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Neurology > 11 Jan 24 > Flashcards

11 Jan 24 Flashcards

1
Q

Lateral medullary syndrome lesions
And tracts with s/S

A

Vestibular nucleus - diplopia dizziness
Trigeminal nucleus - i/L pain sensation of face

Inf Cerebellar peduncle - ataxia
Nucleus ambiguous- dysphonia, dysphagia hoarseness loss of gag.

Lateral ST tract. - C/L pain and temp
Sympathetic fibres- Horners syndrome

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2
Q

Arterial supply of lateral medulla

A

PICA

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3
Q

Common causes of lateral medullary stroke ?

A

Posterior circulation stroke ;

Vertebral artery dissection
Spontaneous
Trauma (sports , neck manipulation)

Atherosclerosis
Embolism

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4
Q

C/F of retinitis pigmentosa

A

Night blindness
Progressive vision loss esp in midperiphery (highest density of rods)
Dec visual acuity (late)

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5
Q

Retinitis pigmentosa fundoscopy ?

A

Retinal vessel attenuation
Optic disc pallor
Abnormal retinal pig

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6
Q

RF for TIA and ischemic stroke

A

HTN Most imp
Smoking 2nd
DM
Hypercholesterolemia
Alcohol /lifestyle/ obesity(small effect)

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7
Q

Pt with central vertigo evaluate for cerebellar hemm/stroke if;

A

Prominent stroke features ;

      Hyperlipidemia 
      HTN
      DM

New onset headache
Neurologic S/S. Weakness/numbness/dysarthria

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8
Q

Central Vertigo ?

A

▶️nystagmus has Any trajectory
▶️Not inhibited by fixation of gaze
▶️Not fatiguable (>1min duration)
▶️No latency period

Vs peripheral
Never purely vertical nystagmus
Inhibted by fixed gaze
Fatiguable <1min
Latency period (2-40sec)

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9
Q

Stroke instant management

A

Do ABCs

Non contrast CT (rapidly diff between ischemic and hemm stroke)

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10
Q

Non contrast CT stroke

A

Hemorrhagic: Hyperdense white area in brain parenchyma
Ischemic :
CT normal in early<6hr ischemic str
Loss of grey white matter diff
Hypoattenuation of deep nuclei

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11
Q

Intracerebral hemorrhage S/S

A

Inc ICP
Headache
N/V
AMS
Focal deficits

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12
Q

Time course of strokes by etiology

A

Embolic; Max at onset
Thrombotic: Fluctuating
Hemm. ; Progressively worsening

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13
Q

Hemorrhagic stroke mech

A

Generally involve small penetrating arteries resp for lacunar infarcts but result in rupture of charcot bouchard aneurysms

Common location
BG (putamen)
Cerebellum
Thakamus
Pons

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14
Q

Putaminal hemorrhage C/P

A

S/S due to involvement of adj internal capsule (compression from hemorrhage)
C/L hemiparesis
Hemianesthesia

             👹Corticospinal and somatosensory fibers in posterior limb

Conjugate gaze deviation toward side of lesion (frontal eye field fibres pass thru anterior limb of capsule )
(See conjugate gaze palsy exhibit from INO of MS)

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15
Q

Broca aphasia C/P and supply

A

Slow speech poor pronounciation cannot repeat (dysarthria and expressive aphasia)

Supply MCA ➡️ dominant frontal lobe

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16
Q

Wernicke aphasia

A

Non sensical speech with lack of comprehension

Supplye dominat tempora cortex

17
Q

Pt with ischemic stroke comes 7 hours later ,,,,,?

A

Do CTA head n neck

If large vessel occlusion ➡️mech thrombectony

If LVO absent ➡️ standard ttt antiplatelets etc

18
Q

Indications for mechanical thrombectomy criteria;

A

➡️. Diabling neurological S/s
➡️. Symptom onset < 24hrs
➡️. CT scan showing no evidence of hemmorhage
➡️Large vessel occlusion on CTA

19
Q

BP control in ischemic stroke

A

THROMBOTICS INDICATED
Control BP < 185/110 prior to thrombolytics
After thrombolytic maintain 180/105 for 24hr

THROMBOTICS NOT INDICATED
Permissive HTN 169/90 to maintain perfusion to ischemic penumbra

