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CA > Consolidation slides > Flashcards

Consolidation slides Flashcards

1
Q

Types of Intracranial Haemorrhage

A

1) Epidural haemorrhage
2) Subdural haemorrhage
3) Subarachnoid haemorrhage
4) Intraparenchymal haemorrhage

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2
Q

The cause of Epidural haemorrhage

A

Head trauma -> skull fracture from blunt trauma-> laceration of arterial vessels (most commonly meningeal artery)

more tremendous force is required than subdural haemorrhage

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3
Q

The cause of subdural haemorrhage

A

Head trauma -> rupture of bridging veins

Elderly/ alcoholics are more susceptible, can occur with minor head trauma

Anticoagulation meds

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4
Q

The cause of subarachnoid haemorrhage

A

Rupture of saccular, or berry, aneurysum (80%); and rupture of arteriovenous malformation (AVM) (10%)

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5
Q

Known risk factor of aneurysm rupture (4)

A
  1. Tobacco use
  2. Alcohol abuse
  3. Hypertension caused by cocaine and other stimulants
  4. Large aneurysm size
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6
Q

The cause of Intraparenchymal haemorrhage

A

Damaged blood vessels due to:

  1. HTN
  2. Cerebral amyloid angiopathy
  3. Head trauma
  4. Ruptured aneurysm
  5. Blocked vessels
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7
Q

Presentation of EDH

A

Triphasic Presentation

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8
Q

S&S of EDH

A

Brief LOC -> Lucid interval -> headache, progressive obtundation (altered level of consciousness), hemiparesis (contralateral) -> “ blown pupil” (ipisilateral) secondary to uncal herniation

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9
Q

Presentation/ signs and symptoms of SDH

A

Non-specific clinical signs including
Headache, altered mental status, hemiparesis

Non-convulsive seizure may occyr in 20% of patients with acute SDH

Can be subacute or chronic

Gradual change in mental status may present as delirium or dementia in elderly, careful history will reveal remote fall

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10
Q

Presentation of SAH

A

Aneurysmal SAH is typically characterised by explosive or “thunderclap headache” instantaneously maximal at onset, “worst”

Normally associated with activities

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11
Q

Presentation of ICH

A

FAST + headache

occur without warning

s&s depend on location affected

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12
Q

Weakness of the left arm, leg and face (damage to?)

A

Damage to the motor area of the right cerebral hemisphere

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13
Q

Speech problem damage to the ?

A

Broca’s area

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14
Q

Small stroke in the ________ can cause severe problems as many __________ pass through here from the brain to the spinal cord

A

brain stem, nerves

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15
Q

loss of co-ordination in the right arm and leg is caused by the damaged to

A

left parietal lobe

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16
Q

difficulty in understanding speech, reading, naming object is caused by the damage to the

A

wernicke’s area

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17
Q

Unsteadiness and poor co-ordination is the damage to the

A

cerebellum

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18
Q

TIA vs Established stroke

TIA pathogensiesis vs Established stroke

A

Transient Ischemic Attacks
(TIA)

  • Any neurological dysfunction that lasts for a few seconds to a few minutes
  • Should recover within 24
    hours
  • Pathogenesis of TIA
  • Low-flow states in vascular
    obstruction
  • Small emboli which get
    dissolved later
  • Recognition of TIA helps in
    prevention of major stroke

Established stroke

  • Infarction of brain tissue occurs due lack of blood. Deficit is permanent
  • Increasing obstruction may
    involve a proximal branch of the artery and increase the deficit: stroke-in-evolution
  • Edema occurs in surrounding tissue
  • Resolution of edema after the acute stage may restore some function
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19
Q

Non modifiable risk factor of ischemic stroke (8)

A
  • Age
  • Race
  • Sex
  • Ethnicity
  • History of migraine headaches
  • Sickle cell disease
  • Fibromuscular dysplasia
  • Heredity
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20
Q

Modifiable risk factor of ischemic stroke

A
  • HTN
  • DM
  • Hypercholesterolemia
  • TIA
  • Carotid stenosis
  • Oral contraceptive use
  • Cardiac disease

1) AF
2) Valvular disease
3) Prosthetic valve
4) Mitral stenosis

-Lifestyle issues:

1) Excessive alcohol intake
2) Tobacco and illicit drug use
3) Obesity and physical inactivity

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21
Q

Lumbar puncture indication

A

CNS infection – meningitis

Thunderclap headache to rule out SAH when CT/MRI is normal or beyond 3
days

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22
Q

Lumbar puncture is to evaluate _____________________.

