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Year 3 > MM neuro tutorial > Flashcards

MM neuro tutorial Flashcards

1
Q

What are the types of haemorrhages?

A

Subdural
Extradural/epidural
Subarachnoid

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2
Q

What effect would an extradural haemorrhage compressing the right motor cortex have?

A

Loss of motor function on the left side of the body

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3
Q

Where do the arteries in the brain run?

A

Under the arachnoid mater and pia mater

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4
Q

What are the meningeal layers from outer to innermost

A

Dura
Arachnoid
Pia

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5
Q

What does a subdural haemorrhage look like on a scan?

A

Like a crescent

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6
Q

What does an epidural haemorrhage look like on a scan?

A

Lenticular (like a half ball shape)

this is because its outside the brain under the skull

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7
Q

What does an subarachnoid haemorrhage look like on a scan?

A

Bright spots in the cisterns (spaces in the brain)

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8
Q

What are the risk factors for subdural haemorrhage?

A

Elderly and alcoholics

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9
Q

What are the risk factors for extradural haemorrhage?

A

Trauma

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10
Q

What are the risk factors for subarachnoid haemorrhage?

A

Burst aneurysm or trauma

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11
Q

How does extradural haemorrhages present?

A

Acute onset after lucid interval (accident occurs, unconscious for a few mins then fine and then rapid deterioration)
Deterioration of GCS
Syncope, nausea, vomiting
Severe pain

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12
Q

What is the main cause of extradural haemorrhage? What artery is usually involved?

A

Trauma, usually middle meningeal artery

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13
Q

What investigations are done for extradural haemorrhage?

A

Non contrast CT of the head straight away

MRI

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14
Q

What is the epidemiology for extradural haemorrhage?

A

Young, male

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15
Q

Why is non contrast CT used for extradural haemorrhage?

A

Blood appears bright when its fresh

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16
Q

What blood vessel is mainly associated with an extradural haemorrhage?

A

Middle meningeal artery

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17
Q

Where does the middle meningeal artery run?

A

Pterion

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18
Q

How is GCS calculated?

A 
There are 3 categories:
Eye opening (scored 1-4)
Verbal response (scored 1-5)
Motor response (scored 1-6)
The higher the score the better (suggesting the patient is ok)
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19
Q

What is the max GCS?

A

15

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20
Q

How many GCS are there?

A

Adult and paediatric

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21
Q

What does localise pain mean on the GCS?

A

They move their hands/ legs towards where pain is inflicted

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22
Q

What is the minimum GCS?

A

3

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23
Q

At what GCS are patients intubated?

A

A score below 9

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24
Q

How does sub arachnoid haemorrhage present?

A

Sudden onset thunderclap headache at the back of their head (occipital region)
Neck may be stiff
May have meningeal symptoms
Syncope, nausea, vomiting
Very severe headache (worst in their life)

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25
Q

How should you report a GCS score

A

E 1-4
V 1-5
M 1-6
ie not just the total, report each section differently

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26
Q

What is epidemiology for subarachnoid haemorrhage?

A

50-55 year old woman

higher incidence in black people

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27
Q

What are causes of subarachnoid haemorrhage?

A

Rupture of sacular aneurysm (80%)- is spontaneous
Arterial venous malformation
Arterial dissections

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28
Q

What is a sacular aneurysm?

A

Not a full length aneurysm but it looks like a sac

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29
Q

What is arterial venous malformation?

A

When artery and vein blend together but they shouldn’t

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30
Q

What are risk factors of subarachnoid haemorrhage?

A

Smoking
hypertension
alcohol misuse

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31
Q

What is the first line investigation for subarachnoid haemorrhage and second line? What other investigations are done?

A

Non contrast head CT
if negative and you think they have it do a lumbar puncture
Serum electrolytes (they may be hyponatraemic if they have SIADH)
ECG
Serum glucose (1/3 are hypoglycaemic)

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32
Q

Which nerves are most affected by haemorrhages?

A

CN III and IV

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33
Q

When can you do a lumbar puncture? Why?

A

At least 12 hours post beginning of symptoms, you need to leave time for the haemoglobin to break down

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34
Q

How many tubes need to be filled in lumbar puncture?

A

3

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35
Q

What are cisterns?

A

Where CSF flows but not ventricles

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36
Q

What colour is CSF on CT?

A

Black

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37
Q

What syndrome is affected with head trauma?

A

SIADH

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38
Q

How will SIADH affect electrolytes?

A

Hyponatraemia

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39
Q

What test is done on all neuro patients?

A

ECG

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40
Q

How does subdural haemorrhage present?

A

Gradual onset
Fluctuating consciousness, personality change
Diminished response, nausea, vomiting

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41
Q

What are causes of subdural haemorrhage?

A

Trauma

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42
Q

What are risk factors for subdural haemorrhage?

