Diseases Of Central And Peripheral Nervous System Flashcards
What is ischemic stroke?
A sudden focal neurological deficit due to part of the brain loosing its blood supply.
What are the different classes of ischemic stroke?
- TIA: a neurological deficit that lasts from a few minutes to no more than 24 hours
- Evolving stroke: a stroke that is worsening
- Completed stroke: maximal deficit has occurred
What are the important risk factors for ischemic stroke?
Age and HTN
What are the causes of ischemic stroke?
- Emboli (common cause): Heart being most important source, embolization of mural thrombus in patients with AFib.
- Thrombotic stroke
- Lacunar stroke (small vessel thrombotic stroke)
- Nonvascular causes such as low cardiac output and anoxia
How does a patient with thrombotic stroke present?
Patient awakens from sleep with a neurological deficit.
When does emboli stroke symptoms appear?
Onset of symptoms is very rapid and deficits are maximal initially.
What is the most commonly involved artery in ischemic stroke?
Middle cerebral artery
What is the treatment of ischemic stroke in acute setting?
- Supportive treatment (airway protection, oxygen, IV fluids)
- Thrombolytic therapy (t-PA): given within 4.5 hours
- Aspirin given ASAP, but avoided for 24 hours if t-PA is given
How to prevent stroke recurrence?
- Lifestyle and pharmacotherapy
- Long-term antiplatelet therapy
- High intensity statin
- Anticoagulation for cardioembolic strokes
What is hemorrhagic stroke?
Bleeding from brain blood vessels resulting in a hematoma that compresses and damages surrounding brain tissue
What are the clinical features of ICH?
- Abrupt onset of a focal neurological deficit that worsens steadily over 30 to 90 minutes.
- Altered level of consciousness, stupor, coma
- Headache, vomiting
- Signs of ICP
What are the diagnostic tests of ICH?
- CT scan of the head
- Coagulation panel and platelets
What is the treatment of ICH?
- Admission to ICU
- ABC’s
- BP reduction if systolic BP is >180
- Management of elevated ICP: elevate head of bed to 30 degree, appropriate sedation, pain control, mannitol
What is the characteristic feature of SAH?
Worst headache of my life
What are the diagnostic tests of SAH?
- Noncontrast CT scan
- Perform lumbar puncture if CT scan is unrevealing:
- Blood in the CSF is the hallmark of SAH
- Xanthochromia
What is the treatment of SAH?
- Surgically clip the aneurysm
- Medical therapy:
- Bed rest in quiet, dark room
- Stool softeners to avoid straining
- Analgesia for headache
- IV fluid for hydration
- Control of HTN (gradual)
- CCB for vasospasm
What is multiple sclerosis?
Selective demyelination of CNS (autoimmune), multi focal zones of demyelination are scattered throughout the white matter.
What are the clinical features of multiple sclerosis?
- Transient sensory deficit
- Fatigue
- Motor symptoms mainly weakness or spasticity
- Visual disturbances (optic neuritis, inter nuclear ophthalmoplegia)
- Cerebellar involvement
- Loss f bladder control
- Autonomic involvement
- Cerebral involvement
- Neuropathic pain
How is MS diagnosed?
- It is diagnosed clinically based on multiple CNS lesions separate by time and space.
- MRI is the most sensitive test which shows periventricular whit matter plaques
- LP and CSF analysis: oligoclonal bands of immunoglobulin G
How is MS treated?
- Acute attacks are treated with high-dose IV corticosteroids
- Disease-modifying therapy
- Symptomatic therapy
What is Guillian-Barré Syndrome?
Inflammatory demyelinating polyneuropathy that primarily affects motor nerves (autoimmune)
How does GBS present?
- It usually is preceded by a viral or mycoplasma infection of upper respiratory or GI tract.
- Rapid ascending weakness/paralysis of all four extremities, frequently progresses to involve respiratory, facial, and bulbar muscles
How is GBS diagnosed?
Based on:
1. Clinical findings
2. CSF analysis findings showing elevated protein and normal cells
3. Decreased motor nerve conduction velocity
What is the management plan for GBS?
- Careful monitoring of pulmonary function
- Administering IV immunoglobulin if patient has significant weakness