Deck 2 - neuro Flashcards
Q. What type of stroke is the most common?
A. 85% are embolic (10% are haemorrhagic, 5% have rarer causes)
Q. In what layer do the a) meningeal vessels, b)bridging veins, c) circle of wilis lie?
A. Meningeal vessels: extradural space
B. Bridging veins: cross the subdural space
C. Circle of wilis: subarachnoid space
D. There are no vessels deep to the pia – the pia forms part of the BBB
- Q. What causes an extradural haemorrhage?
A. Traumatic – fractured skull
B. Causes bleeding from the meningeal arteries
C. There is a lucid period then a rapid rise in inter-cranial pressure – - coning and
death if not treated!
Q. What occurs in a subdural haemorrhage, who is this most likely to occur in?
A. Bleeding from the bridging veins – these are low pressure so bleed soon stops,
days or weeks later the haematoma starts to autolyse. There is a massive
increase in osmotic and oncotic pressure which sucks water into the haematoma
B. Gradual rise in ICP over many weeks
C. Commonly occurs in pts with small brains (alcoholics, elderly with dementia),
also occurs in “shaken babies”
Q. What occurs in a subarachnoid haemorrhage? Name three features of clinical
presentation
A. Rupture of the arteries forming the circle of willis (often due to berry enurysms)
B. Thunderclap headache: sudden onset of severe headache, photophobia and
reduced consciousness, rapidly fatal
Q. Describe the management of a subarachnoid haemorrhage
(CT, LP, angiography), resuscitation, nimodipine, early intervention to prevent re- bleeding, monitor
Q. Where is a traumatic blow to the pterion likely to rupture?
Anterior division of the middle meningeal artery causing an extradural (aka epidural) haematoma. The pterion may also be fractured indirectly by high force blows to the top or back of the head.
Q. Name 3 forms of primary headache and 3 forms of secondary headache
A. Primary: tension, cluster, migraine
B. Secondary: meningitis, subarachnoid haemorrhage, GCA, idiopathic intracranial
HTN, medication overuse headache
Q. Name five features that require urgent investigation due to increased brain tumour risk (red)
A. New headache with Hx cancer, cluster headache, seizure, significantly altered
consciousness, memory, confusion, coordination, papilledema, other abnormal
neuro exam or symptom
Q. Name five features that require monitoring due to mod brain tumour risk
(orange)
New headache where diagnostic pattern not emerged after 8 weeks,
exacerbated by exercise or Valsalva (e.g. coughing, laughing, straining), headache
associated with vomiting, headache increasing in frequency, new headache if
> 50yrs, headache that wakes pt from sleep, confusion
Q. Name four features of headache examination
Any fever? altered consciousness, neck stiffness (Kernigs sign), focal neurological
signs (fundoscopy)
Q. Describe the features of migraine without aura
A. 5 attacks with the following:
B. Attacks last 4-72 hours
C. Two of the following: unilateral, pulsing, mod/severe, aggravation by routine
physical activity
D. During headache at least one of: Nausea/vomiting, photophobia and
phonophobia
E. Not attributed to another disorder
Q. Describe the features of infrequent tension type headache
A. ≥ 10 attacks occurring < 1 day/moth (<12 days/year) and fulfilling B-D
B. Headache lasting from 30 minutes to 7 days
C. Headache has two of the following characteristics:
- Bilateral
- Pressing/tightening (non pulsating) quality
- Mild or moderate intensity
- Not aggravated by routine physical activity (e.g. walking or climbing stairs)
D. Both of the following: 1. No nausea or vomiting (anorexia may occur) 2. No more
than one of photophobia and phonophobia
E. Not attributed to another disorder
- Q. Describe the features of cluster type headache
A. At least five headache attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting
15-180 minutes if untreated
C. Headache is accompanied by ipsilateral cranial autonomic features and/or a sense
of restlessness or agitation
D. Attacks have a frequency from 1 every other day to 8 per day
E. Not attributed to another disorder
- What is the difference between episodic and chronic cluster headache?
A. Episodic ≥ 2 cluster periods lasting 7 days to 1 year separated by pain free periods lasting ≥1 month
Chronic attacks occur for more than 1 year without remission or with remission lasting
