Acute Neurology Flashcards
What is the definition of stroke and TIA?
Stroke:
- Focal neurological deficit of presumed vascular origin lasting more than 24 hours
TIA: symptoms resolve in less than 24 hrs.
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?
- CHA2DS2-Vasc score.
- HAS-BLED score
CHA2DS2-Vasc more than 2 suggests anti-coagulation necessary, unless HAS-BLED is more than 3.
Give 5 features of stroke presentation.
- Sudden onset
- Weak/ numb face, arms, legs
- Change in vision
- Dizziness
- Speech problems
What areas of the brain do the following arteries supply?
- Anterior cerebral artery
- Middle cerebral artery
- Posterior cerebral artery?
- Anterior: medial aspect of frontal and parietal lobes
- Middle: Lateral surface of hemispheres and subcortical surface
- Posterior: Occipital lobe and inferomedial temporal lobe.
Give physiological effects of following:
- ACA stroke
- MCA stroke
- PCA stroke
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
Give the acronym for signs of cerebellar damage.
Are cerebellar lesions ipsi or contralateral?
- DANISH
- Dysdiadochokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred, staccato speech
- Hypotonia, Heel-shin test.
NB cerebellar lesions lead to ipsilateral signs.
Give an eye symptom in TIA.
- Amaurosis fugax- like curtain descending.
Give 3 features required for total anterior circulation stroke.
Give 3 features of posterior circulation stroke
Give 3 features of lacunar stroke.
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.
Give immediate management for stroke
- 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)
Following exclusion of haemorrhage what is management of stroke < 4.5hrs and > 4.5hrs?
< 4.5 hrs: IV alteplase (r-tPA) then oral aspirin 300mg
> 4.5hrs (or thrombolysis contraindicated): oral aspirin 300mg.
Give 3 alternative investigations for stroke
- CT angiogram
- MRI
- Carotid doppler to asses for carotid artery stenosis with >70% occlusion.
Give secondary prevention management in stroke for: - AF and non-AF patients. - TIA - Haemorrhagic stroke What is surgical long term management?
- 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).
What tool is used to asses risk of TIA patient developing stroke?
ABCD2
- Age
- Blood pressure
- Clinical presentation
- Duration of symptoms
- Diabetes mellitus
Give 4 possible triggers of epilepsy.
Give 4 signs of epileptic seizure.
Give 5 post-ictal signs.
- 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.
What occurs in tonic-clonic seizure
- Initial tonic straightening of body and limbs, then clonus, jerking of body.
Give symptoms of the following focal epileptic seizures:
- Frontal lobe
- Parietal lobe
- Temporal lobe
- Occipital lobe
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.
Give 3 investigations for epilepsy.
- Electroencephalogram (EEG)
- Bloods
- Brain imaging- CT/MRI.
What is 1st and second line medication management for generalised and focal seizures?
Which antiepileptic should be avoided in pregnancy?
- Generalised: Sodium valproate, then carbamazepine
- Focal: carbamazepine then lamotrigine.
- Avoid sodium valproate in pregnancy, use Lamotrigine.
What is management of status epilepticus?
ABC approach
- Secure airway, 100% O2
- IV access and monitoring vitals
- IV lorazepam. then repeat after 10 minutes
- IV phenytoin
- ICU
What is the definition of Guillain- Barré syndrome.
What is the pathophysiology?
Which infections are common precedents?
- Acute autoimmune demyelinating polyneuropathy affecting PNS.
- AI process attacking myelin (Schwann cells) in peripheral nerves.
- URTI, gastroenteritis.
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?
- 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.
Give 4 investigations for Guillain-Barré syndrome
- 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.
What is epidemiological age distribution of hydrocephalus?
Give 4 aetiologies of hydrocephalus
- 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.
Give 3 features of acute onset hydrocephalus.
Give 4 features of gradual onset hydrocephalus
Give 3 signs of normal pressure hydrocephalus.
Acute: (raised ICP)
- N&V
- Headache
- Papilloedema
Gradual:
- Cognitive impairment
- Unsteady gait
- Double vision
- CN palsies
NPH:
- Cognitive impairement
- Gait apraxia
- Hyperreflexia.
