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Neurology > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What causes a subdural haemorrhage

A

Tearing of the bridging veins
Very delicate so happens easily
Common in the elderly when they fall

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2
Q

What is the function of the oligodendrocytes

A

Produce the myelin sheath in the CNS

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3
Q

What happens to nerve cells when they are damaged

A

Rapid necrosis with acute functional failure -seen in stroke
Slow atrophy with gradual increasing dysfunction - seen in dementia

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4
Q

When would you see a red neuron

A

After neuronal cell death in the context of ischaemia
Cytoplasm will be red on histology
Nuclei shrink and become angulated

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5
Q

In which conditions are the oligodendrocytes damaged

A

Demyelinating disorders - MS

Sensitive to oxidative damage as well

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6
Q

What are the functions of astrocytes

A

Ionic, metabolic and nutritional homeostasis
Maintain the BBB and regulate blood flow
Repair and scar formation

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7
Q

What is gliosis

A

Indicator of CNS injury - response from the astrocytes
Increase in the number and size of astrocytes
Can become a glial scar - dense area of processes

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8
Q

How do ependymal cells respond to injury

A

Limited response

Infectious agents can produce changes in them

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9
Q

What is the function of the microglia

A

They mop up debris in the brain - phagocytosis
Aggregate around areas of damage and necrosis
Recruited by inflammatory mediators

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10
Q

What can cause injury to the nervous system

A 
Hypoxia 
Trauma 
Toxins - endogenous or exogenous
Metabolic abnormalities
Nutritional deficiency 
Infections 
Genetic abnormalities 
Ageing
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11
Q

What can cause brain hypoxia

A 
Cerebral ischaemia
Infarct,
Haemorrhages
Trauma
Cardiac arrest
Cerebral  palsy
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12
Q

Why is the brain so sensitive to hypoxia

A

It consumes 20% of the body’s oxygen at rest
So needs consistent oxygenation to function
Will use up ATP stores within minutes without aerobic respiration

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13
Q

What is excitotoxicity

A

Mediator of neuronal injury
Glutamate accumulates as the reuptake is interrupted
Post-synaptic channels are excited which leads to rapid accumulation in Ca+
This can lead to death of the neuron

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14
Q

What types of oedema can affect the brain

A

Cytotoxic oedema - water and NaCl move into the cytoplasm of cells
Ionic oedema - osmosis which occurs in excess water intake and hyponatraemia
Vasogenic - occurs in trauma, inflammation and tumours

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15
Q

How much of the cardiac output does the brain receive

A

15%

Also consumes 20% of the oxygen

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16
Q

How does the brain maintain constant blood flow

A

Autoregulatory mechanisms can control the dilation and constriction of cerebral vessels to maintain an appropriate pressure

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17
Q

When is the autoregulation of blood pressure in the brain no longer efficient

A

The regulatory methods will be exhausted at either very high pressures (>160) or very low (<60)
This will lead to issues with flow and oxygenation

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18
Q

What is cerebrovascular disease

A

Any abnormality of brain caused by a pathological process of blood vessels
Common cause of death and adult disability

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19
Q

What causes global hypoxic ischaemic damage

A

Generalised reduction in blood flow or oxygenation
Cardiac arrest
Severe hypotension - e.g. after trauma with hypovolemic shock

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20
Q

What causes focal ischaemic damage

A

Vascular obstruction

Thrombus or emboli

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21
Q

What are the watershed areas of the brain

A

The zones between 2 arterial territories

They are particularly sensitive to ischaemic injury

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22
Q

What is the definition of a stroke

A

Sudden disturbance of cerebral function of vascular origin that causes death or lasts over 24 hours

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23
Q

What is the most common type of stroke

A

Ischaemic
Most commonly due to a thrombus
Embolic strokes also happen but aren’t as common

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24
Q

What are the different types of haemorrhagic stroke

A

Intracerebral - most common
Subarachnoid
Bleeding into an infarct - haemorrhagic transformation

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25
Q

Which brain artery is most commonly affected by thrombosis

A

Middle cerebral artery and its territory

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26
Q

Where do the emboli that cause strokes commonly come from

A

From atheroma in internal carotid and aortic arch

Heart - AF

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27
Q

What are the risk factors for ischaemic stroke

A 
Atheroma 
Hypertension 
Obesity and high serum lipids 
Diabetes mellitus 
Heart and vessel disease 
Disease of the neck arteries 
AF 
Patent foramen ovale 
Arterial dissection 
Drugs 
Smoking
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28
Q

