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Questions and Answers
What condition is characterized by large amounts of dilute urine and increased thirst?
Diabetes insipidus
Which factors influence ICP (intracranial pressure)?
The oculomotor nerve controls all extraocular muscles.
False
Trigeminal nerve has three main divisions: V1 is the ophtalmic nerve, V2 is the maxillary nerve, and V3 is the ______ nerve.
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Which division of the fifth nerve is responsible for the sensory component of the blink reflex?
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Which muscles are innervated by the motor division of the fifth nerve?
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Which division of the fifth nerve involves testing facial sensation?
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The motor division of the fifth nerve involves muscles of chewing.
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The ______ jerk reflex is tested by tapping lightly with a tendon hammer on the tip of the _.
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Match the following cranial nerves with their functions:
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What is the total combination height in the morning compared to the night before?
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What causes the spine to become more rigid leading to bone and calcification development?
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MRI can show features like reduced canal diameter and nerve root compression.
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What rare cause of torticollis involves subluxation of atlanto-axial joint?
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Match the imaging modality with its application:
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Study Notes
Neurocritical Care
- Modern Neuro ICU requirements:
- Close neuro observations (GCS)
- New onset neurological fallout
- High-risk surgery
- Diabetes insipidus (condition characterized by large amounts of dilute urine and increased thirst)
- Low level of consciousness
- Severe TBI or cerebral infections
- Tumors
- General requirements:
- Airway problems
- Ventilatory/oxygenation problems
- Renal problems
- Metabolic/hormonal problems
ICU Care
- Reasons to go to ICU:
- Airway protection
- Oxygenation
- Perfusion of brain and kidneys
- ICP control
- Neuro observation
- Risk of sudden deterioration
- Subclinical seizures
- ICU management:
- BP control
- ICP monitoring
- PaCO2 and PbtO2 monitoring
- Temp and sodium level monitoring
- Sedation and positioning
- Spine management
Factors Influencing ICP
- CO2
- O2
- Temp
- Venous outflow
- CPP (cerebral perfusion pressure) = MAP (mean arterial pressure)-ICP
- Position in bed
- State of wakefulness
- External compressing dressings and cervical collar
Role of Physio in NICU
- ICP Mx algorithm
- Neuro observation (report any changes)
- Bronchial toilet (suctioning, clearing secretions)
- DVT risk management (mechanical prophylaxis only, no anticoagulants)
- Cervical spine precautions (high incidence of associated spinal injury with severe TBI)
When to Mobilize?
- Spinal injuries
- Spinal instrumentation
- TBI (beware of temp., hypothermia, etc.)
- Ventilated patients
Pain Management
- Avoid NSAIDs
- Opioid-based analgesia in TBI
Long-term Outcomes
- Home vs institution (>60% survivors go back home)
- Schooling
- Sports and psychological outcomes
Cranial Nerves
- 12 cranial nerves in total
- Each cranial nerve is either sensory, motor, or both
- Transmit 7 types of information: SSS, SVS, SVM, and 4 others
Olfactory Nerve (CN I)
- Origin: cerebrum
- Function: transmits sense of smell from nasal cavity
- Pathology: anosmia (loss of sense of smell), bilateral or unilateral
Optic Nerve (CN II)
- Origin: retina
- Function: transmits visual signals to brain
- Pathology: vision loss in affected eye, papilloedema, optic atrophy
Oculomotor Nerve (CN III)
- Origin: midbrain
- Function: innervates extraocular muscles, controls pupil constriction and accommodation
- Pathology: central or peripheral causes (vascular lesions, tumors, diabetes, etc.)
