    What happens in the vascular system when there is a loss of arterial elasticity due to conditions like aneurysms?

    <p>Pulsatile pressure cannot be properly absorbed</p> Signup and view all the answers

    What condition can increase arterial oscillations, potentially affecting aneurysms?

    <p>All of the above</p> Signup and view all the answers

    Which statement accurately describes the influence of the aneurysmal pouch in larger cerebral aneurysms?

    <p>It serves as a reservoir during systole and releases blood in diastole.</p> Signup and view all the answers

    What is the highest risk period for rebleeding after a SAH?

    <p>First 24 hours</p> Signup and view all the answers

    How does Nimodipine function in the treatment of SAH?

    <p>It is a lipophilic vasodilator that crosses the blood-brain barrier to prevent vasospasm</p> Signup and view all the answers

    What type of intervention is used to prevent rebleeding and often requires critical timing 24-48 hr after SAH?

    <p>Timely surgical intervention</p> Signup and view all the answers

    In the context of treating vasospasm after SAH, what is Triple H therapy?

    <p>Hypertension, hypervolemia, hemodilution</p> Signup and view all the answers

    What is the goal of aneurysm coiling and clipping during surgical intervention?

    <p>Close off the aneurysm from the circulation</p> Signup and view all the answers

    What is a potential complication of using flow diverting stents for unruptured aneurysms?

    <p>Thrombosis and stenosis</p> Signup and view all the answers

    Symptoms of aneurysm rupture during induction may include which of the following?

    <p>Increased BP with or without bradycardia</p> Signup and view all the answers

    What is the target mean arterial pressure (MAP) to be achieved after aneurysm rupture for permissive hypotension?

    <p>40-50 mmHg</p> Signup and view all the answers

    Which medications must be readily available in the operating room for managing increased intracranial pressure? select all that apply

    <p>Dilantin 1 g</p> Signup and view all the answers

    What is the purpose of using a temporary proximal occlusion clamp during surgery?

    <p>To reduce the risks of aneurysm rupture</p> Signup and view all the answers

    What are the signs of venous air embolism (VAE) that you should monitor for during surgery?

    <p>Tachycardia and hypotension</p> Signup and view all the answers

    What initial actions should be taken simultaneously when a venous air embolism (VAE) occurs?

    <p>Alert the surgeon to flood the field and aspirate blood/air from the central venous pressure line</p> Signup and view all the answers

    What positioning consideration is important when preparing for an aneurysm clipping surgery?

    <p>Head turned left or right 90 degrees</p> Signup and view all the answers

    What should the intraoperative monitoring for paradoxic air embolism (PAE) include? select 2

    <p>Transesophageal echocardiography (TEE)</p> Signup and view all the answers

    How does the Windkessel effect contribute to maintaining blood flow in smaller vessels?

    <p>By passively contracting after vessel expansion, maintaining relatively constant pressure.</p> Signup and view all the answers

    What happens if a vessel wall is weakened, such as in an aneurysm, in relation to the Windkessel effect?

    <p>Pulsatile pressure is not properly absorbed, causing excessive stress on the vessel.</p> Signup and view all the answers

    Why does the weakening of a vessel wall increase the risk of aneurysm rupture?

    <p>Excessive stress from pulsatile forces contributes to aneurysm growth and potential rupture.</p> Signup and view all the answers

    What is arterial elasticity, also called arterial compliance?

    <p>The ability of arteries to expand and contract with each heartbeat</p> Signup and view all the answers

    In larger aneurysms, the pouch serves as a ___ in systole and is released in diastole.

    <p>reservoir</p> Signup and view all the answers

    What is the incidence of spontaneous subarachnoid hemorrhage (SAH) per 100,000 people?

    <p>10 in 100k</p> Signup and view all the answers

    What is the primary cause of subarachnoid hemorrhage (SAH)?

    <p>Arterial bleeding from a ruptured cerebral aneurysm</p> Signup and view all the answers

    What happens in the body when a subarachnoid hemorrhage (SAH) occurs? (Select all that apply)

    <p>Mass effect due to hemorrhage</p> Signup and view all the answers

    Which of the following cellular changes are associated with subarachnoid hemorrhage (SAH)?

    <p>Increased inflammatory mediators</p> Signup and view all the answers

    Which of the following genetic risk factors is associated with subarachnoid hemorrhage (SAH)? select 3

    <p>Marfan syndrome</p> Signup and view all the answers

    Which electrolyte abnormalities are associated with subarachnoid hemorrhage (SAH)?

