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CP1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Surgical Sieve

A 
Vascular
Infection
Inflammation
Neoplastic
Degenerative
Episodic
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2
Q

Lesions causing homonymous hemianopia

A

Lesion of left or right optic tract impacting both paths which travel within it

Infarct to middle cerebral artery

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3
Q

Lesions causing bitemporal hemianopia

A

Lesion or compression of optic chiasm

Anterior communicating artery aneurysm

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4
Q

Lacunar stroke symptoms

A

Pure motor - contralateral weakness of face, arm, leg

Pure sensory - contralateral numbness of face, arm, leg

Mixed - contralateral weakness and numbness

Ataxic hemiparesis - ipsilateral lower limb weakness and lack of coordination

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5
Q

Total Anterior Circulation Stroke Symptoms

A

ALL THREE OF:

Unilateral weakness and/or sensory deficit

Homonymous Hemianopia

Higher cerebral dysfunction e.g. dysphagia, visuospatial problems

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6
Q

Partial Anterior Circulation Stroke Symptoms

A

TWO OF:

Unilateral weakness and/or sensory deficit

Homonymous Hemianopia

Higher cerebral dysfunction e.g. dysphagia, visuospatial problems

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7
Q

Posterior Circulation Stroke

A

Cerebellum - ataxia, balance issues, nystagmus, vertigo

Occipital lobe - visual field defects e.g. homonymous hemianopia

Thalamus - sensory deficits

Brain Stem - cranial nerve palsy

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8
Q

Arterial supply to lower limb cortex area

A

Anterior Cerebral Artery

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9
Q

Arterial supply to upper limb and face cortex area

A

Middle Cerebral Artery

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10
Q

C5 nerve root lesion symptoms

A

Sensation in C5 dermatome (upper arm below shoulder)

Diminished reflexes in brachioradialis and biceps tendons

Weakness of shoulder abduction weakness, elbow flexion and forearm supination

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11
Q

T1 nerve root lesion symptoms

A

Sensation in T1 dermatome (top of ribs around the axilla level, ulnar aspect of arm)

Wasting of intrinsic muscles of the hand

Weak ab and adduction of the fingers

Reflexes tend to be normal

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12
Q

Upper limb reflexes

A 
Brachioradialis reflex (C5,C6)
Biceps reflex (C5,C6)
Triceps reflex (C6,C7)
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13
Q

Amaurosis Fugax

A

Transient occlusion of the retinal artery causing temporary vision loss in one eye

Described as ‘curtain coming down’

Usually only lasts a few seconds and vision will return gradually over several minutes

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14
Q

Radial Nerve Palsy Symptoms

A

Wrist drop/unable to extend

Loss of sensation over radial nerve distribution

If the injury is at axilla level, can effect triceps and so unable to extend elbow

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15
Q

Symptoms of Ulnar Neuropathy at the Elbow

A

Numbness and/or tingling in digits 4 and 5

Weakness of extending fingers 4 and 5 (claw hand)

Weak finger ab and adduction

Prominent extensor tendons

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16
Q

Median Nerve Compression

A

Numbness in the medial nerve supplied area - thumb and first 2.5 fingers

Weakening and wasting of thenar muscles

Night time pain

Phalen’s test, Tinel’s test etc. positive

17
Q

Link between AF and stroke

A

Blood can pool in the atria leading to thrombus formation

18
Q

Lower Limb Reflexes

A

Patella (L3/4)

Achillies (S1/2)

19
Q

Investigating Haemorrhagic Stroke

A

Non-contrast CT head
Clotting
FBC - is thrombocytopenia cause of bleed?
LFTs - is liver failure the source of bleed?
U&E’s - some stroke treatment contraindicated in renal failure
Toxicology - is this the cause of bleed?
LP if subarachnoid haemorrhage suspected

20
Q

Treating haemorrhagic stroke

A

Supportive Care
BP control
Neurosurgery referral
Reversal of anticoagulant if applicable