A

To evaluate for normal pressure hydrocephalus

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23
Q

Contra-indication of Lumbar puncture

A

Presence of infection in the tissues near the puncture site

  • Presence of SOL (space occupying lesion)
  • Bleeding tendencies (plt < 80 or INR > 1.4)
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24
Q

Types of epileptic seizures (6) Generalised seizures

A

Generalized tonic-clonic

Absence

Myoclonic

Clonic

Tonic

Atonic

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25
Q

Generalised tonic-clonic symptoms

A

Unconsciousness, followed by body stiffening (tonic phase), violent jerking

(Clonic phase), does into a deep sleep after (Postictal phase).

26
Q

Absence seizure symptoms

A

Brief loss of consciousness, interrupts an activity and stares blankly. May occur several time a day

27
Q

Myoclonic symptoms

A

Sporadic jerks, both side of body jerking movements , clustered, no LOC

Describe the jerks as electrical shocks

28
Q

Clonic symptoms

A

Rhythmic jerks of both side of the body

29
Q

Tonic symptoms

A

Muscle stiffness, rigidity

30
Q

Atonic symptoms

A

Loss of muscle tone in four limbs

31
Q

Types of epileptic seizure (3)
Partial seizures (Produced by small area of the brain)

A
  1. Simple
    a. simple motor
    b. simple sensory
    c. simple psychology
  2. complex
  3. partial seizure with secondary generalisation
32
Q

symptoms of simple motor

A

Jerking, muscle rigidity, spasms, head-turning

33
Q

symptoms of simple sensory

A

Unusual sensations affecting either the vision, hearing, smell taste, or touch

34
Q

symptoms of simple psychological

A

Memory or emotional disturbances

35
Q

symptoms of complex (impairment of awareness)

A

Automatisms such as lip smacking, chewing, fidgeting,
walking and other repetitive, involuntary but
coordinated movements

36
Q

Symptoms of partial seizure with secondary generalization

A

Symptoms that are initially associated with a preservation of consciousness that then evolves into a
loss of consciousness and convulsions.

37
Q

Pathology of PD

A

Degeneration of pigmented dopaminergic neurons in the pars compacta of
the substantia nigra

  • There is loss of cells
  • Dying cells may show inclusion bodies (Lewy bodies)
  • Less degree of cell loss in other structures, globus pallidus, putamen etc.

Loss of neurons results in less amount of dopamine in the striatum.

There is an imbalance of dopamine and Acetylcholine

This imbalance results in loss of inhibition by direct pathway and
stimulation by indirect pathway

38
Q

Clinical features of PD (11)

A

Tremor
* Present at rest (resting tremor)
* 4 to 6 Hz (cps)
* Decreased by action
* Increased by stress
* Common in arms
(pill-rolling movements)
* Can affect head, jaw and legs
* Can be unilateral or bilateral

Rigidity
* Increase in tone of muscles
* Affects both flexor and extensor groups of muscles, but flexors are affected
more
* Known as ‘lead-pipe’ rigidity - increased resistance in whole range of movement (cf spasticity)
* Rigidity superimposed with resting tremor can produce a ‘cog-wheel’
phenomenon

Bradykinesia
* Less movement (hypokinesia or akinesia)
* Delay in initiation of movement (freezing)
* Once started, movements are slow (bradykinesia)
* E.g loss of facial expression, blinking, arm swinging

Postural and gait abnormality
* Flexed posture (legs, arms, trunk
and neck)
* Slow, short, shuffling gait
(‘festinant gait’, ‘chasing their
center of gravity’)
* Unable to stop when pushed
forward (propulsion). Unable to
stop when pushed backward
(retropulsion)

  • mask’ facies
  • slow monotonus voice, micrographia
  • Drooling of saliva
  • Excessive sweating
  • Urinary problems, urgency and incontinent
  • mental depression
  • dementia is very rare
39
Q

Cause of headache (3)

A
  1. Migraine
  2. Tension-type headache
  3. Cluster headache
40
Q

Migraine duration

A

Typically lasts from 4 to 72 hours if untreated.

