general neuro Flashcards
what are the main symptoms of a space occupying lesion in the intracranial space? (split into categories…)
signs:
- increased ICP (headache worse on waking / lying down / coughing / papillodema)
- seizures
- evolving focal neurology
- personality changes
what are some causes of an SOL?
tumours - 1y or 2y aneurysms abcesses chronic subdurals granulomas (eg. tuberculoma)..
management of acute stroke?
- arrange immediate emergency admission to an acute stroke facility if:
Persisting neurological symptoms suspected of having acute stroke or emergent TIA.
Resolved neurological symptoms who has a bleeding disorder or is taking an anticoagulant — haemorrhage must be excluded.
Be aware that a person may have ongoing focal neurological deficits despite a negative FAST test — if suspected manage as acute stroke.
Inform the hospital in advance of arrival — include details of time of onset, symptom evolution, current condition and medications (especially anticoagulants).
Do not start antiplatelet treatment until haemorrhagic stroke has been ruled out by a brain scan.
While awaiting transfer:
Monitor and manage any deterioration in clinical condition (airway, breathing and circulation [ABCs]).
Give supplemental oxygen to people with acute stroke if oxygen saturations are less than 95% and there are no contraindications.
Admission may not be appropriate/beneficial in a small number of people with a severe comorbidity. If after discussion with the person and their family/carer, a decision is made not to admit:
Clearly document the reasons for this and,
Discuss with the specialist team possible assessment and management at home or as an out-patient within 24 hours.
NBM until SALT
loading dose aspirin 2 weeks
clopidogrel
2y prevention statins bp if relevant diabetes stuff if relevant af stuff if relevant
surgery:
1.
causes of a haemorrhagic stroke?
AV malformations
warfarin / DOACs
recreational drugs (Cocaine)
HTN
management and investigation? of haemorrhagic stroke
- CT
- surgery if on surface / having mass effect - decompress / drains in 4th ventricle
- may need LP if CT -ve and no contraindications >12hrs after headache onset
why LP >12hrs after headache onset in haemorrhagic stroke?
to allow for xanthochromia to develop - then distinguishes SAH from a traumatic tap
what are the diffferent features of different types of stroke?
TACS - hemiparesis + hemianopia + decreased higher cortical function (gaze is deviated towards side of palsy/bleed)
PACS - 1 or 2 of the above
POCS - Balance issue and CN palsies (posterior circulation stroke syndrome) - often contraleteral nerve palsies / LOC
LACS - lacunar infarct - (1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three / pure sensory stroke / ataxic hemiparesis)
what are the diffferent features of different types of stroke?
TACS - hemiparesis + hemianopia + decreased higher cortical function (gaze is deviated towards side of palsy/bleed)
PACS - 1 or 2 of the above
POCS - Balance issue and CN palsies (posterior circulation stroke syndrome) - often contraleteral nerve palsies / LOC
LACS - lacunar infarct - (1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three / pure sensory stroke / ataxic hemiparesis) IE. usually pure motor or sensory…
what is the mrc power score (1-5)
Grade 0 No muscle movement
Grade 1 Trace of contraction
Grade 2 Movement at the joint with gravity eliminated
Grade 3 Movement against gravity, but not against added resistance
Grade 4 Movement against an external resistance with reduced strength
Grade 5 Normal strength
what are the two main neurocutaneous syndromes and what do they present with? / are associated with in terms of:
- pigmented / hypopigmented lesions?
- other systemic complications?
Neurofibromatosis
- HYPERPIGMENTED lesions
phaeos / NF2 - acoustic neuromas and other CNS tumours
Tuberous sclerosis
- HYPOPIGMENTED lesions
- epilepsy (west syndrome - infantile spasms) / developmental delays
what are the nerve roots of the tricpes / bicpes / ankle / knee reflexes..
Reflex Root Ankle S1-S2 Knee L3-L4 Biceps C5-C6 Triceps C7-C8
what is autonomic dysreflexia ?
who does it occur in?
and when does it occur?
This clinical syndrome occurs in patients who have had a spinal cord injury at, or above T6 spinal level.
Briefly, afferent signals, most commonly triggered by faecal impaction or urinary retention cause a sympathetic spinal reflex - usually mediated by an associated parasympathetic response
however this is prevented by the cord lesion. The result is an unbalanced physiological response, characterised by extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.
Management of autonomic dysreflexia involves removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia.
which antibodies are associated with:
- Myasthenia gravis
- Lambert-Eaton
- ACh receptor antibodies (bind - so ach can’t..)
2. Voltage-gated calcium-channel antibodies are suggestive of Lambert-Eaton Myasthenic Syndrome (LEMS)
what is the triad of normal pressure hydrocephalus?
and what will you see on imaging
and how do you treat?
and what are the complications of treatment….?
wet wobbly and wacky
(urinary incontinent / gait abnormality / bradyphrenia or dementia)..
hydrocephalus with enlarged 4th ventricle
Mx: ventriculoperitoneal shunting
complications of a shunt - seizures / haemorrhage / infection
how can you easily remember the synptoms of bell’s palsy?
FACE EAR, TASTE TEAR
face - unilateral non-forehead sparing facial nerve palsy causing
tx: start within 72hrs 10 days of methylprednisolone -
