Neuro Flashcards
Define transient ischaemic attack
Symptoms of a stroke resolving within 24 hours, secondary to ischaemia without infarction
Crescendo TIA
2 or more TIAs in one week, high risk for future stroke
Presentation of stroke
Sudden onset asymmetrical symptoms
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia
Sudden onset visual/sensory loss
Risk factors for stroke
Pre-existing cardiovascular disease
Previous stroke / TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
COCP
Clinical scoring tool to recognise stroke
ROSIER
Management of stroke
Immediate CT brain to exclude haemorrhage
Aspirin 300mg STAT (continue for 2 weeks)
Thrombolysis with alteplase if within 4.5hrs
Thrombectomy if within 6 hours
Clopidogrel 75mg after aspirin for life
Admit to stroke centre
Management of TIA
Aspirin 300mg
Secondary prevention for CVD
Stroke specialist within 24hrs
Gold standard imaging for stroke
Diffusion-weighted MRI
Secondary stroke prevention
Clopidogrel 75mg
Atorvastatin 80mg
Carotid endarterectomy or stenting if carotid artery
Treat modifiable risk factors
Major stroke categories
Ischaemic stroke
Haemorrhagic stroke
Mechanisms of ischaemic stroke
Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis
Which area of the brain is supplied by the anterior cerebral arteries
Anteromedial cerebrum
Which area of the brain is supplied by the middle cerebral arteries
Lateral cerebrum
Which area of the brain is supplied by the posterior cerebral arteries
Medial & lateral areas of the posterior cerebrum
What are the Bamford classification of strokes
Total anterior circulation (TACS)
Partial anterior circulation (PACS)
Posterior circulation (POCS)
Lacunar (LACS)
Criteria for TACS
Unilateral weakness and/or sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction
Criteria for PACS
TWO of:
- Unilateral weakness and/or sensory deficit of face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction
Criteria for LACS
ONE of:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
Criteria for POCS
ONE of:
- Cranial nerve palsy & contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia
Risk factors for intracranial bleed
Head injury
Hypertension
Aneurysm
Ischaemic stroke
Brain tumour
Anticoagulant
Presentation of intracranial bleed
Sudden onset headache
Seizures
Weakness
Vomiting
Reduced consciousness
Which vascular structure is involved in subdural haemorrhage
Bridging veins
Between which layers does a subdural haemorrhage occur
Dura mater & arachnoid mater
Appearance of subdural haemorrhage on CT
Crescent/banana
Which vascular structure is involved in extradural haemorrhage
Middle meningeal artery
Between which layers does extradural haemorrhage occur
Skull & dura mater
Which injury is associated with extradural haemorrhage
Temporal bone fracture
Appearance of extradural haemorrhage on CT
Biconvex/lemon
Between which layers does a subarachnoid haemorrhage occur
Pia mater & arachnoid membrane
Presentation of subarachnoid haemorrhage
Sudden onset occipital headache
Strenuous activity
Neck stiffness
Photophobia
Neurological changes
Management of intracranial bleed
CT head
Check FBC & clotting
Discuss with specialist neurosurgical centre
Consider escalation to ITU
Correct clotting abnormalities
Correct severe hypertension
Risk factors for subarachnoid haemorrhage
Hypertension
Smoking
Excessive alcohol consumption
Cocaine use
Family history
Sickle cell anaemia
Connective tissue disorders
Neurofibromatosis
ADPKD
CSF findings in subarachnoid haemorrhage
Raised RCC
Xanthochromia
Pathophysiology of Multiple Sclerosis
Immune cell response causing demyelination of neurons of CNS neurons, reducing nerve impulse transmission
Potential causes of Multiple Sclerosis
Multiple genes
Epstein-Barr virus
Low vitamin D
Smoking
Obesity
Signs & symptoms of multiple sclerosis
Optic neuritis
Double vision
Conjugate lateral gaze disorder
Focal weakness
Trigeminal neuralgia
Paraesthesia
Lhermitte’s sign
Ataxia
Positive Romberg’s test
Patterns of multiple sclerosis
Relapsing-remitting
Primary progressive
Secondary progressive
What is the most common pattern of multiple sclerosis
Relapsing-remitting
What is secondary progressive multiple sclerosis
Started off as relapsing-remitting disease, but now there is progressive worsening of disease with incomplete remissions
What is primary progressive multiple sclerosis?
Worsening of disease and symptoms from point of diagnosis, without any initial relapses or remissions
Investigations and findings for multiple sclerosis
MRI to visualise lesions
Oligoclonal bands in CSF
Presentation of optic neuritis
Central scotoma
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect
Management of multiple sclerosis
MDT input
Patient education
DMARDs
Biologics
Methylprednisolone for relapses
Tolterodine/oxybutynin for incontinence
Amitriptyline for neuropathic pain
Baclofen for spasticity
Types of motor neurone disease
Amyotrophic lateral sclerosis
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis
Features of amyotrophic lateral sclerosis
LMN signs in arms
UMN signs in legs
Family history - Ch21
Features of primary lateral sclerosis
UMN signs only
Features of progressive muscular atrophy
LMN signs only
Distal muscles affected before proximal
Carries best prognosis
Features of progressive bulbar palsy
Loss of function of brainstem motor nuclei
Palsy of tongue and facial muscles
Progressive swallowing difficulty
Progressive talking difficulty
Worst prognosis
LMN signs
Muscle wasting
Reduced tone
Fasciculation
Hyporeflexia
UMN signs
Hypertonia
Spasticity
Brisk reflexes
Upgoing plantar response
Presentation of motor neurone disease
Late middle age (usually)
Insidious onset
Progressive weakness
Increased fatigue when exercises
Clumsiness
Trips and falls
Slurred speech
Management of motor neurone disease
Irreversible
Riluzole can slow progression & extend survival
NIV
End of life care planning
Advanced directives
MDT involvement
Pathophysiology of Parkinson’s disease
Progressive reduction of dopamine in the basal ganglia due to reduced production by substantia nigra, leading to disorders of movement
Classic triad of features on Parkinson’s disease
Resting tremor
Rigidity
Bradykinesia
Signs and symptoms of Parkinson’s disease
Unilateral 4-6hz pill rolling tremor
Cogwheel rigidity
Micrographia
Shuffling gait
Facial masking
Difficulty turning
Depression
Sleep disturbance
Anosmia
Cognitive impairment
Features of Parkinsons tremor
Asymmetrical
4-6 hertz
Worse at rest
Improves with intentional movement
No change with alcohol
Feature’s of benign essential tremor
Symmetrical
5-8 hertz
Improves at rest
Worse with intentional movement
Improves with alcohol
Parkinson’s plus syndromes
Multiple system atrophy
Dementia with Lewy bodies
Progressive supranuclear palsy
Corticobasal degeneration
Management of Parkinson’s disease
Co-careldopa’
Entacapone
Cabergoline
Bromocryptine
Selegiline
Rasagiline