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Neurology > 10th Jan 24 > Flashcards

10th Jan 24 Flashcards

1
Q

Amaurosis fugax management

A

🤡Do carotid duplex USG

Transient monocular <10 min vision loss

Most common etoliogy is retinal ischemia due to atherosclerotic emboli from I/L carotid.

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2
Q

MS vs stroke

A

MS increases risk of stroke
Features that say stroke

💩 deficits that localize to arterial distribution

💩 hyperacute onset (mins)

💩 prominent cortical signs ( visaual , aphasia , neglect, sensory VANS )

💩 headache , meningeal signs , signs of Inc ICP

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3
Q

when do we reassure in MS

A

When features suggest pseudorelapse
(Worsening neurological S/S lasting less than 24hrs) often with
Heat / infection ppt MS.

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4
Q

Ttt of amaurosis fugax

A

Smoking cessation
Aspirin
Surgery for candidates of endarterectomy

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5
Q

Subclavian steal C/P

A

Left subclavian artery affected more due to due sharper curvature and turbulent blood flow ➡️ atherosclerosis

Dizziness and spinning sensation while doing arm work

Heaviness and fatigue of Left arm with exertion

Low Bp on the affected arm

Exercising the affected arm causes arterial vasodilation and further lowering Bp

Systolic bruit in supraclavicular fossa on affected side

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6
Q

Management of subclavian steal

A

Dx. Doppler USG
MRA

Ttt. Statins
Smoking cessation
Stent

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7
Q

Brain herniation management

A

Midline shift on CT or decerebrate posturing indicating hemorrhage expansion ➡️ do rapid ABC assessement
➡️ intubate and mechanically ventilate

Remaining management like hemmorrhagic stroke

Brain herniation leads to rapid Resp failure by

▶️ inability to protect airway due to LOC at GCS<8

▶️ dysfunction of CN causes loss of airway protective reflexes (cough gag)

▶️ dec ventilatory drive due to compression of Resp centers -hypercarbia , hypoxia

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8
Q

Vascular dementia dx

A

Strategic infaction ; (One big infarct) Abrupt decline in function
With changes acc to area involved e.g
Frontal lobe infarct ➡️memory , executive dysfunction , behavior and personality.

Multiple infarctions : No h/o overt stroke but stepwise decline in function

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9
Q

Warfarin ass intracerebral hemmorrhage
Ttt

A

Prothrombin complex concentrate
(2,7,9,10)

If PCC not available give FFPs

I/v vitamin K takes 12-24hrs to be effective.

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10
Q

Management of carotid atherosclerosis

A

Intense medical therapy;
Aspirin (Antiplatelet therapy is better than anticoagulation )
Statin
BP control

Do endarterectomy for symptomatic pts with 70-99% stenosis

<50% stenosis no benefit with CEA

50-69% stenosis ;
Men do CEA
Females medical tt

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11
Q

Hemineglect mech

A

Non dominant (right) parietal lobe
Unawareness of one side
Affects sensory motor and conceptual functioning

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12
Q

TIA def and ttt

A

Transient symptoms that last < 24hrs

Ttt:
Aspirin
Statin

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13
Q

Giant cell arteritis ocular manifestation ?

A

Anterior Ischemic Optic Neuropathy AION

Partial or complete occlusion of posterior ciliary artery ( pale edematous disc with blurred margins)

Ttt;
High dose IV steroids 500-1000mg daily for 3days
Followed by oral therapy and taper over several months

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14
Q

Indications for thrombolysis in ischemic stroke

A

Ischemic stroke with disabling neurodeficits
Symptom onset <3-4.5 before ttt initiation

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15
Q

CI of thrombolysis in ischemic stroke

A

Intracranial hemmorrhge
Ischemic stroke in past 3 Mo
BP> 185/110
Anticoagulant use INR > 1.7 inc aptt
Glucose < 60
Platelets < 100,000

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16
Q

Embolic stroke

A

▶️S/s max at onset
▶️Multiple vascular territories involved
▶️Presence if heart dx Afib / left atrial enlargement that predispose to intracardiac thrombus formation

17
Q

Middle cerebral artery stroke

A

Aphasia (word finding difficulty)
Weakness
Frontal eye field damage
Visual field defect (homonymous hemianopia )

18
Q

Cerebellar hemmorhage

A

➡️Headache
➡️N/V
➡️I/L ataxia dysarthria vertigo ➡️nystagmus
➡️Cranial nerve involvement
➡️Obstructive hydrocephalus (tumor compresses 4th ventricle)

19
Q

Management of cerebellar hemmorhage

A

ABC
Reversal of anticoagulation
manage BP
ICP management (mannitol, elevate head of bed)
Surgical decompression

    Hemmorhage > 3cm 
    Neurologic deterioration( lethargy, obtundation, coma) 
    Brainstem compression , obstructive hydrocephalus
20
Q

Alzeimer patient with hemorrhage CT

A

Cerebral amyloid angiopathy (most common cause of lobar intracranial hemorrhage )

Commonly parietal and occipital lobes

21
Q

Crescent shape hyperdensity that crosses suture lines

A

Subdural hematoma
Rupture of bridging veins
Trauma
Old age
Chronic alcoholism
Anticoagulant use

22
Q

Biconvex hemmorrhage that doesnt cross suture line

A

Epidural hematoma

              -Meningeal artery tear due to head injury

C/F:
Altered consciousness
Headache
N/V
Focal neurological deficits

23
Q

Paeds Acute Ischemic stroke C/P

A

Non localising S/S

Headache 
 Seizures 
 Lethargy AMS
24
Q

Acute ischemic stroke in childrn < 6yrs
Dx

A

MRI with MRA
(MRA is imp as paeds stroke mimics migraine and todds paralysis)

25
Q

Hemorrhagic paeds stroke finding on CT

A

Hyperdense fluid collection with irregular margins on CT

26
Q

Cause of hemm stroke in children

A

AVM
Hemophilia / SCD

27
Q

Hemm stroke in childrn S/S

A

Headache
NV
Seizures
Focal deficits
AMS (increasing ICP from hemorrhage)

28
Q

Ttt of hemorrhagic stroke in babies

A

Reduce ICP (head elevation)
Surgical decompression
Supportive: antiepileptics

29
Q

Pt with normal sensory exam but motor symptoms weakness facial asymmetry limp and unable to grip
Non contrast CT normal

A

Lacunar stroke at internal capsule
(Pure motor stroke)
Spares upper face

30
Q

Lacunar stroke RF

A

HTN

31
Q

Mech of lacunar stroke

A

Microatheroma
Lipohylinosis

32
Q

Prosthetic valve thrombosis embolization C/P

A

Thromboembolism
Embolus, stroke ,TIA , bowel ischemia , limb ischemia
Rt sided Prosthetic valve ➡️ pulm embolism

Valve dysfunction;
HF due to valve Stenosis,
regurg (new murmur)

33
Q

Prosthetic valve thrombosis embolus dx

A

TTE

Prevention;

Mechanical prosthetic valve ; anticoagulation

Bioprosthetic valves ;
Only aspirin

Neurology (19 decks)

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