41
Q

Pain characteristics of migraine

A

Pain Characteristics: Often unilateral (one side of the head), but can be bilateral. The pain is usually
throbbing or pulsating.

42
Q

Migraine intensity

A

Intensity: Moderate to severe; often debilitating.

43
Q

Associated symptoms of migraine

A

Associated Symptoms: Nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound
(phonophobia). Some patients also experience visual disturbances known as aura (e.g., flashing lights, zigzag
lines, or temporary loss of vision) before the headache

44
Q

Mechanism of migraine

A

Neurally induced dilatation and inflammation of intracranial
and extracranial vessels

45
Q

Duration of tension-type of headache:

A

Can last from 30 minutes to several days.

46
Q

Pain characteristics of tension type headache

A

Pain Characteristics: Typically bilateral (affecting both sides of the head), with a steady, pressing, or
tightening quality rather than throbbing. The pain is often described as a band-like pressure around the head.

47
Q

Intensity of tension type headache

A

Intensity: Mild to moderate; not usually as severe as migraines or cluster headaches.

48
Q

Associated Symptoms of tension-type headache

A

Generally, there is no associated nausea or vomiting, and sensitivity to light or sound
is not as pronounced. There may be mild tenderness in the neck, shoulders, or scalp.

49
Q

Mechanism of tension type headache

A

Unknown; may be increased sensitivity of pain-mediating
systems in brain

50
Q

Duration of cluster headache:

A

Attacks typically last from 15 minutes to 3 hours.

51
Q

Pain Characteristics of cluster headache:

A

Severe, excruciating, and usually unilateral, focused around one eye or temple. The pain is often described as sharp or burning.

52
Q

Intensity of cluster headache

A

Extremely severe; often described as the most intense headache a person can experience.

53
Q

Associated Symptoms of cluster headache

A

Ipsilateral (same side) symptoms such as nasal congestion, rhinorrhea (runny nose), ptosis (drooping of the eyelid), and lacrimation (tearing).

The patient may also experience agitation or
restlessness.

54
Q

Mechanism of cluster headache

A

Neurally induced inflammation and edema of internal carotid artery

55
Q

Cause

Intracranial Mass Lesion:
e,g, Brain Tumor,
Hydrocephalus

Mechanism

A

Displacement (traction) of pain- sensitive vessels

56
Q

Cause of headache

Low Intracranial Pressure
State: e.g Post-Lumbar
puncture

A

Traction through brain sagging on dural attachments; intracranial
vasodilatation

57
Q

Cause of Headache

Meningitis, Subarachnoid
Haemorrhage

Mechanism

A

Inflammation of vessels in
meninges and of perivascular dura

58
Q

Cause of headache

Temporal Arteritis,
Intracranial Vasculitis

Mechanism

A

Inflammation of scalp and
intracranial vessels

59
Q

Criteria for diagnosing migraine without Aura (common migraine)

A

At least 5 attacks fulfilling the following criteria

Each attack, untreated or unsuccessfully treated, lasts 4-72 hrs

  • The attack has at least 2 of the following characteristics:

 Unilateral location; pulsating quality; moderate or severe intensity; pain aggravated by exertion or routine physical activity

  • During an attack at least 1 of the following symptoms should be present:

 Nausea / vomiting; photophobia, phonophobia

No evidence from history or physical examination of any other disease that might cause headaches

60
Q

Criteria for Diagnosing Migraine with Aura

A

About 15% of migraineurs experience an aura

May occur with only a few, most, or all attacks

Typically precede headache, last 20-60 min and then clears before headache begins

Aura may trespass into the first few min of headache

Most auras are visual

Criteria for diagnosis : same as those for migraine without aura, but include symptoms of neurological dysfunction occurring before or during the attack

CA (15 decks)

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