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ICS > Neuro > Flashcards

Neuro Flashcards

1
Q

What is a subarachnoid haemorrhage

A

An intracranial haemorrhage which causes a bleed into the subarachnoid space
Type of haemorrhagic stroke

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2
Q

Describe the types of subarachnoid haemorrhages

A

Traumatic - mc
Atraumatic (spontanteous)

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3
Q

Name 3 causes of spontaneous subarachnoid haemorrhage

A

berry aneuryesm mc spontaneuos SAH (mc anterior communicating and cerebral artery)

arteriorvenous malfunctinon

mycotic aneurysm - bc of bacterial infection eg infective endocarditis

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4
Q

What conditions are associated with berry aneurysms

A

Polycystic kidney disease
Ehlers and Danlos syndrome

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5
Q

What are the risk factors for a subarachnoid haemorrhage

A

HTN
Smoking
>50yrs age
Alcohol
FHx

(PCKS/ ED)

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6
Q

What are the symptoms of a subarachnoid haemorrhage

A

Headache
- severe
- sudden (1-5min)
- thunderclap headache
- “worst ever headache”
- occipital

Meningism: photophobia, headache, neckstiffness
N+V
Coma, seizures, confusion

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7
Q

WHat are the signs for a subarachnoid haemorrhage

A
  • 3rd nerve palsy: fixed pupil dilation
  • 6th nerve palsy: non-specific sign of incr intracranial pressure
  • reduced glasgow coma scale (GCS)
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8
Q

What are the first line investigations for a subarachnoid haemorrhage

A
  • urgent, non-contrast head CT scan
    star shaped lesions
  • ECG -> ST elevation arrhythmias
  • Bloods; glucose, fbc
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9
Q

In a suspected subarachnoid haemorrhage, if the CT scan is negative what is the second line investigation and result

A
  • Lumbar punchar
  • done after 12 hours
    xanthchromia- yellow pigmentation of CSF due to the breakdown of Hb into bilirubin
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10
Q

What test is done to determine the source of a subarachnoid haemorrhage

A

CT head angiogram

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11
Q

What is the management/ treatment of a subarachnoid haemorrhage

A
  • neruosurgery- endovascular coiling
  • nimodipine- CCB which decr vasospasms and BP
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12
Q

What are 2 differential diagnoses of a subarachnoid haemorrhage

A

Meningitis- presents w no thunderclap headache and signs of infection
Migraine

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13
Q

What are the complications of a subarachnoid haemorrhage

A

death
seizures
rebleed
hydrocephalus

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14
Q

What is an extradural haemorrhage

A

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

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15
Q

What vessel rupture is most commonly associated with an extradural haemorrhage and where is it located

A

Middle meningeal artery
Pterion bone in temporal region

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16
Q

What are the causes of an extradural haemorrhage

A

mainly traumatic
- mc arterial rupture - middle meningeal artery
- venours- dural sinuses lanceration

also nontraumatic eg infection/ coagulopathy

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17
Q

What are the risk factors for an extradural haemorrhage

A

age >65

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18
Q

Pathophysiology for extradural haemorrhage

A
  • 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)
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19
Q

Symptoms of extradural haemorrhage during rapid deteriration

A

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
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20
Q

What is the most common vessel affected in an extradural haemorrhage

A
  • middle meningeal artery
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21
Q

What is cushing’s triad and breifly describe the pathophysiology

A

-irreg resp
-bradycardia
-widened pulse pressure
- incr in intercranial pressure causes cushing reflex causing cushings triad
- also behavior change and HTN

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22
Q

What are the investigations and results for an extradural haemorrhage

A

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

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23
Q

What is the treatment for an extradural haemorrhage

A
  • 1st line: neurosurgery: crainoectomy and haematura drainage
    alongside with IV mannitol to reduce ICP
24
Q

What are the complications for an extradural haemorrhage

A

death fron resp arrest
ICP and hernation
seizure
infection

25
Q

What is a subdural haemorrhage

A
  • 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
26
Q

What vessels are mainly involved in a subdural haemorrhage

A

bridging veins

27
Q

Who is most at risk of a subdural haemorrhage

A

infants and children (abused eg shaking)
those with cortical atrophy eg elderly w dementia or alcoholics