What factors determine the extent of damage in a cerebral infarction

A

The territory supplied by the affected artery
Timescale of the occlusion
Extent of the collateral circulatory relief
Systemic perfusion pressure

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29
Q

How long after a stroke does gliosis occur

A

Around 1 week

Microglia will be the dominant cell type on microscopy

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30
Q

At what point does brain damage become visible after infarction

A

12-24hrs after
On microscopy you will see red neurons and oedema
To the naked eye the brain is pale and slightly swollen - more visible after 48hrs

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31
Q

What are the symptoms of infarct in the carotid arteries

A

Contra‐lateral weakness or sensory loss

If dominant hemisphere, may be aphasia or apraxia

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32
Q

What are the symptoms of infarct in the middle cerebral arteries

A

Weakness will be predominantly in the contralateral face and arm

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33
Q

What are the symptoms of infarct in the anterior cerebral artery

A

Weakness and sensory loss in the contralateral leg

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34
Q

What are the symptoms of infarct in the vertebral or basilar arteries

A

Vertigo
Ataxia
Dysarthria
Dysphasia

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35
Q

What effect does hypertension have on the brain

A

Accelerated atherosclerosis
Microaneurysms
Higher risk of stroke (lacunar particularly)
Risk of rupturing aneurysm and general haemorrhage
Can get hypertensive encephalopathy

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36
Q

What happens in hypertensive encephalopathy

A

Global cerebral oedema
Tentorial and tonsillar herniation
Petechiae
Arteriolar necrosis

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37
Q

What can cause an intracranial haemorrhage

A 
Can be spontaneous 
Trauma 
Hypertension 
Aneurysms 
Coagulation disorders 
Anticoagulants 
Vascular malformations 
Amyloid deposits 
Diabetes 
Vasculitis 
Drugs and alcohol
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38
Q

Where do intracerebral haemorrhages most commonly occur

A

Basal ganglia is the most common

Also thalamus, cerebral white matter and cerebellum

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39
Q

What surrounds a haemorrhage in the brain

A

Significant oedema

This in itself will contribute to brain damage

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40
Q

What is amyloid angiopathy

A

You get deposits of amyloid proteins which stick together
Affects the blood vessels - aren’t as flexible and cant respond to changes in BP
This makes them more likely to rupture

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41
Q

What are the risks with vascular malformations

A

Can lead to haemorrhage - AVM or cavernous angiomas are most likely to
Can also lead to headaches, seizures and focal neurological deficits

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42
Q

Do all vascular malformations cause stroke

A

Nope

Some can be small incidental findings

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43
Q

Describe arteriovenous malformations

A

It is an abnormal tortuous vessel where there is shunting from an artery to a vein
These will undergo smooth muscle hypertrophy
They are not very compliant and so rupture easily
Can also form aneurysms

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44
Q

What causes a subarachnoid haemorrhage

A

Most commonly due to spontaneous rupture of a berry aneurysm in the circle of Willis
Can be due to trauma

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45
Q

What are the risk factors for a subarachnoid haemorrhage

A

Smoking
Hypertension
Kidney disease - PCKD is associated with berry aneurysms
Women often more commonly affected

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46
Q

What are the symptoms of a subarachnoid haemorrhage

A 
Severe headache - thunderclap 
Worst headache they've ever had
Vomiting 
Loss of consciousness 
Usually no history or precipitating factor
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47
Q

What is the mortality and morbidity like for subarachnoid haemorrhage

A

50% will die after a few days

Survivors are at risk of hydrocephalus

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48
Q

What are the 4 main classes of stroke

A

Total anterior circulation infarct (TACI)
Partial anterior circulation infarct (PACI)
Lacunar infarct (LACI)
Posterior circulation infarct (POCI)

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49
Q

Which class of stroke is considered the most severe

A

Total anterior circulation infarct (TACI)

This is because it has the greatest amount of brain damage

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50
Q

What are the key signs of TACI

A

4 main features:
Hemiplegia involving at least 2 of face, arm and leg
Hemisensory loss/deficit
Homonymous hemianopia
Cortical signs - dysphasia, neglect of one side, cognitive issue etc.

