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MedEd > Acute Neuro > Flashcards

Acute Neuro Flashcards

1
Q

Stroke and TIA definition?

A

Sudden onset focal neruological deficit of presumed vascular origin lasting >24 hours

TIA is same but <24hrs

Stroke 3rd leading cause of death. World is 2nd after IHD

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2
Q

Cause of ischaemic stroke?

A

Atehrsoclerosis and thrombosis

Embolism (AF)

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3
Q

Pathologies that lead to intracerebral hemorrhage?

A

HTN, Charcot-bouchard microaneurysm rupture, amyloid angiopathy, AV malformation
trauma, tumour, vasculitis

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4
Q

Score for stroke in AF patients?

A

CHA2DS2VASc

CHF, HTN, AGE >75, DM, Stroke/tia/TE, Vascular disease, Age > 65, Sex Female

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5
Q

Score for bleeding if anticoagulated?

A

HAS-BLED
HTN, Abnormal renal or liver function (1 each), stroke, bleeding, labile INRS, elderly >65, drugs or alcohol (1 each)

> 2 Chad for anticoag unless Has >3

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6
Q

Stroke/TIA RFS?

A

HTN, DM, obesity, old age, hypercholesterolaemia, smoking, AF

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7
Q

Presentation of Stroke?

A 
Sudden onset,
Weakness/numbness face,arm, leg
Vision change
Dizziness, loss of coordination/balance
Speech problems
Sepcific to brain AREA
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8
Q

ACA stroke presentation?

A

Contralateral hemiparesis
Lower>upper
behavioural changes

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9
Q

MCA stroke?

A 
Contralater hemiparesis Upperface/limb>lower
Contralateral hemisensory loss
apraxia
Aphasia
Quadrantopias
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10
Q

PCA stroke?

A

Homonymous contralateral hemianopia

Visual agnosia

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11
Q

Posterior circulation stroke?

A

Brainstem stroke = decreased consciousness and CN pathology

Cerebellar = DANSISH
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia/heel-shin test

Cerebellar is ipsilateral

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12
Q

Features of lacunar infarcts?

A

Affecting internal capsule = pure motor deficit
Pontine = dizziness/vertigo/bilateral affects
Thalamus = cosnciousness
Basal ganglia = dyskinesias

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13
Q

Features of intracerebral haemorrhage?

A

headache and menigism
Focal neurological signs N+V
Signs of ICP
Seizures

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14
Q

Oxford stroke classification?

A

TACS = All3 of motor/sensory deficit, homonymous hemianopia, higher cortical dysfunction

PACS = 2 of above

POCS = isolated homonymous hemianopia, bainstem signs, cerebrellar ataxia

LACS = pure motor, pure sensory, senosrimotor deficits

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15
Q

Ix for strokes/TIAs?

A

Urgent non contrast CT head 1st

Bloods, ecg, vitals and maintain BP, hydration, sats and temp

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16
Q

Mx for hyperacute stroke?

A

<4.5 hours = IV alteplase

>4.5 hours of thrombolysis contraindicated = aspirin 300mg oral

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17
Q

What is further stroke management?

A

Swallowing assessment, VTE prophylaxis, GCS monitoring, early mobilisation adn rehab, MDT approach

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18
Q

Other IX for stroke?

A

CTA, MRI/MRA, carotid doppler

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19
Q

What is secondary prevention for stroke?

A

AF = warfarin prophylaxis

Non AF = continue aspiring for 2 weeks then lifelong clopidogrel

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20
Q

management of haemorrhagic stroke?

A

ICU/stroke unit for monitoring and support

Surgery

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21
Q

Complication of stroke?

A

Aspiration pneumonia, cerebral oedema (ICP), immobility, depression, dvt, seizures, death

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22
Q

Complication of TIA?

A 
Stroke = ABCD2
Age 
BP
Clinical presentation
Duration
DM
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23
Q

Causes of non-syncopal collapse?

A

Epileptic seizures, non-epileptic sezures and others e.g. hypoglycaemia, alcohol and drugs

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24
Q

Features of reflex syncope?

