Lecture day 1 Flashcards
What are the first questions you ask during a neuro history?
- Age
- Dexterity
- Occupation
What questions would you ask to establish a timeline?
- When in your life did you first ever have one of these events?
- You never had anything like this before that?
- What is the longest interval free of events and when did that occur?
- When were these attacks at their worst?
- Have you had any bad patches with more frequent or more
severe attacks? - How many of these events have you had in the recent past?
(week, month, 3 months, 6 months) - When was the last event?
- Are you completely normal between events?
What questions would you ask to understand the aggravating and precipitating factors?
- Have they occurred while you are standing, sitting or lying down, or any of these?
- Are they related to a change of position or exercise?
- Do they occur at any particular time of day or night?
- Indoors or outdoors, or both?
- Do you know of anything which specifically triggers an attack?
- Are you conscious of your heartbeat or breathing?
- In women: are they related to your periods?
What are CT scans used for?
- Head trauma
- Intracerebral haemorrhage
- Acute stroke
What are the advantages of CT?
Quick, good visualisation of the brain
What does MRI image?
Water and fat
What are the advantages of MRI?
Very good contrast and very sensitive
What is MRI used for?
- Cerebral oedema, gliosis
- Encephalitis
- Plaques of demyelination
- Acute infarcts
What are the contraindications for MRI?
Claustrophobia
Metalic implants
What is cerebral angiography used for?
Interventional technique
When would you use imaging for someone who had a headache?
- Meningitis (sometimes)
- Encephalitis (CT shows oedema and swelling in medial temporal lobe)
- Cerebral abscess (common in IV drug users)
- Subarachnoid haemorrhage (CT)
- Brain tumours
What are the CT findings for a subarachnoid haemorrhage?
- High density in the cisterns
- Communiciating hydrocephalus
- Cerebral angiogram is usually done in first 24 hours after injury
what causes a subarachnoid haemorrhage?
Usually due to rupture of berry aneurysm from the circle of willis; others due to arteriovenous malformation or trauma
What are the most common brain tumours?
Glioma (35%) - Astrocytoma most common
Meningiomas (15%) - often benign
Metastases (20%) - lung or breast
Besides headache, what are other indications for head imaging?
- TIA and stroke (doppler, US, MRI)
- Epilepsy or fit (most have normal CT)
- MS (MRI can look at plaques)
- Coma (look for cause)
- Trauma (CT preferred)
What are absolute indications for CT head after trauma?
- Decreased conscious level
- Focal neurological signs and symptoms
- Seizures
- Depressed fracture, penetrating injury
What are relative indications for CT head after trauma?
- Persistent or severe headache
- Vomiting
- Temporary loss of consciousness
- Amnesia
What does a CT for an acute extradural haematoma show?
Biconvex shapes