    <p>Hyponatremia due to cerebral salt wasting syndrome</p> Signup and view all the answers

    When do peak systemic symptoms occur in subarachnoid hemorrhage (SAH)?

    <p>2-3 days</p> Signup and view all the answers

    What is the cause of systemic complications in subarachnoid hemorrhage (SAH)?

    <p>Injury to the posterior hypothalamus resulting in norepinephrine (NE) release</p> Signup and view all the answers

    Which systemic complications from subarachnoid hemorrhage (SAH) are associated with sepsis? select 2

    <p>Renal dysfunction</p> Signup and view all the answers

    Match the following aneurysm types with their descriptions:

    <p>Saccular = &lt; 2.5 cm Giant = &gt; 2.5 cm Fusiform = Severe atherosclerotic or childhood degenerative processes Dissecting = Tear between endothelium and media of vessel</p> Signup and view all the answers

    What is the cause of mycotic aneurysms?

    <p>Infection</p> Signup and view all the answers

    What are Dolichoectatic aneurysms characterized by?

    <p>Chronic and progressive causing brainstem ischemia</p> Signup and view all the answers

    Where are aneurysms typically located in females?

    <p>Internal carotid artery</p> Signup and view all the answers

    Where are aneurysms typically located in males?

    <p>Anterior communicating artery</p> Signup and view all the answers

    Where are aneurysms typically located in children?

    <p>Internal carotid bifurcation</p> Signup and view all the answers

    What are higher scores in cerebral aneurysm grading associated with?

    <p>Worse symptoms and outcomes</p> Signup and view all the answers

    How does the Hunt and Hess grading scale classify aneurysms based on clinical signs and symptoms? select all that apply

    <p>Grade I: Asymptomatic</p> Signup and view all the answers

    How does the World Federation of Neurological Surgeons scale classify aneurysms?

    <p>By Glasgow Coma Scale (GCS)</p> Signup and view all the answers

    How does the risk of rebleeding change over time in subarachnoid hemorrhage (SAH)?

    <p>Decreases by 1-2% for 13 days</p> Signup and view all the answers

    What is the primary cause of vasospasm following a subarachnoid hemorrhage (SAH)?

    <p>Reactive narrowing of the larger vessels in the SA space surrounding the clot after SAH</p> Signup and view all the answers

    When does the risk of vasospasm occur and peak after a subarachnoid hemorrhage?

    <p>Onset on the 3rd day with peak at 6-8 days</p> Signup and view all the answers

    When does the risk of vasospasm typically resolve after a subarachnoid hemorrhage (SAH)?

    <p>3 weeks post-SAH</p> Signup and view all the answers

    What percentage of patients are at risk of vasospasm following a subarachnoid hemorrhage?

    <p>50%</p> Signup and view all the answers

    What is the result of impaired autoregulation?

    <p>Oxidative stress and release of free radicals</p> Signup and view all the answers

    What is unique about CO2 reactivity in patients with subarachnoid hemorrhage (SAH)?

    <p>Patients exhibit normal CO2 reactivity</p> Signup and view all the answers

    Why does hydrocephalus occur in subarachnoid hemorrhage (SAH)?

    <p>Due to disruption of production and drainage of cerebrospinal fluid (CSF)</p> Signup and view all the answers

    What are the surgical options for managing rebleeding? (Select all that apply)

    <p>Embolization via coils or clipping</p> Signup and view all the answers

    What are the treatment options for vasospasm? (Select all that apply)

    <p>Triple H therapy</p> Signup and view all the answers

    When should nimodipine be started after a subarachnoid hemorrhage (SAH)?

    <p>Within 96 hours</p> Signup and view all the answers

    What is the mechanism of action of nimodipine?

    <p>It preferentially blocks calcium channels in cerebral blood vessels due to its ability to cross the BBB</p> Signup and view all the answers

    What is a contraindication to aneurysm coiling?

    <p>Smaller aneurysms</p> Signup and view all the answers

    When should aneurysm clipping occur?

    <p>Within the first 24-48 hours</p> Signup and view all the answers

    What approach is commonly used in aneurysm coiling?

    <p>Femoral approach under fluoroscopy</p> Signup and view all the answers

    How is the aneurysm accessed for clip ligation?

    <p>Through a craniotomy</p> Signup and view all the answers

    How do flow-diverting stents treat aneurysms?

    <p>By bypassing flow around the aneurysm via a stent.</p> Signup and view all the answers

    What is unique about flow diverting stents in the treatment of aneurysms?