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51
Q

What are the key signs of PACI

A

Any 2 out of 4 features of TACI (hemiplegia, hemisensory issue hemianopia, cortical signs)
OR
Isolated cortical dysfunction such as dysphasia
OR
Pure motor/sensory signs less severe than in lacunar

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52
Q

What are lacunar infarcts

A

Small infarcts in the deeper parts of the brain or in the brainstem
Can affect the basal ganglia, thalamus or white matter or brainstem
Caused by the occlusion of a single, deep penetrating artery

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53
Q

How does a lacunar infarct present

A

Can be a pure motor stroke - hemiplegia affecting 2 from face, arms or legs
Can also be purely sensory or sensorimotor
May present with ataxic hemiparesis
Or may go unrecognised if not in a clinically relevant area

Has no cortical signs
Higher cerebral function/cognition preserved

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54
Q

What are some risk factors for lacunar stroke

A

Hypertension
Diabetes
Smoking

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55
Q

How does posterior circulation syndrome/infarcts present

A

Symptoms and signs fit the vertebrobasilar system (vertigo, ataxia, dysarthria) or brainstem

Cranial nerve palsies
Bilateral motor and/or sensory deficits
Conjugate eye movement disorders 
Isolated homonymous hemianopia  - PCA supplies the occipital lobe
Cortical blindness
Cerebellar deficits
Can lead to locked in syndrome
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56
Q

Infarcts/events in the left hemisphere (usually dominant) causes what issues?

A

Often affects language and communication
Dysphasia, agnosia and dysarthria
More involved in sensory functions
Implications in rehab

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57
Q

Infarcts/events in the right hemisphere (usually non-dominant) causes what issues?

A

Affect spatial awareness - neglect or sensory inattention
Usually more involved in motor functions
Can however cause personality change

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58
Q

What type of thrombus is a carotid plaque (usually)

A

Tend to be white thrombi - platelet rich

Therefore need to be treated with antiplatelets

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59
Q

What type of clot is a cardiac embolism (usually)

A

They tend to be red clots - protein rich

Should be treated with anticoagulants

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60
Q

How can you check for carotid artery disease

A

Carotid US - looks for narrowing of the arteries

CT/MRI angiogram can give you a clearer picture

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61
Q

What are the classifications of small vessel disease

A

Type 1 - arteriosclerotic (associated with typical CV risk factors)
Type 2 - Sporadic and hereditary cerebral amyloid angiopathy
Type 3 - other genetic disease
Type 4 - inflammatory and immunologically mediated
Type 5 - venous collagenosis
Type 6 - other

62
Q

Where do most cardiac emboli come from

A

Due to atrial fibrillation

5x higher risk of stroke if you have AF

63
Q

When might you consider patent foramen ovale as a cause of stroke

A

In a young person with no other cardiac risk factors

Congenital defect in the heart - close surgically when young to lower stroke risk

64
Q

How can an arterial dissection lead to stroke

A

Tear in the arterial wall sets of the clotting cascade which can then embolise

65
Q

What can cause an arterial dissection

A

Hypertension
trauma
Sudden movement

66
Q

What are the causes of primary intracerebral haemorrhage

A

Hypertension

Amyloid angiopathy

67
Q

What are the causes of secondary intracerebral haemorrhage

A

AVM
Aneurysms
Tumours

68
Q

How do haematomas expand in the brain

A

Will continue to bleed for a while after onset
Oedema that occurs around a bleed will set of an inflammatory cascade that can lead to secondary bleeds
Therefore it gets bigger over time

69
Q

What are the main parts of stroke prevention

A 
Anti-thrombotic therapy - either anti-platelets or anticoagulants 
Blood pressure control 
Cholesterol control 
Diabetes control 
DONT smoke
70
Q

Which score can be used to assess the risk of stroke

A

CHA2DS2VASc

71
Q

What score can be used to assess the risk of bleeding/haemorrhage

A

HAS-BLED

72
Q

What is one of the biggest risk factors for haemorrhage

A

Anticoagulation treatment

However the treatment is usually so beneficial that the risk is accepted

73
Q

What is a carotid endarterectomy

A

Surgical procedure where the artery is opened and the plaques physically cleared out
They also hoover up any other clots in the area
Reduces stroke risk

74
Q

How do you manage dysphagia after a stroke

A

Initial swallow screen
If abnormal get them assessed by speech and language therapy
May need textured diet, fluid diet or NG tube

