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
What is Status Epilepticus?
Seizure lasting 5 minutes or more
What can cause Status Epilepticus?
Non-adherence to medication
Alcohol Abuse
OD
How is Status Epilepticus managed?
ABCDE
100% O2
IV Access & Monitoring
IV Lorazepam
IV Phenytoin
ICU
What is Guillain Barre Syndrome?
Acute autoimmune demyelinating polyneuropathy affecting the PNS.
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
How is Guillain Barre investigated?
Nerve Conduction Studies - Decreased Conduction Velocity
Lumbar Puncture - Raised Protein, Normal Glucose
Spirometry (to monitor respiratory weakness)
What is Hydrocephalus?
Excessive accumulation of CSF in the ventricles of the brain.
What can cause Hydrocephalus?
Non-Communicating (CSF Flow obstruction)
Communicating (Increased Production/Reduced Absorption of CSF)
Normal Pressure (Idiopathic, chronic ventricular enlargement)
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)
How would you investigate a suspected case of Hydrocephalus?
1) CT/MRI
CSF Analysis if ICP normal
What can cause Cord Compression?
Trauma
Chronic Conditions - Tumours, Osteoporosis, Corticosteroids
Invertebral Disease 9Herniation)
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
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)
How does Cauda Equina Syndrome present?
LMN Symptoms
Perianal Anaesthesia
Bladder Retention
Leg Weakness
How does Sciatica present?
Pain and tingling radiating from the lower back to the ipsilateral leg
Weakness in the calves