A

Vasovagal: young, with precipitating factor, sweating, pale, quick recovery. May have brief clonic jerking of limbs

Carotid sinus hypersensitivity: tight collar and head turning

Situational syncope = micturation

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25
Q

Features of cardiac sncopes?

A

Arrhythmias: chesrt pain, palpitations, seconds and rapid spontaneous attack

Stokes-adams attach = pallor, seconds, facial flush

Outlet obstruction e.g. HOCM or AS
Massive PE

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26
Q

Orthostatic causes of syncope?

A

Collapse on standing up from stress, lack of sleep, dehydration, drugs e.g. antihypertensives, ANS instability and baroreceptor dysfunction

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27
Q

Cerebrovascular causes of syncope?

A

Vertebrobasilar insuffiiency, subclavian steal and aortic dissection

28
Q

Features of epileptic seizures?

A

Aura or no warning, <3 mins, tongue biting, twitching, incontinence, slow recovery and confusion

29
Q

Feature of non-epileptic seizure?

A

Background Hx of depression

30
Q

Definition of epilepsy?

A

A recurrent tendency to have unprovoked seizures.

Seizure = an abnormal paroxysmal discharge of cerebral neurons

31
Q

Aetiology of epilepsy?

A

Primary epileptic syndrome = idiopathic and seizures unprovoked

Secondary seizures = tumours, infection, inflammation and trauma

32
Q

Triggers for epilepsy?

A

Anything that alters cerebral excitability e.g. lack of sleep, flickering lights, alcohol and stress

There may be no trigegr

33
Q

Describe an aura?

A

Strainge feeling in gut, deja vu, strange smells and flashing lights, tingling, stiffness and twitching

34
Q

Features post-seizure?

A

Slow recovery, post-ictal headache, confusion and myalgia

Todds paresis is syndrome with wakness of paralysis of area of focal onset for seizure

35
Q

What are the generalised epileptic seizure types?

A

Tonic clonic (LOC -> limbs stiffen = tonic and limb jerking = clonic)
myoclnic (repetitive myoclonic jerks and common in puberty)
clonic, tonic,
atonic (loss of muscle tone and in children
Absence seizures ( brief episodes with behaviorudal arrest 5-10 sec but maintained posture and in chldren

36
Q

WHat are the epileptic focal seizures?

A

Focal impaired awareness seizure, focal aware seizures and focal seizures with secondary generalisation

37
Q

Features of frontal lobe epilepsy?

A

Motor symptoms
Jacksonian march : muscular spasm spreads from distal part of limb to wider body area
Todds paresis
Involuntary actions

38
Q

Temporal lobe epilepsy features?

A

Aura
Automatisms (playing with fingers, lip smacking)
Hallucinations

39
Q

Features of parietal lobe epilepsy?

A

Sensory disturbances e.g. pain, tingling, numbness

40
Q

Features of occipital lobe epilepsy?

A

Visual phenomena e.g. spots, lines and flashes

41
Q

Ix for epilepsy?

A

Need 2 or more unprovoked seizures >24 hours apart

EEG
Bloods (hypo, FBC, Electrolyte, serum prolactin elevated post seiuzure)
CT/MRI (structural lesions)

42
Q

Mx for seizures?

A

Generalised :

1) Sodium valproate
2) carbamazepine

Focal:

1) Carbamazepine
2) Lamotrigine

Others = phenytoin, levetiracetam, cobazam

Pregnancy = avoid valproate and use lamotrigine

43
Q

SEs of seizure management?

A

Psychiatric (depression)
Weight gain

Carbamezepine = neutropaenia and osteoporosis
Lamotrigine = TENS/Steven-johnsons
44
Q

AED MOA?

A

Benzos via enhanced GABA inhibition

Levitarecem b reduced glutamate excitation (pre)

Lamotrigine, phenyotin and CBZ via block action potential deplaisation

45
Q

What is status epilepticus and triggers?

A

Seizure lasting >5mins and repeated seixures without recovery or consciousness regain

Trigger: non adherence to meds, alcohol abuse and OD & toxicivity

46
Q

Mx for status epilepticus?

A 
ABC
Airway, IV access and monitoring
-> IV lorazepam (repeat after 10mins)
-> IV phenytoin
-> ICU
47
Q

Complications of epilepsy?