Lower BP acutely only if > 220/120
By only 15% in 24hr

20
Q

Hemorrhagic stroke ttt

A

ABC

BP control (IV nicardipine or labetalol with SBP goal 140-160

Reversal of anticoagulation
Vit K Protamine sulfate

Regulate ICP

21
Q

Malignant hemispheric infarction
Cause

A

Massive ischemic stroke causes cerebral edema (inc ICP) leading to brain herniation
and
hemmorrhagic transformation

Mostly follows large vessels ischemia

Dx repeat CT non contrast

Ttt decompressive hemicraniectomy

22
Q

Anterior cerebral artery stroke

A

Motor and sensory deficits of lower limb
More in LL than UL
Face not involved
See homunculus

Urinary incontinence ( medial frontal lobe)

23
Q

Lacunar infarcts S/S

A

Supplies deep brain structures

Can cause
Pure motor hemiparesis
Pure sensory
Dysarthria Clumsy hand syndrome
Ataxic hemiparesis
Sensorimotor syndrome

24
Q

MCA stroke

A

C/L motor and somatosensory deficits
More pronounced in upper limb than lower

Homonymous hemianopia or quadrantanopia

If dominat lobe LT. Aphasia
Non dominant RT. Hemineglect / anosognosia

25
Q

SAH C/P

A

Ruptured berry aneurysm (imp)
Thunderclap headache
N/V
Brief LOC
Focal deficits
Meningismus

26
Q

SAH. Dx

A

😵‍💫Non contrast CT
😵‍💫 if Ct negative LP

       Elevated opening pressure 
       Xanthochromia 
       High RBC that doesnt decline from first collection tube to last

😵‍💫Confirm dx with cerebral Angio

📞. CT is done in first 6hr. Minor bleeding and degradation of blood reduce efficacy of CT over time . Hence we do LP

27
Q

SAH ttt

A

🚜Aneurysm clipping
🚜Endovascular procedure ( coiling /stenting)

🚜Nimodipine and euvolemia to reduce delayed cerebral ischemia

28
Q

Isolated cranial nerve neuropathies from compressing aneurysm SAH

A

3rd nerve ; Pcom aneurysm
Pupillary dilation (outward parasym fibres).
ptosis , down and out gaze (motor fibres inwards)

2nd nerve : Internal carotid or Acom
U/L visionloss or bitemporal hemianopisa

4th and 6th ; SCA or AICA aneurysm

29
Q

Complication of SAH

A
  1. Rebleeding : rapid neurologic deterioration at first dayManagement; urgent aneurysm repair reduces risk

2: Vasospasm ( vasogenic metabolites from degraded blood )
Presents with stroke like symptoms again
Occurs at 3-14 days after SAH

    Ttt;  Nimodipine reduces risk by vasodilating small vessels and improves outcomes
30
Q

3rd nerve ischemic neuropathy

A

3rd nerve

Inner somatic fibers :
Levatir muscle (ptosis) , 4 EOMs
Down n outgaze

Outr parasympathetic fibers ;
Supple iris and ciliary muscles
(Dilated pupils)

Farther from blood supply
Ischemic neuropathy (DM)
Causes ptosis and down and out gaze
Sparing pupil

31
Q

3rd nerve compressive neuropathy

A

Aneurysm

Outer fibers involved first. Later somatic

So dilated pupils with ptosis and down n out gaze

Managemnet: CT or MRA

32
Q

Cavernous sinus thrombosis features

A

Skin infection/ sinus/oribit
Severe headache
Intracranial HTN
Vomiting
Papilledema
Low grade fever
B/L periorbital edema
Hypoesthesia
Hyperesthesia in V1/V2 dist
Cranial nerve 3,4,5,6 deficits

Dx : MRV

Ttt : Antibiotics
Prevent/reverse cerebral herniation

33
Q

Why we dont use anticoagulants for ischemic stroke

A

Increase risk for hemmorrgic conversion

34
Q

Strokes localization
Cerebral cortex

A

VANS
Hemiparesis
Hemianopia gaze preference Vision
Aphasia A (Dominant)
Neglect N (Non dominant)
Sensory deficits S

35
Q

Internal capsule (lacunar infarct ) deficit

A

Pure motor
Lower half of face

36
Q

ACA occlusion

A

Lower extremity motor and sensory deficit
Abulia (lack of will)
Dyspraxia , emotional disturbance , urinary incontinence

37
Q

Vertebrobasilar system lesion(brainstem)

A

C/L hemiplegia
I/L cranial nerve involvement
Ataxia

Neurology (19 decks)

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