    <p>They can only be used in unruptured aneurysms.</p> Signup and view all the answers

    What should be part of your setup for general anesthesia in treating an aneurysm?

    <p>Blood products</p> Signup and view all the answers

    When using permissive hypotension to treat a ruptured aneurysm, when should the blood pressure goal return to normal?

    <p>After clipping/ligation of the aneurysm</p> Signup and view all the answers

    What should blood loss be replaced with in the event of an aneurysmal rupture?

    <p>Blood products</p> Signup and view all the answers

    What is the purpose of a temporary proximal occlusion clamp?

    <p>To reduce the risk of intraoperative aneurysmal rupture by causing local hypotension around the aneurysm</p> Signup and view all the answers

    How long does the temporary proximal occlusion clamp provide its effects?

    <p>20 minutes</p> Signup and view all the answers

    What is the purpose of a lumbar drain?

    <p>To reduce ICP by draining cerebrospinal fluid (CSF)</p> Signup and view all the answers

    How are giant aneurysms managed differently from other aneurysms? Select the correct options.

    <p>Proximal balloon occlusion - balloon is temporarily inflated near aneurysm to block blood flow and reducing pressure</p> Signup and view all the answers

    What are characteristics of brain tumors in adults?

    <p>They are typically found in supratentorial spaces and will have symptoms of increased ICP</p> Signup and view all the answers

    Where are brain tumors typically found in children?

    <p>Infratentorial spaces</p> Signup and view all the answers

    What is the most common cause of delayed awakening in the sitting position?

    <p>Tension Pneumocephalus</p> Signup and view all the answers

    What is tension pneumocephalus?

    <p>A buildup of air within the skull causing increased intracranial pressure</p> Signup and view all the answers

    Intraoperative management for brain tumors is similar to that of intracranial aneurysms

    <p>True</p> Signup and view all the answers

    Flat ToF desired in the anesthetic care of aneurysms and brain tumors

    <p>True</p> Signup and view all the answers

    Where is the posterior fossa located?

    <p>Between the foramen magnum and the tentorium cerebelli</p> Signup and view all the answers

    What does the posterior fossa contain?

    <p>Brainstem, cerebellum, and cranial nerves</p> Signup and view all the answers

    Why is hydrocephalus associated with posterior fossa tumors?

    <p>Due to obstruction of CSF into the 4th ventricle</p> Signup and view all the answers

    What symptoms are associated with posterior fossa tumors? (Select all that apply)

    <p>Dysphagia</p> Signup and view all the answers

    Which nerves are most at risk of compression from posterior fossa tumors?

    <p>Cranial nerves</p> Signup and view all the answers

    How does the management of posterior fossa tumors differ from tumors located in the supratentorial region?

    <p>Requires specialized surgical approaches like midline, paramedian, or retromastoid incisions to access the tumor while minimizing brainstem manipulation.</p> Signup and view all the answers

    What type of surgery has a high incidence of venous air embolism (VAE)?

    <p>Posterior fossa surgery in the sitting position (40-45% risk)</p> Signup and view all the answers

    Why do we use precordial Dopplers in the sitting position?

    <p>To identify air entrainment which occurs very slowly</p> Signup and view all the answers

    Why does decreased ETCO2 but increased PaCO2 occur in Venous Air Embolism (VAE)?

    <p>Increased dead space ventilation</p> Signup and view all the answers

    What occurs to the ETCO2 and PaCO2 in VAE? (Select the correct answer)

    <p>ETCO2 decreases while PaCO2 increases</p> Signup and view all the answers

    What gas can appear in exhaled gas on the gas analyzer in the case of Venous Air Embolism (VAE)?

    <p>Nitrogen</p> Signup and view all the answers

    What is the effect on the heart in venous air embolism (VAE)?

    <p>Right heart pressures increase</p> Signup and view all the answers

    What is the result on the heart of untreated VAE? (Select the correct answer)

    <p>Cardiac output decreases due to right heart failure and/or reduced left ventricular filling</p> Signup and view all the answers

    How can we prevent venous air embolism (VAE) using mechanical ventilation? select 2

    <p>Deliberate hypoventilation</p> Signup and view all the answers

    What is a consequence of increased PEEP in mechanical ventilation?

    <p>Increased intracranial pressure (ICP) due to decreased cerebral venous flow to the heart</p> Signup and view all the answers

    What are the risk factors for developing a paradoxical artery embolism (PAE)?

