Acute Neuro Flashcards
How is the risk of stroke assessed in patients with AF?
CHA2DS2vasc Score
What are the main risk factors for Stroke/TIA?
HTN
DM
Obesity
Age
Cholesterol
Smoking
How do strokes present?
Sudden
Weakness
Visual Changes
Dizziness, Loss of Coordination
Speech Problems
Specifics depends on the location of the lesion
How do Anterior Cerebral Artery Strokes present?
Contralateral Hemiparesis (Lower Limb>Upper Limb)
Behavioural Changes
How do Middle Cerebral Artery Strokes present?
Contralateral Hemiparesis - Upper Limb > LL
Contralateral Hemisensory Loss
Apraxia
Aphasia
Quadrantopias
How do Posterior Cerebral Artery Strokes present?
Homonymous Contralateral Hemianopias
Visual Agnosia (Difficulty recognising objects)
Reduced Consciousness
Cerebellar Signs
What are the main cerebellar signs?
DANISH
Dysdiadokinesia
Ataxia
Nystagmus
Inetntion Tremor
Slurred, staccato speech
Hypotonia/Heel-Shin test
How should you investigate a suspected stroke?
ABCDE
CT to exclude haemorrhage
Bloods, Vitals, ECG
How do you manage a Stroke?
CT to exclude Haemorrhage
<4.5 Hours - Alteplase IV then Aspirin 300mg Oral
>4.5 Hours - Aspirin 300mg Oral
How would you prevent a secondary Stroke?
In AF Patients - Warfarin
Non-AF Patients - Continue Aspirin for 2 weeks, then lifelong Clopidogrel
How would you manage a Haemorrhagic Stroke?
Neurosurgical Referral
ICU/Stroke Unit
Surgery
What are the main complications of Stroke/TIA?
Aspiration Pneumonia
Cerebral Oedema
Depression
DVT
Death
Seizures
Immobility
What can trigger epileptic seziures?q
Lack of Sleep
Flickering Lights
Alcohol
Stress
What can be considered ‘Epileptic Aura’?
Strange feeling in the gut
Deja Vu
Strange Smells
Flashing Lights
What may occur during an epileptic seizure?
Tongue Biting
Incontinence
Jerking Movements
How do Post-Ictal patients typically present?
Confused
Slow to recover
Headache
Myalgia
How do Tonic-Clonic Seizures present?
Muscle stiffness
Rhythmical Jerking of the limbs
What are Absence Seizures?
Patient suddenly becomes vacant
Activity ceases
Lack of response from the patient
What are Myoclonic Seizures?
Repetitive myoclonic jerks
What are Atonic Seizures?
Complete loss of muscle tone
How do Focal Seizures present?
Localised - symptoms specific to the location of the seizure.
Frontal - Motor symptoms
Parietal - Sensory Disturbances
Occipital - Visual Phenomena
Temporal - Aura, Automatisms, Hallucinations
How is Epilepsy diagnosed?
Clinically
2 or more unprovoked seizures >24 hours apart
EEG
Bloods, CT/MRI used to exclude other causes
How are patients with Epilepsy managed?
Focal - Carbamazepine & Lamotrigine
Generalised - 1) Sodium Valproate (Not in pregnancy)
2) Carbamazepine
What are the main side-effects of anti-epileptics?
Psychiatric effects, Depression
Weight Gain