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Yr4 Neuro > Intro to stroke 5 - stroke mimics > Flashcards

Intro to stroke 5 - stroke mimics Flashcards

1
Q

what are the 7 S’s that can mimic stroke

A 
seizures
syncope (hypotension)
sugar (hyper or hypo)
sepsis (+previous stroke)
severe migraine
space occupying lesion
Si-chological
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2
Q

what are some other less common stroke mimics

A

vestibular disorders
demyelination
transient global amnesia
mononeuropathy

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3
Q

what causes positive symptoms

A

excess CNS neurone electrical discharges

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4
Q

give some examples of positive symptoms

A

visual - flashing lights, zigzags, shapes, lines, objects

somatosensory - pain, paraesthesia

motor - jerking limb movements

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5
Q

what causes negative symptoms

A

loss or reduction of CNS neurone function

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6
Q

give some examples of negative symptoms

A

loss of vision
loss of hearing
loss of sensation
loss of limb power

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7
Q

what are the demographics for migraine

A

younger age BUT can occur at any age

more common in women

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8
Q

what is the neurology of migraines

A 
\+ve, spreading symptoms
can be followed by -ve symptoms 
may evolve into different modality eg somatosensory, sequentially 
LOC extremely rare 
confusion can occur
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9
Q

what are the associated symptoms and timing of migraines

A

headaches, NV, photophobia

usually 20-30 mins
can recur over years/decades

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10
Q

what causes a migraine aura

A

cortical spreading depression

- classical spreading onset

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11
Q

how can an aura present and when does the headache usually start

A

visual disturbances

  • scintillating scotolata
  • geometric (espzigzag) patterns
  • +ve symptoms

can include sensory, motor or speech disturbance

headache onset can be >1hr after the end of aura OR no headache

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12
Q

what is an acephalic migraine

A

aura with NV, photophobia, motor/sensory/visual disturbances BUT no headache

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13
Q

what are the demographics of functional/anxiety disorder

A

younger
more common in males
no conventional risk factors

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14
Q

what is the neurology in functional/anxiety disorder

A 
isolated sensory symptoms common
60% occur suddenly or on wakening 
dissociative or multiple symptoms
often non-dominant side
inconsistency between symptoms and examination
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15
Q

what are the associated symptoms and timing of functional/anxiety disorder

A

panic
pain
physical injury

stereotypical and recurrent

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16
Q

what tests can indicate a functional disorder

A

hoovers test

abductor sign

17
Q

briefly explain how hoovers test works

A

involuntary extension of the “normal” leg occurs when flexing the contralateral leg against resistance - if extension is felt, the paresis is most likely organic in cause, if not its most likely functional

18
Q

briefly explain how the abductor sign works

A

the affected leg is abducted against pressure from the examiners hand - in organic paresis the contralateral leg stays in place, in non-organic paresis the contralateral leg hypperadducts

19
Q

what is acute vestibular syndrome

A

rapid onset of vertigo, n/v, nystagmus (unidirectional), unsteady gait, and head motion intolerance lasting more than 24 hours

20
Q

what are the demographics of seizures

A

any age

may have previous hx of epilepsy

21
Q

what is the neurology of seizures

A

positive symptoms
LOC and amnesia common
post octal negative symptoms may persist for days

22
Q

what are the associated symptoms of seizures

A 
tongue biting
incontinence
muscle pain
disorientation
headache
23
Q

what is the timing of seizures

A

usually progress very quickly (seconds)
last up to 5 minutes
can recur over years
usually stereotypical attacks

24
Q

what are the demographics of syncope

A

any age, often younger

more common in women

25
Q

what is the neurology of syncope

A 
light headed (presyncope)
vision may darken
hearing muffled
loss of awareness
transient LOC with loss of posture tone and rapid recovery
no focal symptoms
26
Q

what is the timing of syncope

A

seconds to <1 minute
rapid recovery (unless patient stays upright)
can recur over years

27
Q

what is transient global amnesia

A

temporary loss of anterograde-grade episodic memory
(usually people >50)
*NOT TIA

28
Q

how long does transient global amnesia usually last

A

lasts several hours after which there is a filling in of old memory and a restoration of ability to lay down new ones
- a gap for the episode persist

29
Q

how can you differentiate a stroke/TIA from a structural brain lesion

A

gradual or stuttering onset
over a longer period of time eg weeks
associated symptoms of raised ICP

Yr4 Neuro (17 decks)

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