Acute Neuro

Question 1

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

Answer 1

CHA₂DS₂vasc Score

Question 2

What are the main risk factors for Stroke/TIA?

Answer 2

HTN

DM

Obesity

Age

Cholesterol

Smoking

Question 3

How do strokes present?

Answer 3

Sudden

Weakness

Visual Changes

Dizziness, Loss of Coordination

Speech Problems

Specifics depends on the location of the lesion

Question 4

How do Anterior Cerebral Artery Strokes present?

Answer 4

Contralateral Hemiparesis (Lower Limb>Upper Limb)

Behavioural Changes

Question 5

How do Middle Cerebral Artery Strokes present?

Answer 5

Contralateral Hemiparesis - Upper Limb > LL

Contralateral Hemisensory Loss

Apraxia

Aphasia

Quadrantopias

Question 6

How do Posterior Cerebral Artery Strokes present?

Answer 6

Homonymous Contralateral Hemianopias

Visual Agnosia (Difficulty recognising objects)

Reduced Consciousness

Cerebellar Signs

Question 7

What are the main cerebellar signs?

Answer 7

DANISH

Dysdiadokinesia

Ataxia

Nystagmus

Inetntion Tremor

Slurred, staccato speech

Hypotonia/Heel-Shin test

Question 8

How should you investigate a suspected stroke?

Answer 8

ABCDE

CT to exclude haemorrhage

Bloods, Vitals, ECG

Question 9

How do you manage a Stroke?

Answer 9

CT to exclude Haemorrhage

<4.5 Hours - Alteplase IV then Aspirin 300mg Oral

>4.5 Hours - Aspirin 300mg Oral

Question 10

How would you prevent a secondary Stroke?

Answer 10

In AF Patients - Warfarin

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

Question 11

How would you manage a Haemorrhagic Stroke?

Answer 11

Neurosurgical Referral

ICU/Stroke Unit

Surgery

Question 12

What are the main complications of Stroke/TIA?

Answer 12

Aspiration Pneumonia

Cerebral Oedema

Depression

DVT

Death

Seizures

Immobility

Question 13

What can trigger epileptic seziures?q

Answer 13

Lack of Sleep

Flickering Lights

Alcohol

Stress

Question 14

What can be considered ‘Epileptic Aura’?

Answer 14

Strange feeling in the gut

Deja Vu

Strange Smells

Flashing Lights

Question 15

What may occur during an epileptic seizure?

Answer 15

Tongue Biting

Incontinence

Jerking Movements

Question 16

How do Post-Ictal patients typically present?

Answer 16

Confused

Slow to recover

Headache

Myalgia

Question 17

How do Tonic-Clonic Seizures present?

Answer 17

Muscle stiffness

Rhythmical Jerking of the limbs

Question 18

What are Absence Seizures?

Answer 18

Patient suddenly becomes vacant

Activity ceases

Lack of response from the patient

Question 19

What are Myoclonic Seizures?

Answer 19

Repetitive myoclonic jerks

Question 20

What are Atonic Seizures?

Answer 20

Complete loss of muscle tone

Question 21

How do Focal Seizures present?

Answer 21

Localised - symptoms specific to the location of the seizure.

Frontal - Motor symptoms

Parietal - Sensory Disturbances

Occipital - Visual Phenomena

Temporal - Aura, Automatisms, Hallucinations

Question 22

How is Epilepsy diagnosed?

Answer 22

Clinically

2 or more unprovoked seizures >24 hours apart

EEG

Bloods, CT/MRI used to exclude other causes

Question 23

How are patients with Epilepsy managed?

Answer 23

Focal - Carbamazepine & Lamotrigine

Generalised - 1) Sodium Valproate (Not in pregnancy)

2) Carbamazepine

Question 24

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

Answer 24

Psychiatric effects, Depression

Weight Gain

Question 25

What is Status Epilepticus?

Answer 25

Seizure lasting 5 minutes or more

Question 26

What can cause Status Epilepticus?

Answer 26

Non-adherence to medication

Alcohol Abuse

OD

Question 27

How is Status Epilepticus managed?

Answer 27

ABCDE

100% O2

IV Access & Monitoring

IV Lorazepam

IV Phenytoin

ICU

Question 28

What is Guillain Barre Syndrome?

Answer 28

Acute autoimmune demyelinating polyneuropathy affecting the PNS.

Question 29

How does Guillain-Barre present?

Answer 29

URTI/Gastroenteritis, commonly due to Campylobacter

2-3 Weeks later, a progressive peripheral neuropathy develops with symmetrical limb weakness.

Can progress to respiratory paralysis

Question 30

How is Guillain Barre investigated?

Answer 30

Nerve Conduction Studies - Decreased Conduction Velocity

Lumbar Puncture - Raised Protein, Normal Glucose

Spirometry (to monitor respiratory weakness)

Question 31

What is Hydrocephalus?

Answer 31

Excessive accumulation of CSF in the ventricles of the brain.

Question 32

What can cause Hydrocephalus?

Answer 32

Non-Communicating (CSF Flow obstruction)

Communicating (Increased Production/Reduced Absorption of CSF)

Normal Pressure (Idiopathic, chronic ventricular enlargement)

Question 33

How does Hydrocephalus present?

Answer 33

Acute Onset (Nause & Vomiting, Headache, Papilloedema)

Gradual Onset (Cognitive Impariment, Unsteady Gait, Diplopia, CN Palsies)

Normal Pressure (Cognitive Impairment, Gait Ataxia, Hyperreflexia)

Question 34

How would you investigate a suspected case of Hydrocephalus?

Answer 34

1) CT/MRI

CSF Analysis if ICP normal

Question 35

What can cause Cord Compression?

Answer 35

Trauma

Chronic Conditions - Tumours, Osteoporosis, Corticosteroids

Invertebral Disease 9Herniation)

Question 36

How does Cord Compression present?

Answer 36

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

Question 37

How would you investigate a possible case of Cord Compression?

Answer 37

X-Ray

MRI is definitive

Bloods - Calcium is important

Investigate Multiple Myeloma (calcium, ig electrophoresis, Bence Jones Proteins in the urine)

Question 38

How does Cauda Equina Syndrome present?

Answer 38

LMN Symptoms

Perianal Anaesthesia

Bladder Retention

Leg Weakness

Question 39

How does Sciatica present?

Answer 39

Pain and tingling radiating from the lower back to the ipsilateral leg

Weakness in the calves