A

Recent trauma
Coagulopathy/ anticoagulants
Over 65
Elderly and alcoholics

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43
Q

What is the epidemiology of subdural haemorrhages?

A

After falls, elderly patients, coagulopathy

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44
Q

Whats the main difference between subdural and extradural haemorrhage?

A 
Subdural= gradual onset
Extradural= sudden onset
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45
Q

Why must you be careful if you suspect someone has a change in behaviour due to a subdural haemorrhage?

A

Rule out whether this could be because of dementia etc as usually the patients are old

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46
Q

What are the 2 types of subdural haemorrhages?

A

Acute and chronic

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47
Q

How do you differentiate acute subdural and epidural

A

If there is trauma involved and if the person is young it is more likely epidural

48
Q

What should you look for when examining eyes in a neuro patient?

A

Are their eyes responsive to light and can they follow a light (shows CN 1-4 are fine)

49
Q

What medication may be given to those with subdural haemorrhage?

A

Anti epileptics

50
Q

What are the 2 ways to treat a subdural haemorrhage?

A 
Watchful waiting (they might just get better)
Drill a burr hole and remove the haematoma
51
Q

What are the 2 ways to treat a subdural haemorrhage?

A 
Watchful waiting (they might just get better)
Drill a burr hole and remove the haematoma
52
Q

When should you use a burr hole to treat a subdural haemorrhage?

A

If it is starting to affect their memory

If they have a really poor GCS

53
Q

What does plegic mean?

A

Paralysed/ can’t move

54
Q

How do you differentiate between an acute and chronic subdural haemorrhage on CT?

A

Acute will show blood to be white

Chronic will show blood to be black

55
Q

What is the biggest complication of a subdural haemorrhage? List some of the others too

A 
Biggest= epilepsy
Others= Coma, stroke, neuro deficits eg plegia
56
Q

How do you treat a subdural haematoma?

A

Acute, below 10mm, below 5mm midline shift, no CNS dysfunction= observe and wait
Acute, above 10mm, above 5mm midline shift, CNS dysfunction= surgery burr holes and prophylactic antiepileptics
Chronic haematoma= anti epileptics

57
Q

What anti epileptics may be given for prophylaxis in subdural haematoma?

A

Levitiracetam or phenytoin

58
Q

What may levitiracetam also be called?

A

Cepra

59
Q

What disease is subarachnoid haemorrhage associated with?

A

Polycystic kidney disease

60
Q

What symptom will a brain bleed commonly present with?

A

Headache

61
Q

What are the 2 types of stroke?

A

Ischaemic or haemorrhagic

62
Q

Define stroke

A

A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24 hours

63
Q

Define TIA

A

A sudden onset focal neurological deficit of presumed vascular origin which lasts under 24 hours

64
Q

What is an ischaemic stroke?

A

Loss of blood flow to a region of the brain due to stenosis or occlusion

65
Q

What is a haemorrhagic stroke?

A

A burst blood vessel

66
Q

How will a haemorrhagic stroke present?

A

Sudden onset
Loss of function
Vision changes

67
Q

What are causes of haemorrhagic stroke?

A

Hypertension

Drugs (cocaine, amphetamines)

68
Q

How should you investigate stroke?

A

CT head (exclude haemorrhage if its ischaemic)

69
Q

What treatment do you need to start if someone comes in with an ischaemic stroke? Why would you not do this if the stroke is haemorrhagic?

A

Alteplase IV

If stroke is haemorrhagic this would make them bleed more

70
Q

What is the epidemiology of haemorrhagic stroke?

A

Most are intracerebral, rest are subarachnoid
More common in men
More come in elderly
More common in asains

71
Q

How is haemorrhagic stroke treated?

A

Refer them to neurosurgery

Go through ABCDE and protect airway etc

72
Q

If weakness in a stroke is right sided which side will the bleed be on?

A

Left

73
Q

What area has been affected if there is expressive aphasia?

A

Broca’s

74
Q

What area has been affected if there is recepetive aphasia?

A

Wernicke’s

75
Q

If the arm is more affected than the leg in stroke which artery is more likely affected?

A

Middle cerebral (supplies the lateral parts of the brain and this is what controls the arms)

76
Q

How does ischaemic stroke present?

A 
Sudden onset
Loss of function
Vision changes
Headache
Aphasia
77
Q

What is the epidemiology of ischaemic stroke?

A 
Older people
Black people
Hispanic people
Lower levels of education
Men more than women
78
Q

What are causes of ischaemic stroke?

A

Those with vascular sclerosis or occulsion eg diabetics atrial fibrillation, high cholestrol
Cerebral venous thrombosis

79
Q

What is the first line investigation for haemorrhagic stroke?

A

Non contrast CT head

80
Q

How will ischaemic stroke appear on CT?

A

Hypo attenuated ie area is less intense than the surrounding area

81
Q

What should you think when you see hypo attenuation on a CT?

