Acute Neuro Flashcards

1
Q

How is the risk of stroke assessed in patients with AF?

A

CHA2DS2vasc Score

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2
Q

What are the main risk factors for Stroke/TIA?

A

HTN

DM

Obesity

Age

Cholesterol

Smoking

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3
Q

How do strokes present?

A

Sudden

Weakness

Visual Changes

Dizziness, Loss of Coordination

Speech Problems

Specifics depends on the location of the lesion

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4
Q

How do Anterior Cerebral Artery Strokes present?

A

Contralateral Hemiparesis (Lower Limb>Upper Limb)

Behavioural Changes

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5
Q

How do Middle Cerebral Artery Strokes present?

A

Contralateral Hemiparesis - Upper Limb > LL

Contralateral Hemisensory Loss

Apraxia

Aphasia

Quadrantopias

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6
Q

How do Posterior Cerebral Artery Strokes present?

A

Homonymous Contralateral Hemianopias

Visual Agnosia (Difficulty recognising objects)

Reduced Consciousness

Cerebellar Signs

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7
Q

What are the main cerebellar signs?

A

DANISH

Dysdiadokinesia

Ataxia

Nystagmus

Inetntion Tremor

Slurred, staccato speech

Hypotonia/Heel-Shin test

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8
Q

How should you investigate a suspected stroke?

A

ABCDE

CT to exclude haemorrhage

Bloods, Vitals, ECG

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9
Q

How do you manage a Stroke?

A

CT to exclude Haemorrhage

<4.5 Hours - Alteplase IV then Aspirin 300mg Oral

>4.5 Hours - Aspirin 300mg Oral

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10
Q

How would you prevent a secondary Stroke?

A

In AF Patients - Warfarin

Non-AF Patients - Continue Aspirin for 2 weeks, then lifelong Clopidogrel

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11
Q

How would you manage a Haemorrhagic Stroke?

A

Neurosurgical Referral

ICU/Stroke Unit

Surgery

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12
Q

What are the main complications of Stroke/TIA?

A

Aspiration Pneumonia

Cerebral Oedema

Depression

DVT

Death

Seizures

Immobility

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13
Q

What can trigger epileptic seziures?q

A

Lack of Sleep

Flickering Lights

Alcohol

Stress

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14
Q

What can be considered ‘Epileptic Aura’?

A

Strange feeling in the gut

Deja Vu

Strange Smells

Flashing Lights

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15
Q

What may occur during an epileptic seizure?

A

Tongue Biting

Incontinence

Jerking Movements

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16
Q

How do Post-Ictal patients typically present?

A

Confused

Slow to recover

Headache

Myalgia

17
Q

How do Tonic-Clonic Seizures present?

A

Muscle stiffness

Rhythmical Jerking of the limbs

18
Q

What are Absence Seizures?

A

Patient suddenly becomes vacant

Activity ceases

Lack of response from the patient

19
Q

What are Myoclonic Seizures?

A

Repetitive myoclonic jerks

20
Q

What are Atonic Seizures?

A

Complete loss of muscle tone

21
Q

How do Focal Seizures present?

A

Localised - symptoms specific to the location of the seizure.

Frontal - Motor symptoms

Parietal - Sensory Disturbances

Occipital - Visual Phenomena

Temporal - Aura, Automatisms, Hallucinations

22
Q

How is Epilepsy diagnosed?

A

Clinically

2 or more unprovoked seizures >24 hours apart

EEG

Bloods, CT/MRI used to exclude other causes

23
Q

How are patients with Epilepsy managed?

A

Focal - Carbamazepine & Lamotrigine

Generalised - 1) Sodium Valproate (Not in pregnancy)

2) Carbamazepine

24
Q

What are the main side-effects of anti-epileptics?

A

Psychiatric effects, Depression

Weight Gain

25
What is Status Epilepticus?
Seizure lasting 5 minutes or more
26
What can cause Status Epilepticus?
Non-adherence to medication Alcohol Abuse OD
27
How is Status Epilepticus managed?
ABCDE 100% O2 IV Access & Monitoring IV Lorazepam IV Phenytoin ICU
28
What is Guillain Barre Syndrome?
Acute autoimmune demyelinating polyneuropathy affecting the PNS.
29
How does Guillain-Barre present?
URTI/Gastroenteritis, commonly due to Campylobacter 2-3 Weeks later, a progressive peripheral neuropathy develops with symmetrical limb weakness. Can progress to respiratory paralysis
30
How is Guillain Barre investigated?
Nerve Conduction Studies - Decreased Conduction Velocity Lumbar Puncture - Raised Protein, Normal Glucose Spirometry (to monitor respiratory weakness)
31
What is Hydrocephalus?
Excessive accumulation of CSF in the ventricles of the brain.
32
What can cause Hydrocephalus?
Non-Communicating (CSF Flow obstruction) Communicating (Increased Production/Reduced Absorption of CSF) Normal Pressure (Idiopathic, chronic ventricular enlargement)
33
How does Hydrocephalus present?
Acute Onset (Nause & Vomiting, Headache, Papilloedema) Gradual Onset (Cognitive Impariment, Unsteady Gait, Diplopia, CN Palsies) Normal Pressure (Cognitive Impairment, Gait Ataxia, Hyperreflexia)
34
How would you investigate a suspected case of Hydrocephalus?
1) CT/MRI CSF Analysis if ICP normal
35
What can cause Cord Compression?
Trauma Chronic Conditions - Tumours, Osteoporosis, Corticosteroids Invertebral Disease 9Herniation)
36
How does Cord Compression present?
Depends on the level and part of the spinal cord affected Motor - Limb Weakness, UMN Below, LMN at the level Sensory Loss below the level Constipation, Urinary Retention, Erectilce Dysfunction Acute onset if - Trauma, Disc Herniation Chronic if - Osteoporosis, Tumours
37
How would you investigate a possible case of Cord Compression?
X-Ray MRI is definitive Bloods - Calcium is important Investigate Multiple Myeloma (calcium, ig electrophoresis, Bence Jones Proteins in the urine)
38
How does Cauda Equina Syndrome present?
LMN Symptoms Perianal Anaesthesia Bladder Retention Leg Weakness
39
How does Sciatica present?
Pain and tingling radiating from the lower back to the ipsilateral leg Weakness in the calves