Acute neurological complaints Flashcards

Question

What is the most common cause of vertigo?

Answer 1

The most common cause is benign paroxysmal positional vertigo (BPPV), which accounts for 32% of all peripheral vertigo

Answer 2

Other causes include Ménière's disease (12%), superior canal dehiscence syndrome, labyrinthitis, and visual vertigo

Answer 3

Any cause of inflammation such as common cold, influenza, and bacterial infections may cause transient vertigo if it involves the inner ear, as may chemical insults (e.g., aminoglycosides) or physical trauma (e.g., skull fractures).

Answer 4

Motion sickness is sometimes classified as a cause of peripheral vertigo

Answer 5

Patients with peripheral vertigo typically present with mild to moderate imbalance, nausea, vomiting, hearing loss, tinnitus, fullness, and pain in the ear.[14] In addition, lesions of the internal auditory canal may be associated with facial weakness on the same side.[14] Due to a rapid compensation process, acute vertigo as a result of a peripheral lesion tends to improve in a short period of time (days to weeks).[14]

Answer 6

Other CNS deficits | But 4% of isolated nystagmus is caused by stroke

Answer 7

* Ptosis (70% of L paplebrae by Parasympathetic III fibres) – may be complete * Mydriasis with decreased direct and consensual constriction * Inferio-lateral deviation of eye in primary position * Diplopia on upwards and inwards gaze * Loss of accomodation Sudden onset with papillary sparing – sudden infarction of the nerve ‘MEDICAL’ - Diabetes - Hypertension

Answer 8

Normal eye position in primary position. Diplopia and strasbismus on lateral gaze towards the side of the lesion. True horizontal diplopia. Often the strabismus is not appreciable; check the diplopia is true (disappears when you test one eye) the direction of maximal diplopia, and the eye responsible for the outermost image.

Answer 9

Element of fatiguability

Answer 10

If the right medial longitudinal fasciculus is damaged, and patient is instructed to look to the left, the right eye will not look to the left (fails to adduct) while the left eye has horizontal nystagmus. This is because the medial longitudinal fasciculus function is for concurrence contraction of medial rectus muscle and lateral rectus muscle on adduction gaze. Any lesion that damages the unilateral medial longitudinal fasciculus can produce INO.

Answer 11

Most nystagmuses are biocular unless in a medial pontine stroke, where the unilateral medial longitudinal fasciculus is affected. Patient will present with contralateral internuclear opthalmoplegia (INO).

Answer 12

Mild ptosis Miosis Anhydrosis Enophalmos

Answer 13

UMN of the facial nerve tract (left pre central gyrus, left corona radiata or left posterior limb of internal capsule)

Answer 14

full one sided facial nerve palsy

Answer 15

``` Blood Contrast Bone Calcium Metal ```

Answer 16

Air CSF/ H2O Oedema

Answer 17

The sudden death of brain cells due blockage of blood flow or rupture of an artery to the brain parenchyma

Answer 18

``` Hypertension Rupture of an aneurysm or AVM Haemorrhagic necrosis (eg tumour, infection) Venous outflow obstruction (CVT) Trauma Altered haemostasis ``` ``` Pressure of increasing amounts of blood Blood itself (blood is irritating to the brain tissue, causing it to swell) ```

Answer 19

``` Cryptogenic Large vessel atherosclerosis Small vessel disease Cardio embolic Other ```

Answer 20

Oxygen deprivation causes a biochemical cascade leading to cell death Water comes into cell and swells/ bursts resulting in lower density areas on a brain scan

Answer 21

``` HT DM Smoking Cholesterol BMI CAD FMHx Age ``` Intracranial stenosis Carotid stenosis Aortic Arch Plaque

Answer 22

Carotid endarterectomy (CEA) is of additional benefit for symptomatic carotid disease

Answer 23

Anti platelets | Lifestyle changes

Answer 24

Atrial fibrillation (AF) and paroxysmal AF (PAF) Valve disease Ventricular thrombi

Answer 25

``` Patient’s history Clinical symptoms and signs Baseline ECG PAF = AF 24,48,72 hour, 7 day, cont ECG monitoring ``` [ADD PICTURE slide 55]

Answer 26

Ischemic zone surrounds a central core of infarction Viability of brain tissue is preserved if perfusion is restored within a critical time period. Tissue surrounding the infarct that is salvageable, but at risk. Help using rt-PA ``` How do we save it: Collateral circulation Systemic circulation Temperature Glucose Time ```

Answer 27

``` Airway and Breathing Protect from aspiration and hypoxemia Vitals/BM / O2 IV access (Two green venflons) Clinical and neurological Assessment Onset and scenario Significant comorbidities and medications NIHSS scale Review contraindication list for thrombolytics Labs Glucose, electrolytes, FBC , coags Consent Order Non- Contrast Head CT Obtain CT ```