75
Q

What are the major complications of dysphagia after a stroke

A

Choking and aspiration risk

Risk of dehydration and malnutrition

76
Q

How do you diagnose a SAH

A

Urgent CT head scan
Should see blood - appears bright white on non-contrast CT

If this is negative but they have signs that don’t improve you do a LP 12 hours later and test for bilirubin (breakdown of the blood that has leaked into the CSF)
Can’t do immediate LP as fresh blood could be due to LP trauma and give a false positive

77
Q

Are all intracranial haemorrhages considered strokes

A

No
Extradural, subdural and subarachnoid are not strokes
Only intracerebral are true strokes - damage to brain itself not due to compression

78
Q

When someone regains function after a stroke it is because the damage is reversing, true or false

A

False
It is other parts of the brain that take over with training/rehab - neuroplasticity
Damage is irreversible

79
Q

Stroke is a purely clinical diagnosis - true or false

A

True

Imaging is mainly used to rule out other causes

80
Q

List causes of haemorrhagic stroke

A

Hypertension (most common)
Vasculitis
Vessel wall abnormality - aneurysm, AVM, amyloid angiopathy
Anticoagulants or bleeding issues can make it worse - not main cause but contributes
Bleeding from tumours - not quite a stroke

81
Q

Surgery is commonly used in stroke treatment - true or false

A

False
It will do nothing to reverse the damage so it is only used if there is a risk to life such as coning/hydrocephalus
It is used for extracerebral haemorrhage as it relieves compression which is the cause of the damage

82
Q

What are the hyperacute stroke treatments

A

Thrombolysis - used within 4.5 hours

Thrombectomy - used up to 6 hours

83
Q

Hyperacute treatment is only used in which type of stroke

A

Ischaemic
Have a small window for prevention of further ischaemic damage by unblocking the vessel
Aim is to reduce disability and mortality

84
Q

Describe thrombolysis

A

A stroke treatment where a clot dissolving drug (alteplase) is given IV
Only work if within 4.5 hours of onset

85
Q

Describe thrombectomy

A

A catheter is inserted into the vessel and the clot is physically removed
Only used for large vessel proximal occlusion as catheter can reach here (can’t get to tiny lacunar ones)
Only done in certain centres as you need a lot of equipment and expertise

86
Q

List common stroke mimics

A 
Migraine
Post-seizure
Hypoglycaemia
Acute presentation of SOL
Demyelination
Bell's palsy
87
Q

Why does arteriosclerosis increase the risk of haemorrhagic stroke

A

It makes the vessels stiff so they are not as resistant to spikes in blood pressure - can cause rupture which would cause the stroke

88
Q

What is the difference between atherosclerosis and arteriosclerosis

A

Atherosclerosis is plaque formation in vessels- caused by classic risk factors

Arteriosclerosis is a thickening of the artery wall - caused by ageing (sped up by hypertension)

89
Q

How do you differentiate between ischaemic and haemorrhagic stroke

A

Only way is via imaging

90
Q

How does a lobar brain haemorrhage appear on imaging

A

It is superficial/peripheral and large

91
Q

The collateral blood supply of the brain created by the circle of WIllis can prevent a stroke - true or false

A

Bit of both!
Cannot prevent a stroke if a major supply vessel is suddenly blocked
However, it can prevent minor strokes or damage due to gradual loss of vessels (e.g. atherosclerosis as brain has time to adapt)

92
Q

What structure provides the brain with a collateral blood supply

A

The circle of Willis

93
Q

What are the perforating arteries of the brain

A

Smaller vessels which arise from the main trunk of the major vessels and perfuse the deep section of the brain

94
Q

If a stroke has occurred in multiple vascular territories, what is the likely cause

A

Emboli - most commonly from AF as this throws off a lot of clots from the heart

95
Q

Which arteries are affected in a small vessel occlusion stroke

A

The perforating arteries

Strokes blocking one of these vessels will be smaller as they supply smaller areas

96
Q

Explain the situation where a small vessel occlusion can be extremely damaging

A

Can still be severe as can affect the internal capsule - where everything comes together so a lot of structures affected at once

97
Q

Which type of clot typically causes a large vessel occlusion

A

Embolus

To cause stroke it must be sudden and thrombi take time to build up

98
Q

Which type of clot typically causes a small vessel occlusion

A

Thrombus

99
Q

What is the difference between expressive and receptive dysphasia

A

Expressive/motor - non-fluent, jargon speech, can understand but not talk

Receptive/sensory - can speak fluently but not understand

May have a mix

100
Q

What is agnosia

A

Failure to recognise an object despite having an intact sensory system
I.e. cannot recognise a well known object by touch alone