Trochlear Nerve (CN IV)
- Origin: midbrain
- Function: innervates superior oblique muscle
- Pathology: CN IV Trochlear nerve palsy (diplopia, head tilt/turn)
Trigeminal Nerve (CN V)
- Origin: pons
- Function: receives sensation from face, innervates muscles of mastication
- Pathology: trigeminal nerve palsy (central or peripheral causes)
Abducens Nerve (CN VI)
- Origin: pons
- Function: innervates lateral rectus muscle
- Pathology: abducens nerve palsy (bilateral or unilateral, central or peripheral causes)
Facial Nerve (CN VII)
- Origin: pons
- Function: motor innervation of facial expression, stapedius muscle, secretory function of salivary glands
- Pathology: facial nerve palsy (upper motor neuron lesion, lower motor neuron lesion)
Acoustic Nerve (CN VIII)
- Origin: pons
- Function: transmits sound and balance information
- Pathology: hearing loss (conductive or nerve deafness), vertigo, BPPV
Glossopharyngeal Nerve (CN IX)
- Origin: medulla oblongata
- Function: sensory (taste to posterior 1/3 of tongue), motor (stylopharyngeus muscle), parasympathetic (otic ganglion)
- Pathology: dysphagia, swallowing difficulties### Parasympathetic Nervous System
- Reduces resting heart rate through SA and AV nodes
- Stimulates smooth muscle contraction and glandular secretions in the esophagus, stomach, and most of the intestinal tract through the GIT
Cranial Nerve IX (Glossopharyngeal Nerve)
- Has motor, sensory, and autonomic functions
- Originates from the medulla oblongata and exits the skull through the jugular foramen
- Receives sensory fibers from the nasopharynx, pharynx, middle and inner ear, and posterior third of the tongue (including taste fibers)
- Carries secretory fibers to the parotid gland
- Pathology:
- Palate: nasal speech
- Pharynx: dysphagia
- Larynx: voice disturbances
Cranial Nerve X (Vagus Nerve)
- Has motor, sensory, and autonomic functions
- Originates from the medulla oblongata and exits the skull through the jugular foramen
- Receives sensory fibers from the pharynx and larynx
- Innervates muscles of the pharynx, larynx, and palate
- Pathology:
- Palate: nasal speech
- Pharynx: dysphagia
- Larynx: voice disturbances
Cranial Nerve XI (Accessory Nerve)
- Has a purely somatic motor function
- Innervates the sternocleidomastoid and trapezius muscles
- Originates from the upper spinal cord (C1-C5/C6) and medulla oblongata
- Central portion arises in the medulla, close to the nuclei of CNIX, X, and XII
- Leaves the skull with CNIX and CNX through the jugular foramen
- Spinal division innervates the trapezius and sternocleidomastoid muscles
Cranial Nerve XII (Hypoglossal Nerve)
- Has a motor function
- Originates from the hypoglossal nucleus in the medulla oblongata
- Exits the cranium through the hypoglossal canal
- Innervates the vast majority of the muscles of the tongue
- Pathology:
- Tongue deviation towards the weaker side in unilateral lower motor neuron lesions
- No deviation in unilateral upper motor neuron lesions
Spinal Neurosurgery
- Discs shrink over the day due to dehydration, but recover at night
- Physical peak of the body is at age 21, after which muscles, skin, brain, and spinal discs begin to dehydrate slowly
- Total combination height in the morning is 1-1.5cm higher than at night
- Disc compression on the spinal cord can cause numbness, tingling, and pain
- Prone to fractures, complications during and after surgery
- Degenerative process affects vertebral discs and facet joints with age
- Can lead to osteoarthritis of the spine
- Diagnosis:
- Imaging: X-ray, MRI, CT scans
- Clinical: axial back pain, worse in certain postures, mechanical pain
- Management:
- Conservative: pain management, physiotherapy, postural training
- Medical: analgesia, muscle relaxants
- Surgical: interbody fusion, rhizolysis, TLIF, XLIF, PLIF, posterior fusion, disc replacement, ACDF
Spinal Cord Compression
- Causes:
- Compression of the cord
- Neurological diseases: myelitis, demyelination, MS
- Spinal cord tumors
- Diagnosis:
- Clinically: proximal weakness, UMN weakness
- Imaging: MRI, CT scans, X-rays
- Management:
- Conservative
- Surgical: decompression, fusion
Cauda Equina Syndrome
- Bilateral compression at L5/S1 with saddle anesthesia
- Emergency: can result in incontinence and impotence if not addressed within 3 days
- Causes:
- Compression of the cord
- Neurological diseases: myelitis, demyelination, MS
- Spinal cord tumors
- Diagnosis:
- Clinically: proximal weakness, UMN weakness
- Imaging: MRI, CT scans, X-rays
- Management:
- Surgical: decompression, fusion
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Description
This quiz covers neurosurgical conditions such as stroke and diabetes insipidus, as well as the criteria for ICU admission in a modern neuro ICU. Topics include Glasgow Coma Scale (GCS) and post-operative care.
