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Yr 3 MedEd > Acute Neurology > Flashcards

Acute Neurology Flashcards

1
Q

What is the definition of stroke and TIA?

A

Stroke:
- Focal neurological deficit of presumed vascular origin lasting more than 24 hours

TIA: symptoms resolve in less than 24 hrs.

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2
Q

Which scoring system is used to assess risk of stroke in patients with AF?
Which score system is used to check patients risk of bleeding if anticoagulated?

A
  • CHA2DS2-Vasc score.
  • HAS-BLED score

CHA2DS2-Vasc more than 2 suggests anti-coagulation necessary, unless HAS-BLED is more than 3.

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3
Q

Give 5 features of stroke presentation.

A
  • Sudden onset
  • Weak/ numb face, arms, legs
  • Change in vision
  • Dizziness
  • Speech problems
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4
Q

What areas of the brain do the following arteries supply?

  • Anterior cerebral artery
  • Middle cerebral artery
  • Posterior cerebral artery?
A
  • Anterior: medial aspect of frontal and parietal lobes
  • Middle: Lateral surface of hemispheres and subcortical surface
  • Posterior: Occipital lobe and inferomedial temporal lobe.
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5
Q

Give physiological effects of following:

  • ACA stroke
  • MCA stroke
  • PCA stroke
A

ACA

  • Contralateral hemiparesis- lower limb > upper limb.
  • Behavioural changes.

MCA

  • Contralateral hemiparesis upper limb/ face > lower limb.
  • Contralateral hemisensory loss.
  • Apraxia
  • Aphasia
  • Quadrantopia

PCA:

  • Contralateral homonymous hemianopia
  • Visual agnosia
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6
Q

Give the acronym for signs of cerebellar damage.

Are cerebellar lesions ipsi or contralateral?

A
  • DANISH
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred, staccato speech
  • Hypotonia, Heel-shin test.

NB cerebellar lesions lead to ipsilateral signs.

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7
Q

Give an eye symptom in TIA.

A
  • Amaurosis fugax- like curtain descending.
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8
Q

Give 3 features required for total anterior circulation stroke.

Give 3 features of posterior circulation stroke

Give 3 features of lacunar stroke.

A

TACS: all 3 of (partial is only 2)

  • Contralateral motor or sensory deficit
  • Homonymous hemianopia
  • Higher cortical dysfunction

PCS: Any of

  • Isolated homonymous hemianopia
  • Brainstem signs
  • Cerebellar ataxia

LACS: any of

  • Pure motor deficit
  • Pure sensory deficit
  • Sensorimotor deficit

Lacunar infarcts in deep cerebral white matter, basal ganglia or pons occur from occlusion of single small perforating artery supplying brain.

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9
Q

Give immediate management for stroke

A
  • Urgent CT non-contrast head within 1 hour to rule out haemorrhage
  • Bloods, ECG and vital signs
  • Administration of r-tPA (unless hyper or hypoglycaemic)
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10
Q

Following exclusion of haemorrhage what is management of stroke < 4.5hrs and > 4.5hrs?

A

< 4.5 hrs: IV alteplase (r-tPA) then oral aspirin 300mg

> 4.5hrs (or thrombolysis contraindicated): oral aspirin 300mg.

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11
Q

Give 3 alternative investigations for stroke

A
  • CT angiogram
  • MRI
  • Carotid doppler to asses for carotid artery stenosis with >70% occlusion.
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12
Q 
Give secondary prevention management in stroke for:
- AF and non-AF patients.
- TIA
- Haemorrhagic stroke
What is surgical long term management?
A
  • AF: warfarin prophylaxis
  • non- AF: continue aspirin for 2 weeks, switch to lifelong clopidogrel.
  • TIA: lifestyle, statin therapy, consider aspirin.
  • Haemorrhagic: control BP, review anticoagulation medication.
    Surgical: Carotid endarterectomy (atherosclerosis removal).
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13
Q

What tool is used to asses risk of TIA patient developing stroke?

A

ABCD2

  • Age
  • Blood pressure
  • Clinical presentation
  • Duration of symptoms
  • Diabetes mellitus
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14
Q

Give 4 possible triggers of epilepsy.

Give 4 signs of epileptic seizure.

Give 5 post-ictal signs.

A
  • lack of sleep
  • flickering lights
  • alcohol
  • stress
  • Duration >3 mins
  • Incontinence
  • Tongue biting
  • Jerking movements
  • Slow recovery
  • confusion
  • headache
  • myalgia
  • Todd’s paresis: weakness in all or parts of body.
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15
Q

What occurs in tonic-clonic seizure

A
  • Initial tonic straightening of body and limbs, then clonus, jerking of body.
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16
Q

Give symptoms of the following focal epileptic seizures:

  • Frontal lobe
  • Parietal lobe
  • Temporal lobe
  • Occipital lobe
A

Frontal:

  • Motor Sx
  • Jacksonian march
  • Todd’s palsy
  • Involuntary actions

Parietal:
- Sensory disturbance- pain tingling, numbness

Temporal:

  • Aura
  • Automatisms- playing with fingers, lip smacking
  • Hallucinations

Occipital lobe:
- visual phenomena.

