ACUTE NEURO 2 Flashcards
How do you treat ischaemic stroke <4.5hrs and no CVST?
- Alteplase IV (rt-PA)
- Aspirin 300mg 24hrs AFTER rt-PA
- Supportive care
- Swallowing assessment (nerve 9-10 affected)
- VTE prophylaxis (dalteparin/heparin)
How do you treat ischaemic stroke >4.5hrs?
- Aspirin 300mg
- Supportive care
- Swallowing assessment
- VTE prophylaxis (dalteparin/heparin
How do you treat cerebral venous sinus thrombosis?
Anticoagulate – Heparin + supportive care
How do you prevent ischaemic stoke happening again?
- Continue with aspirin for 2 weeks
- then switch to lifelong clopidogrel or dipyramidole
- Lifelong anticoagulation (AF)
What is the onset of a TIA?
sudden onset of focal neurological symptoms <24hr
What are the associated symptoms of a TIA?
- loss of function
- vision changes
What investigations are needed for a TIA?
CT head/FBC/glucose/PT/PTT/ECG
What is the epidemiology for TIA?
- Older people
- Black/Hispanic
- lower lvl of education
- M>W
What are the causes of TIA?
temporary vascular occlusion
What are the risk factors of TIA?
- History of stroke/TIA
- Hypertension/smoking/DM
- AF
- Dislipidiemia
What is the treatment of TIA when there is a atherosclerotic cause?
- Anitplatelets :
aspirin OR clopidogrel or both can be started immediately after excluding haemorrhage – if both switch to single agent post 2wks
+ statin (atorvastatitn) - Lifestyle mod, if carotid >50% - enderartectomy
What is the treatment of TIA when there is a cardioembolic cause?
- Anticoagulation:
Warfarin/apixaban – start within 2 wks
+ statin
What are the complications of TIA?
stroke
What is the prognosis of TIA?
10% chance of getting a stroke within 3 months
What are UMN diseases?
- stroke
- space occupying lesion
- demyelination (MS)
- spinal cord pathology
What are LMN diseases?
- MND
- peripheral neuropathy
- myasthenia gravis
- muscular dystrophy
What are UMN signs?
- contralateral signs
- no fasciculations
- no muscle wasting
- spasticity, may be clonus
- weakness: extensors in arms, 6. flexors in legs
- hyperreflexia
- upgoing plantars
- pronator drift
What are LMN signs?
- unilateral signs
- fasciculations
- muscle wasting
- hypotonia
- weakness
- hyporeflexia
- normal plantar response
What is grade 0 MRC for stroke/TIA?
No muscle contraction
What is grade 1 MRC for stroke/TIA?
Flicker of contraction
What is grade 2 MRC for stroke/TIA?
Some active movement
What is grade 3 MRC for stroke/TIA?
Active movement against gravity
What is grade 4 MRC for stroke/TIA?
Active movement against resistance
What is grade 5 MRC for stroke/TIA?
Normal power allowing for age
What are the signs if there is a stroke/TIA in Anterior Cerebral Artery (ACA)? Anterior circulation
- Contralateral hemiparesis lower limb > upper limb
- Abulia
- Confusion
- Gait apraxia
- Frontal release sign
What are the signs if there is a stroke/TIA in middle cerebral artery (MCA)? Anterior circulation
- Contralateral hemiparesis upper limb/face > lower limb
Contralateral hemisensory loss - Apraxia
- Hemineglect
- Receptive/expressive dysphasia (if left MCA affected)
- Quadrantopia (if Meyer’s/Baum’s loop affected)
What are the signs if there is a stroke/TIA in posterior cerebral artery (PCA)? posterior circulation
- Homonymous hemianopia (with macular sparing)
2. Visual agnosia
What are the signs if there is a stroke/TIA in basilar artery? posterior circulation
- Cranial nerve pathology (III-XII)
- Visual impairments
- Cerebellar pathology
- Impaired consciousness
What are cerebellar strokes?
- Cerebellar strokes or “Dizzy-plus” syndromes
2. All can present with cerebellar signs
What are the signs if there is a stroke/TIA in superior cerebellar (SCA)? posterior circulation
- dizzy
What are the signs if there is a stroke/TIA in anterior inferior cerebellar (AICA)? posterior circulation
- dizzy
2. deaf
What are the signs if there is a stroke/TIA in posterior inferior cerebellar (PICA)? posterior circulation
- dizzy
- dysphagic
- dysphonic
(lateral medullary syndrome)
What does a lacunar infarct affecting the internal capsule do?
pure motor deficit
What does a lacunar infarct affecting the pontine do?
dizziness/vertigo, bilateral affect
What does a lacunar infarct affecting the thalamus do?
affects consciousness
What does a lacunar infarct affecting the basal ganglia do?
dyskinesias
What does an intracerebral haemorrhage present?
- Headache and meningism
- Focal neurological signs
- nausea/vomiting
- Signs of raised ICP
- Seizures
How long do TIAs present?
last 10-15 mins but can last up to 24hrs
What symptoms are associated with TIAs?
- Amaurosis fugax – ”like a curtain descending”
2. Global events like syncope or dizziness not typical
What are the complications for TIAS and strokes?
1. TIAs can complicate to strokes Driving prohibited for 1 month 2, Cerebral oedema (increased ICP) 3. Immobility 4. Infections 5. DVT 6. Psychiatric/mood disturbance 7. Seizures 8. Cardiovascular events 9. Death
