10th Jan 24 Flashcards
Amaurosis fugax management
🤡Do carotid duplex USG
Transient monocular <10 min vision loss
Most common etoliogy is retinal ischemia due to atherosclerotic emboli from I/L carotid.
MS vs stroke
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
when do we reassure in MS
When features suggest pseudorelapse
(Worsening neurological S/S lasting less than 24hrs) often with
Heat / infection ppt MS.
Ttt of amaurosis fugax
Smoking cessation
Aspirin
Surgery for candidates of endarterectomy
Subclavian steal C/P
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
Management of subclavian steal
Dx. Doppler USG
MRA
Ttt. Statins
Smoking cessation
Stent
Brain herniation management
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
Vascular dementia dx
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
Warfarin ass intracerebral hemmorrhage
Ttt
Prothrombin complex concentrate
(2,7,9,10)
If PCC not available give FFPs
I/v vitamin K takes 12-24hrs to be effective.
Management of carotid atherosclerosis
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
Hemineglect mech
Non dominant (right) parietal lobe
Unawareness of one side
Affects sensory motor and conceptual functioning
TIA def and ttt
Transient symptoms that last < 24hrs
Ttt:
Aspirin
Statin
Giant cell arteritis ocular manifestation ?
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
Indications for thrombolysis in ischemic stroke
Ischemic stroke with disabling neurodeficits
Symptom onset <3-4.5 before ttt initiation
CI of thrombolysis in ischemic stroke
Intracranial hemmorrhge
Ischemic stroke in past 3 Mo
BP> 185/110
Anticoagulant use INR > 1.7 inc aptt
Glucose < 60
Platelets < 100,000
Embolic stroke
▶️S/s max at onset
▶️Multiple vascular territories involved
▶️Presence if heart dx Afib / left atrial enlargement that predispose to intracardiac thrombus formation
Middle cerebral artery stroke
Aphasia (word finding difficulty)
Weakness
Frontal eye field damage
Visual field defect (homonymous hemianopia )
Cerebellar hemmorhage
➡️Headache
➡️N/V
➡️I/L ataxia dysarthria vertigo ➡️nystagmus
➡️Cranial nerve involvement
➡️Obstructive hydrocephalus (tumor compresses 4th ventricle)
Management of cerebellar hemmorhage
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
Alzeimer patient with hemorrhage CT
Cerebral amyloid angiopathy (most common cause of lobar intracranial hemorrhage )
Commonly parietal and occipital lobes
Crescent shape hyperdensity that crosses suture lines
Subdural hematoma
Rupture of bridging veins
Trauma
Old age
Chronic alcoholism
Anticoagulant use
Biconvex hemmorrhage that doesnt cross suture line
Epidural hematoma
-Meningeal artery tear due to head injury
C/F:
Altered consciousness
Headache
N/V
Focal neurological deficits
Paeds Acute Ischemic stroke C/P
Non localising S/S
Headache Seizures Lethargy AMS
Acute ischemic stroke in childrn < 6yrs
Dx
MRI with MRA
(MRA is imp as paeds stroke mimics migraine and todds paralysis)