17
Q

Give 3 investigations for epilepsy.

A
  • Electroencephalogram (EEG)
  • Bloods
  • Brain imaging- CT/MRI.
18
Q

What is 1st and second line medication management for generalised and focal seizures?

Which antiepileptic should be avoided in pregnancy?

A
  • Generalised: Sodium valproate, then carbamazepine
  • Focal: carbamazepine then lamotrigine.
  • Avoid sodium valproate in pregnancy, use Lamotrigine.
19
Q

What is management of status epilepticus?

A

ABC approach

  • Secure airway, 100% O2
  • IV access and monitoring vitals
  • IV lorazepam. then repeat after 10 minutes
  • IV phenytoin
  • ICU
20
Q

What is the definition of Guillain- Barré syndrome.
What is the pathophysiology?
Which infections are common precedents?

A
  • Acute autoimmune demyelinating polyneuropathy affecting PNS.
  • AI process attacking myelin (Schwann cells) in peripheral nerves.
  • URTI, gastroenteritis.
21
Q

Give 3 pathogens causing Guillain- Barré syndrome.

Describe subsequent peripheral neuropathy (4). What may it progress to?

Give 1 variant of GBS.
What triad is it characterised by?

A
  • Campylobacter Jejuni, CMV, HIV.
  • Acute progression
  • Ascending paraesthesia and pain
  • Symmetrical limb weakness
  • Autonomic symptoms- urinary retention, ileum.
  • May progress to resp. weakness/ paralysis.
Miller-Fischer syndrome: triad of 
- Opthalomplegia
- areflexia
- ataxia
But no muscle weakness. Antibodies against specific ganglioside.
22
Q

Give 4 investigations for Guillain-Barré syndrome

A
  • Nerve conduction studies- reduced conduction velocity
  • Lumbar puncture: Raised protein, normal glucose and cell count
  • Spirometry: check for muscle weakness
  • Bloods: anti-ganglioside ABs in Miller-Fischer variant.
23
Q

What is epidemiological age distribution of hydrocephalus?

Give 4 aetiologies of hydrocephalus

A
  • Bimodal, affects elderly and young.
  • Non-communicating/ obstructive: caused by CSF flow obstruction.
  • Communicating: reduced absorption, increased production of CSF.
  • Normal pressure hydrocephalus : idiopathic, ventricular enlargement without sig. elevated CSF pressure.
  • Hydrocephalus ex vacuo: ventricular expansion 2ary to brain atrophy.
24
Q

Give 3 features of acute onset hydrocephalus.
Give 4 features of gradual onset hydrocephalus
Give 3 signs of normal pressure hydrocephalus.

A

Acute: (raised ICP)

  • N&V
  • Headache
  • Papilloedema

Gradual:

  • Cognitive impairment
  • Unsteady gait
  • Double vision
  • CN palsies

NPH:

  • Cognitive impairement
  • Gait apraxia
  • Hyperreflexia.
25
Q

Give 2 investigations for hydrocephalus.

What is contraindication for lumbar puncture.

A
  • CT/ MRI head: ventricular enlargement
  • CSF analysis: from ventricular drain, may show infection
  • LP contraindicated if high ICP.
26
Q

Give 2 acute and 2 chronic causes of spinal cord compression.

Where do UMN and LMN symptoms present in relation to cord compression?

Give 3 autonomic symptoms.

A

Acute: trauma, disc herniation
Chronic: osteoporosis, tumours.

  • UMN below level of lesion
  • LMN at level of lesion
  • Constipation
  • Urinary retention
  • erectile dysfunction.
27
Q

Give 2 investigations in cord compression for multiple myeloma.

A
  • Blood: immunoglobulin electrophoresis.

- Urine: bence jones proteins.

28
Q

Give 4 presenting symptoms of cauda equina.

A
  • LMN symptoms
  • Perianal anaesthesia
  • Bladder retention
  • Leg weakness
29
Q

What is definition of radiculopathy.
Give motor and sensory presentation of radiculopathy.
Give example of radiculopathy and clinical diagnosis.

A
  • Symptoms due to nerve compression near root as it exits spinal cord.
  • Motor: LMN symptoms.
  • Sensory: dermatomal pain/ numbness
  • Sciatica: pain tingling radiating from lower back to ipsilateral leg. Weakness in calf muscles.
  • Clinical diagnosis: straight leg raise test. Passive hip flexion 30-70 degrees causes pain.
30
Q

When should dissociative seizure be suspected?

What is management?

A
  • Prolonged duration
  • Hx of abuse, psychological or emotional precipitants.
    No biological correlate but resembles epilepsy.

Management involves psychotherapy.

31
Q

Give scoring method for GCS.

A
  • EVM. Minimum 3, max 15.
    Eyes
  • 4 spontaneous, 3 speech, 2 pain, 1 no response.
    Verbal
  • 5 orientated, 4 confused, 3 inappropriate words, 2 incomprehensible, 1 no response.
    Motor
  • 6 obeys command, 5 moves to localised pain, 4 flex to withdraw from pain, 3 abnormal flexion, 2 abnormal extension. 1 no response.

Yr 3 MedEd (31 decks)

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