Neuro Flashcards
What is a subarachnoid haemorrhage
An intracranial haemorrhage which causes a bleed into the subarachnoid space
Type of haemorrhagic stroke
Describe the types of subarachnoid haemorrhages
Traumatic - mc
Atraumatic (spontanteous)
Name 3 causes of spontaneous subarachnoid haemorrhage
berry aneuryesm mc spontaneuos SAH (mc anterior communicating and cerebral artery)
arteriorvenous malfunctinon
mycotic aneurysm - bc of bacterial infection eg infective endocarditis
What conditions are associated with berry aneurysms
Polycystic kidney disease
Ehlers and Danlos syndrome
What are the risk factors for a subarachnoid haemorrhage
HTN
Smoking
>50yrs age
Alcohol
FHx
(PCKS/ ED)
What are the symptoms of a subarachnoid haemorrhage
Headache
- severe
- sudden (1-5min)
- thunderclap headache
- “worst ever headache”
- occipital
Meningism: photophobia, headache, neckstiffness
N+V
Coma, seizures, confusion
WHat are the signs for a subarachnoid haemorrhage
- 3rd nerve palsy: fixed pupil dilation
- 6th nerve palsy: non-specific sign of incr intracranial pressure
- reduced glasgow coma scale (GCS)
What are the first line investigations for a subarachnoid haemorrhage
- urgent, non-contrast head CT scan
star shaped lesions - ECG -> ST elevation arrhythmias
- Bloods; glucose, fbc
In a suspected subarachnoid haemorrhage, if the CT scan is negative what is the second line investigation and result
- Lumbar punchar
- done after 12 hours
xanthchromia- yellow pigmentation of CSF due to the breakdown of Hb into bilirubin
What test is done to determine the source of a subarachnoid haemorrhage
CT head angiogram
What is the management/ treatment of a subarachnoid haemorrhage
- neruosurgery- endovascular coiling
- nimodipine- CCB which decr vasospasms and BP
What are 2 differential diagnoses of a subarachnoid haemorrhage
Meningitis- presents w no thunderclap headache and signs of infection
Migraine
What are the complications of a subarachnoid haemorrhage
death
seizures
rebleed
hydrocephalus
What is an extradural haemorrhage
A bleed into the potential space between the dura and the skull (extradural/ epidural space)
The collection of blood is refered to as a extradural haematoma
What vessel rupture is most commonly associated with an extradural haemorrhage and where is it located
Middle meningeal artery
Pterion bone in temporal region
What are the causes of an extradural haemorrhage
mainly traumatic
- mc arterial rupture - middle meningeal artery
- venours- dural sinuses lanceration
also nontraumatic eg infection/ coagulopathy
What are the risk factors for an extradural haemorrhage
age >65
Pathophysiology for extradural haemorrhage
- initial trauma/ rupture
- inital LOC - due to formation of haematoma
- rapid deterioration
- bc of incr ICP as the haematoma is autolysed and takes up water (as is osmotically active)
Symptoms of extradural haemorrhage during rapid deteriration
Incr ICP -> cushings triad
- irreg resp
- bradycardia
- widened pulse pressure
(behaviour change, HTN)
uncal herniation
- CN3 palsy -> ipsilateral fixed dilated pupil
- contralateral hemiparaesthesia
- coma/ confusion/ seizures
What is the most common vessel affected in an extradural haemorrhage
- middle meningeal artery
What is cushing’s triad and breifly describe the pathophysiology
-irreg resp
-bradycardia
-widened pulse pressure
- incr in intercranial pressure causes cushing reflex causing cushings triad
- also behavior change and HTN
What are the investigations and results for an extradural haemorrhage
urgent noncontrast CT scan
- Sickle/ rounded- bicinvex, well demarkated hyperdense bleed in the epidural space
- well confined to the suture lines
- often in the temporal lobe
What is the treatment for an extradural haemorrhage
- 1st line: neurosurgery: crainoectomy and haematura drainage
alongside with IV mannitol to reduce ICP
What are the complications for an extradural haemorrhage
death fron resp arrest
ICP and hernation
seizure
infection
What is a subdural haemorrhage
- is a bleed of bridging veins into the subdural space- between the dura mater and arachnorid of the meningeal layers
- the collection of blood is a haematoma