21
Q

Treating ischaemic stroke

A

Presentation < 4.5 hours

  • Thrombolysis (e.g. Alteplase)
  • Supportive care
  • Antiplatelet therapy (aspirin or clopidogrel)
  • High intensity statin
  • Consider thromboectomy

Presentation > 4.5 hours OR thrombolysis contraindicated

  • Supportive care
  • Consider thromboectomy
  • Antiplatelet therapy (aspirin or clopidogrel)
  • High intensity statin
22
Q

Complications from ischaemic stroke

A

Conversion to haemorrhagic stroke
DVT due to immobility
Reactions to thrombolysis
Aspiration pneumonia

23
Q

Complications of haemorrhagic stroke

A

Seizure
Aspiration pneumonia
DVT/PE
Delirium

24
Q

Complications of subarachnoid haemorrhage

A 
Rebleeding 
Seizure 
Vasospasm 
Hydrocephalus 
Neuropsychiatric problems
25
Q

Causes of subarachnoid haemorrhage

A

Formation of cerebrovascular aneurisms due to factors such as, ADPKD, connective tissue disorders, malformations of arterioles etc.

Persistent hypertension

Use of anticoagulants

Trauma to head

26
Q

Treatment of subarachnoid haemorrhage

A

Nimodipine (a CCB) to prevent delayed ischaemia
Analgesia
Anticonvulsant if seizure risk
Stop and reverse anticoagulation if indicated
LP drainage of hydrocephalus if indicated
Neurosurgery input

27
Q

Symptoms of subdural haematoma

A 
Headache 
Nausea and Vomiting 
Diminished eye, verbal and motor response (acute)
Unequal pupils  
Evidence of head trauma
Lucid interval (acute)
Seizure
Cognitive changes 
Incontinence 
Localised weakness
28
Q

Causes of subdural haematoma

A

Most often trauma
Less commonly an aneurysm rupture
More common in the elderly, heavy alcohol use, anticoagulation

29
Q

Treatment of subdural haematoma

A

< 10mm OR mid-line shift < 5mm OR non-expansile

  • Observe and monitor
  • Prophylactic anticonvulsants
  • Consider correcting anticoagulation and reducing ICP

> 10mm OR mid-line shift > 5mm OR expansile

  • Surgery
  • Prophylactic anticonvulsants
  • Consider correcting anticoagulation and reducing ICP
30
Q

Complications of subdural haematoma

A 
Neurological deficits 
Coma
Stroke 
Surgical infection 
Epilepsy 
Rebleed 
Cerebral oedema 
Raised ICP
31
Q

Meningism Triad

A

Neck rigidity

Positive Kernig’s sign - leg cannot be fully extended when raised due to severely tight hamstrings

Positive Brudzinski’s sign - hips and knees flex when head is flexed

32
Q

Organisms causing bacterial meningitis

A

ADULTS
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzaetype b (Hib)

NEONATES
Group B streptococcus
E coli.

33
Q

Treatment of meningitis

A 
IV antibiotics (e.g. Ceftriaxone)
Corticosteroids
34
Q

LP in meningitis

A 
High pressure 
High WCC
High proteins 
High lactate 
Low glucose
35
Q

Diagnosing meningitis

A 
Blood cultures 
Pneumococcal and meningococcal PCR
LP
FBC with differentials 
Lactate 
Clotting
LFTs 
U&Es
HIV screen
36
Q

Meningitis Complications

A 
Sepsis
Septicaemia leading to limb loss 
Seizures
Raised ICP
Hydrocephalus 
Subdural effusion
37
Q

Broca’s aphasia

A

Understands language but finds it very difficult to talk

38
Q

Wernicke’s aphasia

A

Loss of ability to understand language

Fluent speech but makes little sense - ‘word salad’

39
Q

Diagnosing subarachnoid haemorrhage

A

Non-contrast CT scan

LP - be mindful that haemoglobin and bilirubin can take up to 12 hours post symptom onset to appear in CSF

CP1 (13 decks)

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