Neuro Flashcards
Surgical Sieve
Vascular Infection Inflammation Neoplastic Degenerative Episodic
Lesions causing homonymous hemianopia
Lesion of left or right optic tract impacting both paths which travel within it
Infarct to middle cerebral artery
Lesions causing bitemporal hemianopia
Lesion or compression of optic chiasm
Anterior communicating artery aneurysm
Lacunar stroke symptoms
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
Total Anterior Circulation Stroke Symptoms
ALL THREE OF:
Unilateral weakness and/or sensory deficit
Homonymous Hemianopia
Higher cerebral dysfunction e.g. dysphagia, visuospatial problems
Partial Anterior Circulation Stroke Symptoms
TWO OF:
Unilateral weakness and/or sensory deficit
Homonymous Hemianopia
Higher cerebral dysfunction e.g. dysphagia, visuospatial problems
Posterior Circulation Stroke
Cerebellum - ataxia, balance issues, nystagmus, vertigo
Occipital lobe - visual field defects e.g. homonymous hemianopia
Thalamus - sensory deficits
Brain Stem - cranial nerve palsy
Arterial supply to lower limb cortex area
Anterior Cerebral Artery
Arterial supply to upper limb and face cortex area
Middle Cerebral Artery
C5 nerve root lesion symptoms
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
T1 nerve root lesion symptoms
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
Upper limb reflexes
Brachioradialis reflex (C5,C6) Biceps reflex (C5,C6) Triceps reflex (C6,C7)
Amaurosis Fugax
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
Radial Nerve Palsy Symptoms
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
Symptoms of Ulnar Neuropathy at the Elbow
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
Median Nerve Compression
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
Link between AF and stroke
Blood can pool in the atria leading to thrombus formation
Lower Limb Reflexes
Patella (L3/4)
Achillies (S1/2)
Investigating Haemorrhagic Stroke
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
Treating haemorrhagic stroke
Supportive Care
BP control
Neurosurgery referral
Reversal of anticoagulant if applicable
Treating ischaemic stroke
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
Complications from ischaemic stroke
Conversion to haemorrhagic stroke
DVT due to immobility
Reactions to thrombolysis
Aspiration pneumonia
Complications of haemorrhagic stroke
Seizure
Aspiration pneumonia
DVT/PE
Delirium
Complications of subarachnoid haemorrhage
Rebleeding Seizure Vasospasm Hydrocephalus Neuropsychiatric problems
Causes of subarachnoid haemorrhage
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
Treatment of subarachnoid haemorrhage
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
Symptoms of subdural haematoma
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
Causes of subdural haematoma
Most often trauma
Less commonly an aneurysm rupture
More common in the elderly, heavy alcohol use, anticoagulation
Treatment of subdural haematoma
< 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
Complications of subdural haematoma
Neurological deficits Coma Stroke Surgical infection Epilepsy Rebleed Cerebral oedema Raised ICP
Meningism Triad
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
Organisms causing bacterial meningitis
ADULTS
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzaetype b (Hib)
NEONATES
Group B streptococcus
E coli.
Treatment of meningitis
IV antibiotics (e.g. Ceftriaxone) Corticosteroids
LP in meningitis
High pressure High WCC High proteins High lactate Low glucose
Diagnosing meningitis
Blood cultures Pneumococcal and meningococcal PCR LP FBC with differentials Lactate Clotting LFTs U&Es HIV screen
Meningitis Complications
Sepsis Septicaemia leading to limb loss Seizures Raised ICP Hydrocephalus Subdural effusion
Broca’s aphasia
Understands language but finds it very difficult to talk
Wernicke’s aphasia
Loss of ability to understand language
Fluent speech but makes little sense - ‘word salad’
Diagnosing subarachnoid haemorrhage
Non-contrast CT scan
LP - be mindful that haemoglobin and bilirubin can take up to 12 hours post symptom onset to appear in CSF
