Medicine (4) Flashcards
Contraindication to thrombolysis
- active internal bleeding
- recent haemorrhage, trauma or surgery (including dental extraction)
- coagulation and bleeding disorders
- intracranial neoplasm
- stroke < 3 months
- aortic dissection
- recent head injury
- pregnancy
- severe hypertension
Drugs used in thrombolysis and their MoA
Drugs include streptokinase/alteplase
MoA: Work as tissue plasminogen activators
Treatment of ischaemic stroke (outside of thrombolysis window)
Aspirin 300mg (once haemorrhagic stroke excluded)
Management of patient with a stroke (following acute admission)
Conservative
- Stroke rehabilitation – physiotherapy, SALT, depression screening
- Education and optimizing modifiable risk factors (e.g. smoking/alcohol/weight/diet)
- Patients are required to inform the DVLA following a stroke
- Treatment of the complications of stroke (bowel/bladder problems, fatigue, contractures)
Medical
- Antiplatelet therapy (if no AF) with clopidogrel or anticoagulation (if AF present) with warfarin/NOAC.
- Control medical risk factors (hypertension, hyperlipidaemia, diabetes mellitus, obstructive
sleep apnoea)
Surgical
• A carotid endarterectomy can be considered if stenosis is >70%
Signs and symptoms associated with anterior cerebral a. stroke

Signs and symptoms associated with Middle cerebral a. stroke

Signs and symptoms associated with posterior cerebral a. stroke

What happens with Basilar a. stroke?
Locked-in syndrome
Signs and symptoms associated with anterior inferior cerebellar a. stroke

Signs and symptoms associated with posterior inferior cerebellar a. stroke

Features of Total Anterior Circulation stroke
Total anterior circulation infarct (TACI)
- Highest total mortality (60% by one year) and very poor chance of making a good recovery to independent living (less than 5%)
Three features- all three are present:
- Contralateral hemiparesis
- Contralateral homonymous hemianopia
- Higher cortical dysfunction
(dysphasia or dyspraxia or inattention)
Features of Partial Anterior Circulation infract
Partial anterior circulation infarct (PACI)
Two out of the three features of TACI; typically
- Higher cortical dysfunction plus
- Contralateral weakness or sensory loss
Features of Posterior Circulation infract
Any of the three main possibilities:
- Contralateral homonymnous hemianopia OR
- Cerebellar signs OR
- Brainstem signs (e.g. quadraplegia, gaze/visual disturbance)
Features of Lacunar infarct
Presents with 1 of the following:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
What other conditions can mimic stroke?
- Hypoglycaemia
- Head injury
- Subdural haemorrhage
- Intracranial tumours
- Hemiplegic migraine
- Post-seizure (Todd’s paresis)
- CNS infection (e.g. toxoplasmosis, abscess, herpes encephalitis)
Causes of vertigo
- Benign Paroxysmal Positional Vertigo (BPPV)
- Generalised Age-Related Dysequilibrium
- Vestibular Migraine
- Meniere’s Disease
- Acoustic Neuroma
- Labyrinthitis
- Vertebrobasilar ischaemia
- Stroke
Causes of hearing loss

Features of acoustic neuroma

Management of Meniere’s disease
Conservative
• Consider the risks before driving, operating dangerous machinery, using ladders or going
swimming.
- Be encouraged to move around after an attack – Vestibular rehabilitation
- Sound therapy, relaxation techniques, and avoiding silent environments for tinnitus
- An acute attack of vertigo will normally settle within 1–2 days in most people.
Medical
- Short-term (7-14 days) prochlorperazine or an antihistamine (cinnarizine, cyclizine)
- Prevention of attacks: Trial of betahistine (16mg TDS)
Surgical
• intratympanic ototoxic drugs (aminoglycosides)
Causes of unilateral and bilateral facial n. palsy

Features of 3rd nerve palsy + causes
3rd Nerve Palsy (dropped and dilated)
- Eye is deviated down and out
- Dilated Pupil
- Dropping Eyelid
Causes: Diabetes/Stroke/Trauma/Posterior Communicating Artery Aneurysm (painful)
Features of 6th nerve palsy + causes
6th Nerve Palsy
• Failure of abduction of the affected eye leading to diploplia
Causes: Diabetes/Stroke/Trauma/Idiopathic
Features of median n. palsy + causes
Median Nerve
- May have positive Tinel’s/Phalen’s
- Affects LOAF
Causes: Diabetes/Trauma/Neoplasm/RA

Features of common peroneal nerve problems
Common Peroneal Nerve
• Foot drop (ask the patient to dorsiflex against resistance)
Caused by trauma to the fibula head