    <p>Presence of a patent foramen ovale (PFO)</p> Signup and view all the answers

    What causes a paradoxical air embolism (PAE)?

    <p>Air in the arterial circulation</p> Signup and view all the answers

    what are the steps to treatment of VAE?

    <ol> <li>Alert surgeon to flood the field</li> </ol> Signup and view all the answers

    Study Notes

    Brain Tumors & Aneurysms

    • Windkessel Effect: A phenomenon where large, elastic arteries dampen pulsatile blood flow from the heart, allowing smoother flow in smaller vessels. Passive vessel wall contraction helps maintain constant pressure. Weakened vessel walls (like in aneurysms) can't absorb pulsatile pressure, contributing to growth and rupture risk.

    • Arterial Elasticity (Compliance): The ability of arteries to expand and contract with each heartbeat. Loss of elasticity in cerebral arteries contributes to aneurysm formation.

    • Windkessel Effect in Cerebral Aneurysms: The effect helps prevent hemorrhage by keeping pressure inside the vessels constant, acting as a reservoir in systole and releasing blood in diastole.

    • Conditions Increasing Arterial Oscillations: include dehydration, hemorrhage, and upright posture.

    Subarachnoid Hemorrhage (SAH)

    • Definition: Arterial bleeding from the space between the arachnoid and pia mater of the brain, usually caused by a ruptured cerebral aneurysm.

    • Incidence: Information on specific incidence rates isn't included here.

    • Presentation: The worst headache of one's life, accompanied by signs and symptoms of increased intracranial pressure (ICP).

    Risk Factors for SAH

    • Smoking, HTN, birth control pills, Marfan syndrome, and primordial/Ehlers Danlos are included.

    Complications of SAH

    • Rebleeding: Highest risk within the first 24 hours, declining to 1-2% per day after that.
    • Vasospasm: Reactive narrowing of larger vessels, typically peaking 6-8 days after the event, potentially lasting 3 weeks.
    • Other: Cardiogenic/neurogenic pulmonary edema, hepatic dysfunction, ARDS, pneumonia, sepsis, renal issues, and thrombocytopenia (low platelets) can occur.
    • Impaired autoregulation: Leads to oxidative stress & release of free radicals.
    • Intracranial pressure (ICP) increase: A consequence of blood in the subarachnoid space.

    Surgical Management

    • Embolization: Closing off vessels via coils or clipping.
    • Clipping/Ligation: Surgical ligation (tying off) and clipping of aneurysms, typically within 24-48 hours. Coiling is an alternative technique performed under fluoroscopy. Femoral artery access can be utilized.

    Brain Tumors

    • Location (Adults): Primarily supratentorial spaces (above the tentorium cerebelli).

    • Location (Children): Primarily infratentorial spaces (below the tentorium cerebelli).

    • Symptoms: Associated with increased intracranial pressure (ICP).

    • Positioning: Head of the bed (HOB) is turned to the left or right 90 degrees.

    • Intraoperative Management: Similar to intracranial aneurysms, with concerns for tension pneumocephalus. Temporary proximal occlusion clamps may be used, reducing aneurysm risk. Minimally invasive techniques (coiling, etc.) are used in some cases.

    Posterior Fossa Tumors

    • Location: Located in the posterior fossa, between the foramen magnum and tentorium cerebelli.
    • Management: Requires specialized surgical approaches like midline, paramedian, or retromastoid incisions to access the tumor. Risk factors are significant and include 40-45% risk of posterior fossa surgery in the sitting position from cervical laminectomy. Air is slowly entrained with sitting positions.
    • Symptoms: Hydrocephalus, laryngeal dysfunction, and irregular breathing are common.

    Paradoxic Air Embolism (PAE)

    • Definition: Air enters the arterial circulation.
    • Risk Factors: Patent foramen ovale (PFO), and sitting position are common risk concerns for PAE.
    • Management: Immediate action is needed, including: alert the surgeon, flood the surgical site with fluid via CVP, and remove any air from the venous system (CVP) using aspiration and positive pressure. FiO2 is often increased to 100%, with N20 discontinued.

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    2024 NUR 730 Study Guide: Brain Trauma, Tumors, & Aneurysms PDF

    Description

    Explore the critical concepts surrounding brain tumors and aneurysms. This quiz delves into the Windkessel effect, arterial elasticity, and the implications of these phenomena in cerebral aneurysms. Understand how these factors contribute to conditions such as subarachnoid hemorrhage and the risks associated with arterial health.

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