Case Rounds Flashcards
Dfx for TIA
Carotid disease
Migraine - is this a typical migraine for you? Otherwise check for secondary
Epilepsy - focal seizure
Cerebral tumour
What is the main investigation you do to screen for TIA?
CT or MRI
Why might you do an echo?
To check for:
Mural thrombus
Valvular disease
Left atrial tumour
Rare causes of TIA
What do you call the symptoms of TIA?
Neurovascular syndrome
Sudden transient symptoms
Negative phenomena that lateralise to certain parts of the body
What symptoms might you get in a
double vision
cross signs e.g
What kind of haemorrhage causes TIA like symptoms?
Subdural haemorrhage
What additional symptoms might they have?
Lethargy
Treatment for haemorrhage
Burr hole drainage
Name a cause for weakness in arm five/six times a day
Cystic lesion with oedematous black area around the cyst
Name a scan that is sensitive for picking up a TIA in the past
MRI DWI scan (damaged area shows up white)
What are the two areas from which TIA can occur?
Small artery disease
Large artery to small artery disease (atherosclerosis from basilar symptom/arch of aorta/carotid lodging in brain)
What might you do in order to identify the origin of the embolus causing
Contrast enhanced CT
Carotid doppler ultrasound
Carotid endarterectomy
What tablets would you give?
Antiplatelets
Modify risk factors e.g. exercise, better diet, reduce salt, manage diabetes and lipid profile
What are the two types of clot causing TIA?
White clot -> atherosclerosis
Red clot -> cardio embolic clot
main causes of red clot
AF / paroxysmal AF (CHA2DS2VASc score) Ventricular thrombi (infarcted wall causing lack of movement of blood)
Investigations for cardiac causes of TIA
Implantable loop recorder (ILR)
24 hr ecg tape
What percentage of people with stroke don’t have a cause?
in 1/3 of patients, there is
Cardiac embolic red clot treatment
Anti coag
Which neuro condition does not affect lower limbs?
MS
endo 124 case
What gives fatigueable ptosis?
Myasthenia gravis
Three key features of parkinsons
Bradykinesia
Led pipe rigidity
Tremor
Both parkinsons and stroke give increased tone
In stroke, there is spasticity - the arm stiff then suddenly it gives
What is a tensilon test and what is it used for? What’s the problem with this?
AchE inhibitor - given to see whether more Ach makes a difference in their speech/movement, used to
What might worsen MG?
Anaesthesia and other drugs might
What neuro condition is associated with small cell lung cancer?
Lambert-eaton myasthenia gravis (different to MG) link to small cell lung cancer