A

Sudden death in epilepsy
Behavioural problems
Fractures
Complications from drugs

48
Q

What is GUillain-Barre syndrome?

A

Acute autoimmune demyelination polyneuropathy affecting the PNS

AI attacks the myelin in peripheral nerves. Mechanism is molecular mimicry

49
Q

Presentation of GBS?

A

URTi, gastroenteritis (Campylobacter, CMV, HIV)

  • > 2-3 wees = peripheral neuropathy with acute progression, ascending aprasthesia and pain, symetrical limb weakness
  • > can progress to affect resp muscles = resp paralysis

Other RFs = cancer (lymphoma and immunisation)

50
Q

What signs are in GBS?

A

Hypotonia, flaccid paralysis, altered sensation and numbness, weakness, fasciculations

51
Q

What is Miller-FIscher syndrome?

A

Triad of opthalmoplegia, areflexia and ataxia but NO muscle weakness

52
Q

Ix for GBS?

A

Nerve conduction studies can be confirmatory (decreased velocity)

CSF = albuminocytological dissociation with increased protein and nirmal glucose and cell count

Spirometry

Bloods = anti-ganglioside Abs n Miller-fisher variant and 25% GBS

53
Q

What is hydrocephalus?

A

Excessive accumulation of CSF in the ventricular system in the brain

Bimodal distribution

54
Q

Types of hydrocephalus?

A

Non-communication/obstructive = stenosis of cerbral aqueduct, lesions in 3rd/4th ventricle, psoterior fossa lesions compressing 4th ventricle

Communication hydrocephalus = decreased absoprton and increased production of CSF = tumours, meningitis (TB), normal pressure hydrocephalus )idiopathic ventricular enlargement with out elevated CSF pressure)

hydrocephalus ex vacuo = ventricular expansion secondary to brain atrophy e.g. alzheimers

55
Q

Presentation of hydrocephalus?

A

Acute = features of ICP e.g. n+V, headache, pappilloedema

Gradual = cognitive impairement, unsteady gait, double vision, CN palsies

NPH = 1) cognitive impairement, gait apraxia, hyperreflexia (wet, wacky, wobbly)

Kids = sunset eyes and large head

56
Q

hydrocephalus Ix?

A

1st = CT/MRI head

CSF = ventricular drain may show infection

LP is contraindicated in hih ICP

57
Q

Causes of cord compression?

A 
Trauma = young
Chronic = old e.g. tumours, osteoporosis, corticosteroids, intervertebral disease e.g. disc herniation
58
Q

Cord compression symptoms?

A

Depends on the level

Motor = limb weakness, UMN symptoms below level of the lesion and LMN at level of lesion

Sensry = loss below a specific level and back pain

Autonomic = constipation, urinary retention, erectile dysfunction

59
Q

Ix for cord compression?

A

Radiology with MRI definitive
Bloods = FBC, U&Es, caclcium and immunoglobulins for MM
Urine for bence jones for MM

60
Q

What is cauda equine syndrome and causes?

A

Lumbosacral nerve roots that from the cauda equine in the spinal canal become compressed

Commonly by disc compression and stenosis of the spinal canal

61
Q

Presentatio of cauda equina syndrome?

A

LMN symptoms, perianal anaesthesis, bladde retention and leg weakness

62
Q

What is radiculopathy and example?

A

Range of symptoms from compression of nerve at or near root where it exits the spinal cord

E.g. sciatica = lumbosacral and pain and tingling radiating from the lower back to ipsilateral leg. Weakening in calf msucles

63
Q

Causes of radiculopathy?

A

Degenerative disc disease, osteoarthritis, tumours, infection e.g. spondylithesis

64
Q

Presentation and IX for radiculopathy?

A 
Motor = LN symptoms from nerve
Sensory = dermatomal with pain and numbness

CT/MRI for herniation
Laegues sign for Sciatic

65
Q

What is a dissociative seizure?

A

Cam resemble epileptic seizure but have NO biological correlate

Prlonged duration
Hx of abuse, psychological or emotional precipitant

Mx involves psychotherapy

MedEd (32 decks)

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