28
Q

What is the main cause of a subdural haemorrhaeg

A

trauma

29
Q

Describe the onset of symptoms for subdural heamorrhaeg

A
  • latent period- feel fine
  • gradual deteriortation
30
Q

Describe the pathophysiology of a subdural haemorrhage

A
  • latent period
  • gradual deterioration due to slow bleeding of vessels and then gradual accumalation and autolysis of blood cauisng incr in ICP -> sx
31
Q

What are the signs and symptoms of subdural haemorrhage

A

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

32
Q

WHat are the investigations and results for subdural haemorrhage

A

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

33
Q

Tx of subdural haemorrhage

A
  • neurosurgery: craniotomy and burr hole surgery
  • IC mannitol to reduce ICP
34
Q

Complications of subdural haemorrhage

A

seizures
death
icp
iinfection

35
Q

what medication is given to reduce ICP

A

IV mannitol

36
Q

What is a migraine

A
  • is a primary and mostly episodic headache
  • is a recurrent throbbing headache often preceeded by an aura and usually associated with nausea and vomiting
37
Q

What are the triggers for a migraine

A

CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins/ lack of food
Alcohol - red wine / anxiety
Tumolt- loud noise / travel
Exercise

38
Q

What/ who is most at risk of hangovers

A

w>m
decr in age
stress
CHOCOLATE (triggers)

39
Q

What is the pathophysiology of a migraine

A

neuronal hyperexcitability
trigeminal nerves cause a an inflam response causing meningeal vasodilation and sensitisation of pain causing a pain response

40
Q

What are the symptoms of a migraine

A
  • 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
41
Q

What are the investigations and criteria for a migraine

A

clinical diagnosis - no investigations unless a secondary pathological cause is suspected

42
Q

What is the treatment for a migraine

A
  • acute - triptan/ aspirin
    -Chronic- propanolol or topiramate (teatrogenic)
  • avoid triggers, antiemtics, mindfulness
43
Q

What causes an aura in a migrane

A
  • cortical depression
  • wave of depolarisation of the cerebral cortex
44
Q

Name 5 UMM signs

A
  • hyperreflexia
  • hypertonia
    • ve Babinskis sign
  • arm stronger extensor than reflexor
  • leg stronger flexor than extensor
  • no fasciculations
  • contralateral
45
Q

Are UMN signs contralateral or ipsilateral to the lesion

A

contralatetal

46
Q

Where would a UMN lesion be located

A

from pre-central gyrus to the anterior horn of the spinal cord

47
Q

Name 5 LMN signs

A
  • hypotonia and muscle wasting
  • hypo/ absent reflexes
  • -ve Babinskis sign
  • limbs generally weaker
  • fasciculations
48
Q

Are LMN signs contralateral or ipsilateral to the lesion

A

ipsilateral

49
Q

Where would a LMN lesion be located

A

from anterior horn of the spinal cord to the peripheries

50
Q

What type of neurone causes LMN signs

A

a- motor neurone

51
Q

Name 5 descending motor tract

A

corticospinal (pyramidal)
corticobulbar (pyramidal)
Reticulospinal (extrapyramidal)
Tectospinal (extrapyramidal)
Rubrospinal (extrapyramidal)
Vestibulospinal (extrapyramidal)

52
Q

What are the function of extrapyramidal tracts

A
  • sends involuntary autonomic motor information from cortex to LMN
  • eg balance, tone, posture, locomotion
53
Q

What are the function of pyramidal tracts

A
  • sends voluntary control of all muscles- face and body
  • corticospinal is to body
  • corticobulbar is to face
54
Q

What is motor neuron disease

A

it is a neurodegenerative disease affecting both the UMN and LMN

55
Q

What are the 4 types of MND

A
  1. ALS- amylotrophic lateral sclerosis
  2. PLS- Primary lateral sclerosis
  3. PMA Progressive muscle atrophy
  4. PBP Progressive bulbar palsy

ICS (11 decks)

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