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Z Year3 Conditions > ACUTE NEURO 2 > Flashcards

ACUTE NEURO 2 Flashcards

1
Q

How do you treat ischaemic stroke <4.5hrs and no CVST?

A
  1. Alteplase IV (rt-PA)
  2. Aspirin 300mg 24hrs AFTER rt-PA
  3. Supportive care
  4. Swallowing assessment (nerve 9-10 affected)
  5. VTE prophylaxis (dalteparin/heparin)
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2
Q

How do you treat ischaemic stroke >4.5hrs?

A
  1. Aspirin 300mg
  2. Supportive care
  3. Swallowing assessment
  4. VTE prophylaxis (dalteparin/heparin
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3
Q

How do you treat cerebral venous sinus thrombosis?

A

Anticoagulate – Heparin + supportive care

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4
Q

How do you prevent ischaemic stoke happening again?

A
  1. Continue with aspirin for 2 weeks
  2. then switch to lifelong clopidogrel or dipyramidole
  3. Lifelong anticoagulation (AF)
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5
Q

What is the onset of a TIA?

A

sudden onset of focal neurological symptoms <24hr

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6
Q

What are the associated symptoms of a TIA?

A
  • loss of function

- vision changes

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7
Q

What investigations are needed for a TIA?

A

CT head/FBC/glucose/PT/PTT/ECG

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8
Q

What is the epidemiology for TIA?

A
  1. Older people
  2. Black/Hispanic
  3. lower lvl of education
  4. M>W
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9
Q

What are the causes of TIA?

A

temporary vascular occlusion

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10
Q

What are the risk factors of TIA?

A
  1. History of stroke/TIA
  2. Hypertension/smoking/DM
  3. AF
  4. Dislipidiemia
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11
Q

What is the treatment of TIA when there is a atherosclerotic cause?

A
  1. Anitplatelets :
    aspirin OR clopidogrel or both can be started immediately after excluding haemorrhage – if both switch to single agent post 2wks
    + statin (atorvastatitn)
  2. Lifestyle mod, if carotid >50% - enderartectomy
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12
Q

What is the treatment of TIA when there is a cardioembolic cause?

A
  1. Anticoagulation:
    Warfarin/apixaban – start within 2 wks
    + statin
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13
Q

What are the complications of TIA?

A

stroke

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14
Q

What is the prognosis of TIA?

A

10% chance of getting a stroke within 3 months

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15
Q

What are UMN diseases?

A
  1. stroke
  2. space occupying lesion
  3. demyelination (MS)
  4. spinal cord pathology
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16
Q

What are LMN diseases?

A
  1. MND
  2. peripheral neuropathy
  3. myasthenia gravis
  4. muscular dystrophy
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17
Q

What are UMN signs?

A
  1. contralateral signs
  2. no fasciculations
  3. no muscle wasting
  4. spasticity, may be clonus
  5. weakness: extensors in arms, 6. flexors in legs
  6. hyperreflexia
  7. upgoing plantars
  8. pronator drift
18
Q

What are LMN signs?

A
  1. unilateral signs
  2. fasciculations
  3. muscle wasting
  4. hypotonia
  5. weakness
  6. hyporeflexia
  7. normal plantar response
19
Q

What is grade 0 MRC for stroke/TIA?

A

No muscle contraction

20
Q

What is grade 1 MRC for stroke/TIA?

A

Flicker of contraction

21
Q

What is grade 2 MRC for stroke/TIA?

A

Some active movement

22
Q

What is grade 3 MRC for stroke/TIA?

A

Active movement against gravity

23
Q

What is grade 4 MRC for stroke/TIA?

A

Active movement against resistance

24
Q

What is grade 5 MRC for stroke/TIA?

A

Normal power allowing for age

25
Q

What are the signs if there is a stroke/TIA in Anterior Cerebral Artery (ACA)? Anterior circulation

A
  1. Contralateral hemiparesis lower limb > upper limb
  2. Abulia
  3. Confusion
  4. Gait apraxia
  5. Frontal release sign
26
Q

What are the signs if there is a stroke/TIA in middle cerebral artery (MCA)? Anterior circulation

A
  1. Contralateral hemiparesis upper limb/face > lower limb
    Contralateral hemisensory loss
  2. Apraxia
  3. Hemineglect
  4. Receptive/expressive dysphasia (if left MCA affected)
  5. Quadrantopia (if Meyer’s/Baum’s loop affected)
27
Q

What are the signs if there is a stroke/TIA in posterior cerebral artery (PCA)? posterior circulation

A
  1. Homonymous hemianopia (with macular sparing)

2. Visual agnosia

28
Q

What are the signs if there is a stroke/TIA in basilar artery? posterior circulation

A
  1. Cranial nerve pathology (III-XII)
  2. Visual impairments
  3. Cerebellar pathology
  4. Impaired consciousness
29
Q

What are cerebellar strokes?

A
  1. Cerebellar strokes or “Dizzy-plus” syndromes

2. All can present with cerebellar signs

30
Q

What are the signs if there is a stroke/TIA in superior cerebellar (SCA)? posterior circulation

A
  1. dizzy
31
Q

What are the signs if there is a stroke/TIA in anterior inferior cerebellar (AICA)? posterior circulation

A
  1. dizzy

2. deaf

32
Q

What are the signs if there is a stroke/TIA in posterior inferior cerebellar (PICA)? posterior circulation

A
  1. dizzy
  2. dysphagic
  3. dysphonic
    (lateral medullary syndrome)
33
Q

What does a lacunar infarct affecting the internal capsule do?

A

pure motor deficit

34
Q

What does a lacunar infarct affecting the pontine do?

A

dizziness/vertigo, bilateral affect

35
Q

What does a lacunar infarct affecting the thalamus do?

A

affects consciousness

36
Q

What does a lacunar infarct affecting the basal ganglia do?

A

dyskinesias

37
Q

What does an intracerebral haemorrhage present?

A
  1. Headache and meningism
  2. Focal neurological signs
  3. nausea/vomiting
  4. Signs of raised ICP
  5. Seizures
38
Q

How long do TIAs present?

A

last 10-15 mins but can last up to 24hrs

39
Q

What symptoms are associated with TIAs?

A
  1. Amaurosis fugax – ”like a curtain descending”

2. Global events like syncope or dizziness not typical

40
Q

What are the complications for TIAS and strokes?

A 
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

Z Year3 Conditions (13 decks)

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