101
Q

What is dysarthria

A

Slurring of speech

Does not need to have a neurological cause

102
Q

Which artery is affected in a TACI

A

The middle cerebral artery

Supplies both motor and sensory areas so get deficits in both

103
Q

What is the Oxford classification used for in stroke medicine

A

Developed to guide management of stroke
Clinical classification only
Applies to both ischaemic and haemorrhagic

104
Q

Which lobe of the brain is supplied by the anterior cerebral artery

A

Frontal lobe

105
Q

Cortical signs are characteristic of which types of stroke

A

TACI and PACI

106
Q

TACI and PACI are usually embolic strokes - true or false

A

True!

107
Q

Which type of stroke might present with a headache

A

Posterior circulation stroke

Unusual presentation for stroke except this type

108
Q

Which type of stroke is usually the least damaging

A

Lacunar

Less brain damage - more chance for recovery due to neuroplasticity

109
Q

Posterior circulation strokes are always embolic - true or false

A

False

can be embolic or thrombotic

110
Q

List the 5 sections of the TOAST classification for ischaemic stroke

A

1 - cardioembolic (mainly AF)

2- large vessel atheroembolic (from atherosclerosis in large vessel)

3 - small vessel - usually thrombotic disease

4 - infarct due to other identified cause (dissection, hypoperfusion, vasospasm, unusual emboli, venous etc)

5 - unknown cause (only chosen after all investigation)

111
Q

Pain over an artery is suggestive of what

A

Artery dissection

112
Q

Dysphasia is always neurological - true or false

A

True
Due to the cortex being damaged
It is dysarthria that has a variety of causes

113
Q

Describe a watershed infarct

A

Vessel isn’t actually occluded but relative hypoperfusion causes infarcts in the border zones of the vessel’s supply area
E.g. BP drops and is no longer enough to perfuse a narrowed vessel

114
Q

Describe a venous stroke

A

Caused by blockage of the venous sinus by a thrombus
Like a DVT in the brain - swells up due to backflow
This leads to infarct but also some leakage of blood products into brain

115
Q

What is a paradoxical embolic stroke

A

When a venous clot emoblises but instead of going to the lung it gets to the brain due to a septal defect (ASD)

Presents as any other ischaemic stroke and treatment is the same except you would also involve anticoagulation (standard DVT treatment)

116
Q

How can illegal drugs cause a stroke

A

Drugs like cocaine can induce vasospasm and cause a stroke

More common cause in younger people

117
Q

What is the most common cause of paroxysmal AF

A

HTN

Always look for it in patients with a HTN history

118
Q

What is the only difference between a TIA and ischaemic stroke

A

Only thing is a TIA is transient neurological symptoms without brain damage whereas the stroke isn’t transient and causes damage

119
Q

How long does a true TIA last

A

Only a few minutes

If they last hours it is actually a small stroke but due to neuroplasticity the symptoms improve

120
Q

The risk of stroke is very high following a TIA - true or false

A

TRUE
You should therefore investigate the person post-TIA and try and reduce their future stroke risk with treatment
This is why they have rapid access TIA clinics now

121
Q

If someone presents with a stroke, which investigations should you do

A 
General bloods (to get baseline) and specifics (lipids and glucose) 
ECG - look for AF 
Carotid doppler
Ambulatory monitoring - R test, telemetry etc. To look for AF 
Echo - if person has atrial dilatation this may indicate AF (done if ambulatory monitoring not picked it up)
122
Q

What is an R test

A

R test is a halter monitoring - usually done over 4 days and then data downloaded to look for AF
Used in stroke patients to determine if paroxysmal AF is a cause

123
Q

What typically causes an arterial clot

A

Usually due to arterial wall disease like atherosclerotic plaques

124
Q

How do you treat arterial clots

A
  • Treated with antiplatelets as clots are platelet rich
125
Q

What other disease processes are typically caused by arterial clots

A

Ischaemic arterial disease like stroke, MI, ischaemic legs etc

126
Q

What typically causes an venous clot

A
  • Usually due to imbalance in Virchow (haemostasis, hypercoagulability, endothelial injury)
127
Q

