Nervous system 2 Flashcards
1
Q
What percentage of the popultaion experience migraines?
A
15%
2
Q
How does migraine classically present?
A
Visual or other aura lasting 15–30min followed within 1h by unilateral, throbbing headache.
3
Q
Partial triggers of migraine
A
CHOCOLATE
- Chocolate
- Hangovers
- Orgasms
- Cheese/Caffeine
- Oral contraceptives
- Lie-ins
- Alcohol
- Travel
- Exercise
4
Q
Management of migraine
A
- Prophylactic
- Propanolol
- Botulinum toxin type A injections are a last resort
- During attack
- Oral triptan with either NSAID or paracetamol
5
Q
Differential diagnosis for blackouts
A
- Vasovagal syncope
- Situational syncope
- Carotid sinus syncope
- Epilepsy
- Hypoglycaemia
- Orthostatic hypotension
6
Q
Causes of stroke
A
- Small vessel occlusion or thrombosis in situ
- Cardiac emboli
- Atherothromboembolism (eg from carotids)
- CNS bleeds
7
Q
Cardiac causes of stroke
A
- AF
- endocarditis
- MI
8
Q
Modifiable risk factors for stroke
A
- Hypertension
- Smoking
- Diabetes mellitus
- Heart disease (valvular, ischaemic, AF)
- Combined OCP
- Carotid bruit
- Increased clotting
9
Q
Signs of cerebral infarcts (50%)
A
- contralateral sensory loss or hemiplegia
- initially flaccid (floppy limb, falls like a dead weight when lifted)
- becoming spastic (UMN)
- dysphasia
- homonymous hemianopia
- visuospatial deficit
10
Q
Signs of brainstem infarcts (25%)
A
- Varied
- Includes quadriplegia
- Locked in syndrome
11
Q
Acute management of stoke
A
- Screen swallow - nil by mouth until this is done
- CT/MRI within 1 hour
- Antiplatelet agents - give 300mg of aspirin once haemorrhagic stroke is excluded
- Thrombolysis
- consider this as soon as haemorrhage is ruled out
- provided the onset of symptoms was ≤4.5h ago (best results are within 90 minutes)
- Thrombectomy
12
Q
Transient ischaemic attack
A
- This is an ischaemic neurological event with symptoms lasting <24h (often much shorter)
- Without intervention, more than 1 in 12 patients will go on to have a stroke within a week, so prompt management is imperative
13
Q
TIA treatment
A
- Control cardiovascular risk factors
- BP, hyperlipidaemia, DM, smoking
- Antiplatelet drugs - as with stroke
- aspirin 300mg for 2 weeks, then switch to clopidogrel 75mg od
- Anticogulation indications
- Cardiac source of emboli
- Carotid endarterectomy
- Perform within 2wks of first presentation if 70–99% stenosis and operative risk is acceptable
14
Q
What is epilepsy?
A
Epilepsy is a recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures.
15
Q
What are the types of generalised seizures?
A
- Absence seizures: Brief (≤10s) pauses, eg suddenly stops talking in mid-sentence, then carries on where left off. Presents in childhood.
- Tonic–clonic seizures: Loss of consciousness. Limbs stiffen (tonic), then jerk (clonic). May have one without the other. Post-ictal confusion and drowsiness.
- Myoclonic seizures: Sudden jerk of a limb, face, or trunk. The patient may be
thrown suddenly to the ground, or have a violently disobedient limb: one patient described it as ‘my flying-saucer epilepsy ’, as crockery which happened to be in the hand would take off. - Atonic (akinetic) seizures: Sudden loss of muscle tone causing a fall, no LOC.
