Case Rounds

Question 1

Dfx for TIA

Answer 1

Carotid disease
Migraine - is this a typical migraine for you? Otherwise check for secondary
Epilepsy - focal seizure
Cerebral tumour

Question 2

What is the main investigation you do to screen for TIA?

Answer 2

CT or MRI

Question 3

Why might you do an echo?

Answer 3

To check for:
Mural thrombus
Valvular disease
Left atrial tumour

Rare causes of TIA

Question 4

What do you call the symptoms of TIA?

Answer 4

Neurovascular syndrome
Sudden transient symptoms
Negative phenomena that lateralise to certain parts of the body

Question 5

What symptoms might you get in a

Answer 5

double vision

cross signs e.g

Question 6

What kind of haemorrhage causes TIA like symptoms?

Answer 6

Subdural haemorrhage

Question 7

What additional symptoms might they have?

Answer 7

Lethargy

Question 8

Treatment for haemorrhage

Answer 8

Burr hole drainage

Question 9

Name a cause for weakness in arm five/six times a day

Answer 9

Cystic lesion with oedematous black area around the cyst

Question 10

Name a scan that is sensitive for picking up a TIA in the past

Answer 10

MRI DWI scan (damaged area shows up white)

Question 11

What are the two areas from which TIA can occur?

Answer 11

Small artery disease

Large artery to small artery disease (atherosclerosis from basilar symptom/arch of aorta/carotid lodging in brain)

Question 12

What might you do in order to identify the origin of the embolus causing

Answer 12

Contrast enhanced CT
Carotid doppler ultrasound
Carotid endarterectomy

Question 13

What tablets would you give?

Answer 13

Antiplatelets

Modify risk factors e.g. exercise, better diet, reduce salt, manage diabetes and lipid profile

Question 14

What are the two types of clot causing TIA?

Answer 14

White clot -> atherosclerosis

Red clot -> cardio embolic clot

Question 15

main causes of red clot

Answer 15

AF / paroxysmal AF (CHA2DS2VASc score)
Ventricular thrombi (infarcted wall causing lack of movement of blood)

Question 16

Investigations for cardiac causes of TIA

Answer 16

Implantable loop recorder (ILR)

24 hr ecg tape

Question 17

What percentage of people with stroke don’t have a cause?

Answer 17

in 1/3 of patients, there is

Question 18

Cardiac embolic red clot treatment

Answer 18

Anti coag

Question 19

Which neuro condition does not affect lower limbs?

Answer 19

MS

endo 124 case

Question 20

What gives fatigueable ptosis?

Answer 20

Myasthenia gravis

Question 21

Three key features of parkinsons

Answer 21

Bradykinesia
Led pipe rigidity
Tremor

Question 22

Both parkinsons and stroke give increased tone

Answer 22

In stroke, there is spasticity - the arm stiff then suddenly it gives

Question 23

What is a tensilon test and what is it used for? What’s the problem with this?

Answer 23

AchE inhibitor - given to see whether more Ach makes a difference in their speech/movement, used to

Question 24

What might worsen MG?

Answer 24

Anaesthesia and other drugs might

Question 25

What neuro condition is associated with small cell lung cancer?

Answer 25

Lambert-eaton myasthenia gravis (different to MG) link to small cell lung cancer