Neuro Flashcards
What is a stroke and TIA?
Stoke = permanent, neurological deficit lasting >24 hours
TIA = transient neurological dysfunction secondary to ischaemic without infarction
Px of TACS?
3/3 of:
1. Unilateral weakness (+/- sensory loss) of the face, arms and leg
2. Homonymous hemianopia
3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Px of lacunar syndrome?
- Pure motor or pure sensory stroke
- Ataxic hemiparesis
- Dysarthia
Px of POCS?
- Isolate homonymous hemianopia
- Cerebellar dysfunction
MCA embolism affects?
Face & upper limb > lower limb
ACA embolism affects?
Lower limb > upper limb
Scoring tools to identify stroke?
In community -> FAST (Face, arm, speech, time)
+ Exclude hypoglycaemia
In hospital -> Rosier scoring tool
TIA Mx?
- Aspirin
- <24hr see stroke specialist
- Consider MRI, carotid imaging
- secondary prevention:
- Clopidogrel
- Atorvastatin
- If carotid stenosis >50%
-> endarterectomy
- Modify risk factor
- secondary prevention:
Acute ischaemic stroke mx?
- Aspirin
+ PPI if dyspepsia hx - Thrombolysis (alteplase)
- Within 4.5 hours - Thrombectomy
- Within 6 hours
- Salvageable brain tissue seen
- Thrombectomy
- Consider decompressive hemicraniectomy in previously fit cases
Haemorrhagic stroke mx?
Return clotting levels to normal
- Reverse warfarin with Prothrombin + IV vit K
Consider lowering BP if:
- Px within 6h
- Systolic Bp between 150-220
What does a dominant hemisphere stroke affect?
Often affects language
What does a non-dominant hemisphere stroke affect?
Affects spatial awareness
Points for eyes in GCS?
4 = Spontaneous
3 = Speech
2 = Pain
1 = None
Points for verbal response in GCS?
5 = Orientated
4 = Confused conversation
3 = Inappropriate words
2 = Incomprehensible words
1 = None
Points for motor response in GCS?
6 = Obeys commands
5 = Localises pain
4 = Normal flexion
3 = Abnormal flexion
2 = Extends
1 = None
At what score, consider securing airway?
8 or less
What is the origin of a extradural haemorrhage?
Middle meningeal artery
What is the origin of an subdural haemorrhage?
Bridging cerebral veins
What is the origin of a subarachnoid haemorrhage?
Circle of wilis, sacular
‘Berry’ aneurysms
Where does an extradural haemorrhage occur?
Between skull bone and dura
Where does a subdural haemorrhage occur?
Between dura and arachnoid
Who and Px of extradural haemorrhage?
Who:
Young
Head trauma
Rapid GCS decline
Temporal bone fracture
Px:
Lucid intervals
Unilateral fixed pupil ->
bilateral
Who and Px of subdural haemorrhage?
Who:
Older patients
Low impact trauma
Alcoholics
Px:
Progressive headache and confusion
Who and Px of subarachnoid haemorrhage?
Who:
Sickle cell anaemics
CTD
Cocaine use
Strenuous activity (weightlifting, sex)
Px:
Worst headache ever (occipital)
N&V
Neck stiffness Photophobia