A

Vascular occlusion

Ischaemia

82
Q

What should you think when you see white on a CT?

A

Blood

83
Q

How is ischaemic stroke treated?

A

Non contrast head CT to rule out haemorrhage THEN

Less than 4.5 hrs= alteplase IV, aspirin after 24 hrs of IV, supportive care, swallowing assessment, VTE prophylaxis (heparin)

Over 4.5 hrs= Aspirin 300 mg, supportive care, swallowing assessment, VTE prophylaxis

Central venous sinus thrombosis= antioagulate using heparin and supportive care

84
Q

How is secondary prevention for ischaemic stroke carried out?

A

Continue with aspirin for 2 weeks, then switch to lifelong clopidogrel or diphyramidole
If they have AF offer lifelong anticoagulation

85
Q

When is alteplase IV given for ischaemic stroke?

A

Only if you are completely sure they have prevented in under 4.5 hours of symptoms

86
Q

How does presentation/risk factors/ epidemiology/ of TIA differ from stroke?

A

It doesn’t, everything is the same

87
Q

What is the ABCD referral system?

A

It is a way of scoring patients to see how quickly they have to be referred for stroke eg score of above 2= refer within 24 hrs

88
Q

How is TIA treated?

A

Depending on the cause

89
Q

How is atherosclerotic TIA treated?

A

Antiplatelet (aspirin or clopidogrel)
Statin
Lifestyle modification
If carotid is obstructed over 50% do an enderartectomy

90
Q

How is cardioembolic TIA treated?

A

Anticoagulation (warfarin or apixaban started in 2 weeks)

91
Q

What is an enderartectomy?

A

When the plaque obstructing more than 50% of the carotid is surgically removed

92
Q

What are complications of TIA?

A

Stroke

93
Q

What are upper motor neurone signs?

A 
Contralaterally: 
Weakness
Higher spasticity
Hyperreflexia 
Upgoing plantars
94
Q

What signs are not present with upper motor neurone lesion?

A

No fasciculations or muscle wasting

95
Q

What are the lower motor neurone signs?

A 
Unilaterally:
Fasciculations
Muscle wasting
Hyporeflexia 
Weakness
Normal plantar response
96
Q

How are strokes/TIAs graded?

A

MRC grading (0-5)

97
Q

Describe MRC grading

A 
0= no muscle contraction
1= flicker of contraction
2= some active movement 
3= active movement against gravity
4= active movement against resistance 
5= normal power considering their age
98
Q

On the motor homunculus what organs are associated with the lateral regions?

A

Arm, face etc

99
Q

On the motor homunculus what organs are associated with the medial regions?

A

Legs

100
Q

Which artery is associated with the lateral areas of the brain?

A

Middle cerebral artery

101
Q

Which artery is associated with the medial areas of the brain?

A

Anterior cerebral

102
Q

If arms are more affected in stroke what artery is likely to be involved?

A

Middle cerebral

103
Q

If legs are more affected in stroke what artery is likely to be involved?

A

Anterior cerebral

104
Q

What vessels are associated with the posterior circulation in the brain?

A

They arise from the basilar artery and mainly include the posterior cerebral

105
Q

What vessels are associated with the anterior circulation in the brain?

A

They arise from the internal carotid artery and mainly include middle and anterior cerebral arteries

106
Q

How will stroke of the anterior cerebral artery present?

A

Contralateral hemiparesis (more so the lower limb)
Abulia
Confusion
Gait apraxia

107
Q

How will stroke of the middle cerebral artery present?

A

Contralateral hemiparesis (more so the upper limb and face)
Contralateral hemisensory loss
Apraxia
Hemineglect
if the left MCA is affected: receptive/expressive aphasia
if meyer’s/baum’s loop is affected quadrantopia

108
Q

If the left MCA is affected what stroke sign will occur?

A

Receptive or expressive aphasia

109
Q

What is quadtrantopia?

A

A quarter of the visual field is lost

110
Q

If someone is right hand dominant what side will their language center be dominant?

A

Left side

111
Q

What visual symptoms arise after stroke affecting the posterior cerebral artery?

A 
Homonymous hemianopia (macular sparing)
Visual agnosia
112
Q

What symptoms arise after stroke of the basilar artery?

A

Cranial nerve pathology (basilar artery is on the pons which also has the cranial nerves)
Visual impairments
Cerebellar pathology
Impaired consciousness

113
Q

What does aneurysm of the superior cerebellar artery cause?

A

Trigeminal nerve neuralgia

Dizziness

114
Q

What is amaurosis fugax?

A

A type of TIA

115
Q

What are complications of stroke?

A 
Loss of function of half of body will affect mood
DVT (due to loss of movement)
Immobility
Seizures
Infections
Cardiovascular events 
Cerebral oedema 
Psychiatric/mood disturbance 
Death

Year 3 (104 decks)

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