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Z Year3 Conditions > ACUTE NEURO > Flashcards

ACUTE NEURO Flashcards

1
Q

Where does a subarachnoid bleed happen?

A

-Between arachnoid and pia mater
-Where the arteries run
(arterial)

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2
Q

Where does a subdural bleed happen?

A
  • Between Dura and Arachnoid

- Mainly bridging veins

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3
Q

Where does an extradural bleed happen?

A

Outside of the Dura (between skull and Dura)

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4
Q

What is the onset of an epidural/extradural bleed?

A
  • acute onset after a lucid interval

- falls down hits head out for a little bit then is like I’m fine

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5
Q

What is the symptoms of an epidural/extradural bleed?

A
  1. deterioration of GCS (very quick)

2. syncope, nausea and vomiting

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6
Q

What is the time of the epidural/extradural bleed?

A

continuous

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7
Q

What is the severity of an epidural/extradural bleed?

A

very severe, max intensity within minutes

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8
Q

What is the epidemiology of an epidural/extradural bleed?

A

young, RTA, male

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9
Q

What are the usual causes of an epidural/extradural bleed?

A

Trauma (middle meningeal artery) - near to pterion

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10
Q

What are the investigations of an epidural/extradural bleed?

A
  1. Non-contrast CT (GCS: 9-12 straight away)

2. MRI

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11
Q

What does a subdural bleed look like on a scan?

A

Crescent

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12
Q

What does an epidural bleed look like on a scan?

A
  • More concentrated with lenticular shape

- Always white

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13
Q

What does a subarachnoid bleed look like on a scan?

A
  • in between cisterns
  • look bright on CT (first 12 hours)
  • Can be dark if chronic
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14
Q

What are risk factors for subdural bleed?

A
  • Elderly

- Alcoholics

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15
Q

Why do you use non contrast CT?

A

-Blood appears bright on non contrast CT when it is fresh

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16
Q

What makes up GCS?

A
  • Eyes: 4
  • Verbal: 5
  • Motor: 6
  • Below 9: intubated
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17
Q

What is the presentation of a subarachnoid haemorrhage?

A
  1. Usually occipital

2. Back of head

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18
Q

What is the onset of a subarachnoid haemorrhage?

A
  • Sudden: thunderclap “worst headache ever”

- spontaneous

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19
Q

What is the associated symptoms of a subarachnoid haemorrhage?

A
  1. Syncope
  2. Nausea
  3. Vomiting
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20
Q

What is the time of a subarachnoid haemorrhage?

A

Continuous

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21
Q

What is the severity of a subarachnoid haemorrhage?

A

very severe, max intensity within mins

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22
Q

What is the epidemiology of a subarachnoid haemorrhage?

A
  1. 50-55
  2. W>M
  3. Black people higher
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23
Q

What are the causes of a subarachnoid haemorrhage?

A
  1. Rupture of sacular aneurysm
  2. AVM (arterial venous malformations)
  3. Arterial dissections
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24
Q

What are the risk factors of a subarachnoid haemorrhage?

A
  1. Smoking
  2. Hypertension
  3. Alcohol misue
    - polycystic kidney disease
25
What are the investigations for a subarachnoid haemorrhage?
1. Non-contrast CT head 2. LUMBAR PUNCTURE 3. Serum Electrolytes: C-ADH 4. ECG 5. Serum glucose: hypoglycaemia with head trauma
26
What is the onset of a subdural haemorrhage?
gradual onset over days/week
27
What is the presentation of a subdural haemorrhage?
1. Fluctuating consciousness | 2. Personality change
28
What are the associated symptoms in a subdural haemorrhage?
1. Diminished response 2. Nausea 3. Vomiting
29
What is the epeidimology of subdural haemorrhage?
1. Usually after falls 2. Higher in patients with coagulopathy 3. Chronic subdurals more common in >65yrs
30
What are the causes of a subdural haemorrhage?
trauma
31
What are the risk factors of a subdural haemorrhage?
1. Recent trauma 2. Coagulopathy/anticoagulants 3. Advanced age (>65yrs) 4. Elderly and alcoholics
32
What are the investigation for subdural haemorrhage?
- non-contrast CT head | - burr hole or watch
33
What are the complications of a subdural haemorrhage?
1. Epilepsy 2. Coma 3. stroke 4. Neuro deficits
34
How would you treat an acute haematoma in subdural haemorrhage with <10mm size, <5mm midline shift, no sig CNS dysfunctinon?
1. If GCS >9 or GCS <9 + reactive pupils + ICP <20mmHg | 2. Observation + monitor + prophylactic anti-epileptics (levitracetam/phenytoin) follow up image 2/3wks
35
How would you treat an acute haematoma in subdural haemorrhage >10mm size, >5mm midline shift or sig CNS dysfunction?
1. Surgery (burr holes) | 2. ICP monitoring for GCS <9 + prophylactic antiepileptics (levitiracetum/ phenytoin)
36
How do you treat a chronic haematoma in subdural haemorrhage?
1. Antiepileptics (phenytoin/levitiracetum) | 2. Surgery may be indicated for some patients
37
What are EMQ features in an extradural haemorrhages?
hit by cricket ball
38
What are EMQ features in an subarachnoid haemorrhages?
FHx of PCKD - Berry aneurysm in Circle of Willis
39
What are EMQ features in an subdural haemorrhages?
Alcoholics (fall over), elderly (brain atrophy, pulls on venous sinuses to tear)
40
What is the definition of classification of strokes?
A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24hrs
41
What is the onset of a haemorrhagic stroke?
sudden onset
42
What are the associated symptoms of a haemorrhagic stroke?
- loss of function (YOUNG) | - vision changes
43
What are the investigations for a haemorrhagic stroke?
- CT head/fbc/glucose/PT/PTT/ECG | - Acute haemorrhage appears bright !!
44
What is the epidemiology of a haemorrhagic stroke?
1. Intracerebral (75%) 2. Rest SAH 3. M>W 4. Older age 5. Asians
45
What are the causes of a haemorrhagic stroke?
1. Hypertension | 2. Drugs (cocaine)
46
What is the treatment of a haemorrhagic stroke?
1. Neurosurgical referral | 2. Airway protection
47
What is the onset of an ischaemic stroke?
sudden
48
What are the associated symptoms of an ischaemic stroke?
1. loss of function | 2. vision changes/headache/aphasia
49
What are the investigations for an ischaemic stroke?
1. CT head 2. FBC 3. glucose 4. PT 5. PTT 6. ECG
50
When do you do a LP in a subarachnoid haemorrhage?
at least 12h post, fill min 3 tubes
51
What is an ischaemic stroke?
stenosis or occlusion
52
What is a haemorrhagic stroke?
burst blood vessel
53
What are TIA?
Less than 24hr
54
What are extradural vs epidural?
extradural: arterial and epidural: venous
55
What is the epidemiology of an ischaemic stroke?
1. Older people 2. Black/Hispanic 3. lower lvl of education 4. M>W
56
What are the causes of ischaemic stroke?
vascular occlusion/stenosis
57
What are the risk factors of ischaemic stroke?
1. History of stoke/TIA 2. hypertension/smoking/DM 3. AF 4. Dylipidemia
58
What do ischaemic strokes look like on non-contrast CT?
hypoattenuated (dark/grey)

Z Year3 Conditions (13 decks)

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