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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
Q

What are the investigations for a subarachnoid haemorrhage?

A
  1. Non-contrast CT head
  2. LUMBAR PUNCTURE
  3. Serum Electrolytes: C-ADH
  4. ECG
  5. Serum glucose: hypoglycaemia with head trauma
26
Q

What is the onset of a subdural haemorrhage?

A

gradual onset over days/week

27
Q

What is the presentation of a subdural haemorrhage?

A
  1. Fluctuating consciousness

2. Personality change

28
Q

What are the associated symptoms in a subdural haemorrhage?

A
  1. Diminished response
  2. Nausea
  3. Vomiting
29
Q

What is the epeidimology of subdural haemorrhage?

A
  1. Usually after falls
  2. Higher in patients with coagulopathy
  3. Chronic subdurals more common in >65yrs
30
Q

What are the causes of a subdural haemorrhage?

A

trauma

31
Q

What are the risk factors of a subdural haemorrhage?

A
  1. Recent trauma
  2. Coagulopathy/anticoagulants
  3. Advanced age (>65yrs)
  4. Elderly and alcoholics
32
Q

What are the investigation for subdural haemorrhage?

A
  • non-contrast CT head

- burr hole or watch

33
Q

What are the complications of a subdural haemorrhage?

A
  1. Epilepsy
  2. Coma
  3. stroke
  4. Neuro deficits
34
Q

How would you treat an acute haematoma in subdural haemorrhage with <10mm size, <5mm midline shift, no sig CNS dysfunctinon?

A
  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
Q

How would you treat an acute haematoma in subdural haemorrhage >10mm size, >5mm midline shift or sig CNS dysfunction?

A
  1. Surgery (burr holes)

2. ICP monitoring for GCS <9 + prophylactic antiepileptics (levitiracetum/ phenytoin)

36
Q

How do you treat a chronic haematoma in subdural haemorrhage?

A
  1. Antiepileptics (phenytoin/levitiracetum)

2. Surgery may be indicated for some patients

37
Q

What are EMQ features in an extradural haemorrhages?

A

hit by cricket ball

38
Q

What are EMQ features in an subarachnoid haemorrhages?

A

FHx of PCKD - Berry aneurysm in Circle of Willis

39
Q

What are EMQ features in an subdural haemorrhages?

A

Alcoholics (fall over), elderly (brain atrophy, pulls on venous sinuses to tear)

40
Q

What is the definition of classification of strokes?

A

A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24hrs

41
Q

What is the onset of a haemorrhagic stroke?

A

sudden onset

42
Q

What are the associated symptoms of a haemorrhagic stroke?

A
  • loss of function (YOUNG)

- vision changes

43
Q

What are the investigations for a haemorrhagic stroke?

A
  • CT head/fbc/glucose/PT/PTT/ECG

- Acute haemorrhage appears bright !!

44
Q

What is the epidemiology of a haemorrhagic stroke?

A
  1. Intracerebral (75%)
  2. Rest SAH
  3. M>W
  4. Older age
  5. Asians
45
Q

What are the causes of a haemorrhagic stroke?

A
  1. Hypertension

2. Drugs (cocaine)

46
Q

What is the treatment of a haemorrhagic stroke?

A
  1. Neurosurgical referral

2. Airway protection

47
Q

What is the onset of an ischaemic stroke?

A

sudden

48
Q

What are the associated symptoms of an ischaemic stroke?

A
  1. loss of function

2. vision changes/headache/aphasia

49
Q

What are the investigations for an ischaemic stroke?

A
  1. CT head
  2. FBC
  3. glucose
  4. PT
  5. PTT
  6. ECG
50
Q

When do you do a LP in a subarachnoid haemorrhage?

A

at least 12h post, fill min 3 tubes

51
Q

What is an ischaemic stroke?

A

stenosis or occlusion

52
Q

What is a haemorrhagic stroke?

A

burst blood vessel

53
Q

What are TIA?

A

Less than 24hr

54
Q

What are extradural vs epidural?

A

extradural: arterial and epidural: venous

55
Q

What is the epidemiology of an ischaemic stroke?

A
  1. Older people
  2. Black/Hispanic
  3. lower lvl of education
  4. M>W
56
Q

What are the causes of ischaemic stroke?

A

vascular occlusion/stenosis

57
Q

What are the risk factors of ischaemic stroke?

A
  1. History of stoke/TIA
  2. hypertension/smoking/DM
  3. AF
  4. Dylipidemia
58
Q

What do ischaemic strokes look like on non-contrast CT?

A

hypoattenuated (dark/grey)

Z Year3 Conditions (13 decks)

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