What vessels are mainly involved in a subdural haemorrhage
bridging veins
Who is most at risk of a subdural haemorrhage
infants and children (abused eg shaking)
those with cortical atrophy eg elderly w dementia or alcoholics
What is the main cause of a subdural haemorrhaeg
trauma
Describe the onset of symptoms for subdural heamorrhaeg
- latent period- feel fine
- gradual deteriortation
Describe the pathophysiology of a subdural haemorrhage
- latent period
- gradual deterioration due to slow bleeding of vessels and then gradual accumalation and autolysis of blood cauisng incr in ICP -> sx
What are the signs and symptoms of subdural haemorrhage
Incr ICP
- Cushings triad (bradycardia, irreg bleeding, widened PP)
-HTN
Focal neurological deficits (depending on where bleed is)
- eg cn3 palsy-> ipsilateral fixed dilated pupil
- contralateral hemiparaesthesia - temporal region
coma/ seizure/n/v
WHat are the investigations and results for subdural haemorrhage
Noncontrast ct scan
- crescent shaped, haematoma, not confined by suture lines
- midline shift
- hyperdense if acute <3 days
-isodense if subacute 3-21 days
- hypodense if chonic >21 days
Tx of subdural haemorrhage
- neurosurgery: craniotomy and burr hole surgery
- IC mannitol to reduce ICP
Complications of subdural haemorrhage
seizures
death
icp
iinfection
what medication is given to reduce ICP
IV mannitol
What is a migraine
- is a primary and mostly episodic headache
- is a recurrent throbbing headache often preceeded by an aura and usually associated with nausea and vomiting
What are the triggers for a migraine
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins/ lack of food
Alcohol - red wine / anxiety
Tumolt- loud noise / travel
Exercise
What/ who is most at risk of hangovers
w>m
decr in age
stress
CHOCOLATE (triggers)
What is the pathophysiology of a migraine
neuronal hyperexcitability
trigeminal nerves cause a an inflam response causing meningeal vasodilation and sensitisation of pain causing a pain response
What are the symptoms of a migraine
- headache: severe, unilateral, recurrent, throbbing/ pulsatile for upto 72 hrs
- photophobia/ phonophobia
nauea and vomiting - preceeeded by an aura
- visual - zigzag/ black hole in visual field
- sensory - paraesthesia (pins and needles) weakness, dysphasia
What are the investigations and criteria for a migraine
clinical diagnosis - no investigations unless a secondary pathological cause is suspected
What is the treatment for a migraine
- acute - triptan/ aspirin
-Chronic- propanolol or topiramate (teatrogenic) - avoid triggers, antiemtics, mindfulness
What causes an aura in a migrane
- cortical depression
- wave of depolarisation of the cerebral cortex
Name 5 UMM signs
- hyperreflexia
- hypertonia
- ve Babinskis sign
- arm stronger extensor than reflexor
- leg stronger flexor than extensor
- no fasciculations
- contralateral
Are UMN signs contralateral or ipsilateral to the lesion
contralatetal
Where would a UMN lesion be located
from pre-central gyrus to the anterior horn of the spinal cord
Name 5 LMN signs
- hypotonia and muscle wasting
- hypo/ absent reflexes
- -ve Babinskis sign
- limbs generally weaker
- fasciculations
Are LMN signs contralateral or ipsilateral to the lesion
ipsilateral
Where would a LMN lesion be located
from anterior horn of the spinal cord to the peripheries
What type of neurone causes LMN signs
a- motor neurone
Name 5 descending motor tract
corticospinal (pyramidal)
corticobulbar (pyramidal)
Reticulospinal (extrapyramidal)
Tectospinal (extrapyramidal)
Rubrospinal (extrapyramidal)
Vestibulospinal (extrapyramidal)
What are the function of extrapyramidal tracts
- sends involuntary autonomic motor information from cortex to LMN
- eg balance, tone, posture, locomotion
What are the function of pyramidal tracts
- sends voluntary control of all muscles- face and body
- corticospinal is to body
- corticobulbar is to face
What is motor neuron disease
it is a neurodegenerative disease affecting both the UMN and LMN
What are the 4 types of MND
- ALS- amylotrophic lateral sclerosis
- PLS- Primary lateral sclerosis
- PMA Progressive muscle atrophy
- PBP Progressive bulbar palsy
