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CC: Neuro > Hemiplegia > Flashcards

Hemiplegia Flashcards

1
Q

What histories are important in hemiplegia?

A

Headache, seizures, LOC

Speech deficits, sensory loss and weakness of face/limbs

Risk factors for stroke (HTN, smoking, DM)

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2
Q

What classic upper limb posture will be adopted in hemiplegia?

A

Arm held to the side, elbow flexed and fingers and wrist flexed on to the chest

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3
Q

What classic lower limb posture will be adopted in hemiplegia?

A

Limb extended at both hip and knee

Foot plantar flexed and inverted

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4
Q

What will be the muscular symptoms in hemiplegia?

A

Unilateral weakness

Increased tone, hyper-reflexia and upgoing plantar response (UMN deficit)

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5
Q

Which upper limb muscle groups are most affected by hemiplegia?

A

Shoulder abducters

Elbow extensors

Wrist and finger extensors

Small hand muscles

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6
Q

Which lower limb muscle groups are most affected by hemiplegia?

A

Hip flexors

Knee flexors

Dorsiflexors and evertors of the foot

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7
Q

What are some special things that you should look for on examination in hemiplegia?

A

Homonymous hemianopia and sensory inattention

Horners syndrome

Carotid bruits

Speech defects

AF/murmurs

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8
Q

If the patient had horner’s syndrome contralateral to the hemiplegia what does that suggest?

A

Carotid dissection

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9
Q

What are some geriatric causes of hemiplegia?

A

Vascular event (thrombosis, embolism, haemorrhage)

Tumour

Subdural haematoma

Syphilis

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10
Q

What are some paediatric causes of hemiplegia?

A

MS

Sickle cell disease (most common?)

Neoplasm

Trauma

Neurosyphilis

Intrarcanial infection

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11
Q

If you have a patient that has hemiplegia secondary to an intracranial infection, what else should you look for?

A

Underlying AIDS

Otitis media

Cyanotic heart disease

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12
Q

What is first line therapy for a suspected stroke?

A

Aspirin as soon as possible

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13
Q

What is a possible complication of aspirin therapy for stroke?

A

Increased risk of haemorrhagic stroke

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14
Q

For ischaemic stroke, what early changes can you sometimes see on CTB?

A

Loss of white/grey matter differentiation

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15
Q

What investigations should you perform in a patient with hemiplegia?

A

CTB/MRI

FBE, BSL, INR/aPTT

ECG, pO2

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16
Q

What are some adult causes of hemiplegia?

A

Seizures and postictal deficits

Migraine

Systemic infection

Neoplasm

17
Q

Why is it important to measure BSL in acute stroke patients?

A

Hyperglycaemia associated with stress response of the stroke associated with poor prognosis

Hyperglycaemia worsens ischaemic damage

Hyperglycaemia worsens penumbra salvage

Hyperglycaemia worsens results of re-canalisation and increases chance of intracerebral haemorrhage

18
Q

T/F BSL monitoring is important in acute stroke management, but intensive serum glucose control is not

A

T

No difference found in morbidity or mortality with intense glucose control vs normal therapy

Intense control only associated with higher risk of iatrogenic hypoglycaemia

19
Q

Is it important to assess if the person can swallow correctly?

A

Yes

Dysphagia is a common complication but important for preventing aspiration pneumonia

20
Q

Should tPA (alteplase) be given in the setting of acute ischaemic stroke, and if so, how much?

A

It should, and within 3 hours (but asap after CT/MRI)

0.9mg/kg, 10% of which should be given as a bolus and 90% of which should be infused over 1/24

Maximum dose of 90mg, thus maximum bolus of 9mg

21
Q

How should a TIA patient be managed?

A

Aspirin

Advise re risk factors

Ultrasound/digital subtraction angiography of carotid arteries

MRI

22
Q

Why Is it important to differentiate a carotid TIA from a vertebrobasilar TIA?

A

Carotid TIA more amenable to surgery

TIA in anterior circulation is usually more serious prognostically than one in posterior circulation

23
Q

What features are classically present in an carotid TIA?

A

hemiparesis

Aphasia

Amaurosis fugax

24
Q

What features are classically present in a vertebrobasilar TIA?

A

Two of vertigo, dysphagia, ataxia and drop attacks

Bilateral or alternating weakness or sensory symptoms

Sudden bilateral blindness in patients aged >40

25
Q

When is carotid endarterectomy indicated in the case of TIAs?

A

When carotid stenosis is close to 99% (not 100%, and not much below 80%)

26
Q

Carotid angioplasty (stenting) vs endarterectomy for carotid TIAs?

A

Possibly better results with angioplasty

27
Q

What is RIND?

A

Reversible ischaemic neurological disease

Like a TIA, but resolves within 1/52 rather than 1/7

28
Q

What is the major risk factor for the development of lacunar infarcts?

A

HTN

29
Q

Where can lacunar infarcts occur in the brain?

A

Internal capsule

Pons

Basal ganglia

Thalamus

30
Q

What deficit would a lacunar infarct in the internal capsule produce on examination?

A

Partial hemiparesis or hemisensory impairment

31
Q

What deficit would a lacunar infarct in the pons produce on examination?

A

Ataxia of cerebellar type

Partial hemiparesis

32
Q

What is the pathogenesis of lacunar infarcts?

A

Hyaline arteriolosclerosis causing occlusion of small arteries in the brain

Or

Rupture of Charcot-Bouchard microaneurysms that produce a haematoma, which resolves leaving an area of infarct

CC: Neuro (8 decks)

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