How do you treat venous clots

A
  • Treated with anticoagulants as formed by coagulation factors
128
Q

What other disease processes are typically caused by venous clots

A

Usually causes DVT +/- PE

129
Q

What is the biggest risk associated with a carotid endarterectomy

A

Biggest risk is another stroke - the surgery can lead to embolus formation

130
Q

Which patients are offered a carotid endartectomy

A

Benefit is seen in patients with a significant carotid stenosis - only done in symptomatic arteries and those with over 70% stenosis

Offered within 2 weeks of the first stroke or TIA
Generally used for the minor strokes or TIA as they have the most to benefit from - can prevent brain damage
Larger strokes will already have a significant disability so benefit does not outweigh the risk

Patient must also be able to discuss and understand the risk

131
Q

List options for secondary stroke prevention

A 
Antiplatelets 
Anticoagulants 
Statins
Anti-hypertensives 
Diabetic management 
Lifestyle management 
MDT approach including management of complications
132
Q

Antiplatelets are used as secondary prevention in which type of stroke

A

Used for ischaemic only, and only small vessel thrombotic events and atheroembolic large vessel infarcts

133
Q

Which antiplatelets are used for secondary stroke prevention

A

Aspirin - may start with a high dose for the 2 week high risk period then drop to 75mg
Clopidogrel
Dipyridamole

Dual therapy can be used - aspirin + clopidogrel 75mg each
Used for small stroke or TIA and those with carotid disease

134
Q

Anticoagulants are used as secondary prevention in which type of stroke

A

Used for strokes caused by AF (cardioembolic), paradoxical embolic infarcts and venous infarcts
This is because the clots in these cases are coagulation factor rich

135
Q

Which anticoagulants are used for secondary stroke prevention

A

Give warfarin or DOACs (as good as each other)
Patient’s tend to prefer taking DOAC as INR is much more reliable, with warfarin the INR is unreliable and has many more interactions

136
Q

Why cant heparin be used for secondary stroke prevention

A

It has a much higher risk of haemorrhagic transformation

137
Q

Which type of stroke is most common in those on anticoagulant

A

Still ischaemic!

1/3 will still have another ischaemic stroke despite anti coagulation

138
Q

If on warfarin and have another ischaemic stroke they can be given thrombolysis - true or false

A

True - following a rapid INR

Not an option for those on DOACs

139
Q

What is the biggest risk factor for stroke

A

Hypertension

140
Q

How do you prescribe statins for secondary stroke prevention

A

Start with aggressive treatment as immediate period is highest risk so start on high dose

141
Q

Statins are used as secondary prevention for which type of stroke

A

Used for ischaemic stroke with atherosclerotic disease

142
Q

Early BP control is more important in which type of stroke

A

Haemorrhagic

Can reduce bleeding and therefore damage

143
Q

Why would you not want to bring BP down to early in an ischaemic stroke

A

A slightly raised BP will cause opening of collateral supply which can actually be helpful so don’t want to bring it down too early, unless it is dangerously high (180/110)

144
Q

How are CT scans used in stroke management

A

CT is carried out for every ongoing stroke
It is best for picking up acute haemorrhage as this is hard to see on MRI
Therefore used to identify which type of stroke is happening - rule in or out haemorrhage to decide treatment

145
Q

What is the downside to using CT is stroke

A

Can miss small infarcts

Cannot differentiate between infarcts and haemorrhage after a few weeks

146
Q

How does an infarct show up on a CT scan

A

Takes about 4-5 hours for infarct to show up on CT- done immediately to rule out haemorrhage for treatment
May however see hyper acute signs - may see the clot itself

147
Q

How are MRI scans used in stroke management

A

MRI is good for identifying old haemorrhages
Good for checking the type of stroke in TIA
Also better for small vessel disease

148
Q

List some of the complications of a SAH

A

Spasm of arteries leading to ischaemia

Hydrocephalus and raised ICP

149
Q

How can you locate the causative aneurysm after a SAH

A

In small volume SAH the blood surrounds the cause - e.g. The aneurysm
Would then do a contrast CT to confirm the aneurysm and its location

150
Q

What are the differentials for someone presenting with headache and confusion

A 
Intracranial haemorrhage
Mass (tumour, abscess, hydrocephalus)
Infection (meningitis, encephalitis)
Venous sinus thrombosis
Cerebral infarct (mostly confusion)
Migraine (mainly headache)

Neurology (18 decks)

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