Neuro Flashcards
Features of Cushing’s reflex?
- Cushing’s triad
- Bradycardia, widened pulse pressure, irregular breathing
When should anticoagulation be given after TIA in patient with AF, and what do you use?
- Straight away
- DOAC (e.g. apixaban)
When should anticoagulation be given after stroke in patient with AF, and what do you use?
- After 2 weeks
- DOAC (e.g. apixaban)
- Give anti platelet in the meantime (e.g. aspirin)
Features of lateral medullary syndrome?
- Ipsilateral facial pain and facial temperature loss
- Contralateral trunk/limb pain and temperature loss
- Ataxia, nystagmus
Lateral medullary syndrome is caused by an infarct in which vessel?
Posterior inferior cerebellar artery
Features of lateral pontine syndrome?
Similar to lateral medullary syndrome but with ipsilateral facial paralysis and deafnesss
Lateral pontine syndrome is caused by an infarct in which vessels?
Anterior inferior cerebella artery
Initial management of angina?
- Aspirin and statin
- GTN for acute attacks
Features of syringomyelia?
- Cape like distribution of pain and temperature sensation loss
Investigation for syringomyelia?
MRI spine
What is the first line treatment for trigeminal neuralgia?
Carbamazepine
What are the investigations for GBS syndrome and what would the finding be?
- Lumbar puncture (raised protein, normal WCC)
- Nerve conduction studies (decreased motor nerve conduction velocity)
What are features of Steven-Johnsons syndrome?
- Presents 2 months after starting an anticonvulsant
- Prodromal illness that resembles URTI followed by rapid onset painful rash on face, trunk and limbs
What is the management of Steven-Johnson syndrome?
- Cease culprit drug and admit
Features of ankylosing spondylitis?
- Younger patients (20-30)
- Prolonged back pain and mornings stiffness
- Stiffness improves on activity and worsens at rest
Signs of trochlear nerve palsy?
Defective downward gaze and vertical diplopia
What congenital malformation is associated with syringomyelia?
Arnold-Chiari malformation
Features of syringomyelia?
- Cape-like distribution (neck, shoulders, arms) of loss of temperature sensation but preservative of light touch, vibration and proprioception
- Spastic weakness
- Neuropathic pain
- Upping planters
What are features of Erbs palsy?
- Damage to C5 and C6
- Waiter’s tip
- Winged scapula
- May be caused by breech presentation
What are features of Klumpke’s paralysis?
- Damage to T1
- Loss of intrinsic hand muscles
- Due to traction
What nerve is at risk in shoulder dislocation and humeral neck fracture?
Axillary
What is first line treatment for MS spasticity?
Gabapentin or baclofen
Which type of intracranial haemorrhage can present chronically?
Chronic subdural haematoma
What should you check before prescribing folate and why?
- B12 levels
- Giving folate in B12 deficient patients can trigger subacute degeneration of the cord
Signs of subacute degeneration of the cord?
- When UMN and LMN signs always consider SADC
- Causes damage to posterior and lateral columns of spinal cord
- Damage to the posterior columns: loss of proprioception, light touch and vibration sense (sensory ataxia and a positive Romberg’s test)
- Damage to lateral columns: spastic weakness and upgoing plantars (UMN signs)
- Damage to peripheral nerves: absent ankle and knee jerks (LMN signs)
What condition might give a clue towards SADC and why?
- Macrocytic anaemia
- May have been prescribed folate when B12 deficient
What is the first line investigation for intracranial haemorrhage?
Non-contrast CT head
What is a watershed stroke?
A stroke caused by sudden drop in BP (e.g. sepsis)
What are the 3 aspects of the Bamford Criteria?
1) Unilateral hemiplegia or hemisensory loss
2) Homonymous hemianopia
3) Evidence of higher cortical dysfunction
What are the features of a TACI?
- All 3 Bamford Criteria present
- Proximal infarct
- 15% of ischaemic strokes
What are the features of a PACI?
- 2 of Bamford Criteria present
- More distal infarct
- 25% of ischaemic strokes
What are the features of a lacunar stroke?
- Pure motor or sensory loss
- Perforating arteries of IC, basal ganglia or thalamus
- Very strong link to chronic HTN
What are features of a posterior stroke?
- HiNTs postive
- Infarct of vestibular arteries
- 1 of: cerebellar symptoms, isolated homonymous hemianopia, LOC
An infarct in the basilar artery is likely to result in what?
Locked in syndrome
What tools may be used for initial assessment of stroke?
- FAST by public
- ROSIER by ED staff
- ABCD2 for TIA
- HiNTs for posterior stroke
- Non-contrast CT head
- NIHSS to assess thrombolysis
What ROSIER score suggests stroke?
> 0
What NIHSS score indicates need for thrombolysis?
> 5
What are some absolute contraindications to thrombolysis in stroke? (Give 5)
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid hemorrhage
- Stroke or brain injury in preceding 3 months
- Lumbar puncture in 7 days previous
- GI hemorrhage in 3 weeks previous
- Active bleeding
- Pregnancy
- Esophageal varices
- Uncontrolled hypertension above 200/120
What are somme relative contraindications to thrombolysis in stroke? (Give 3)
- Concurrent anticoagulation with an INR above 1.7
- Haemorrhagic diathesis
- Active diabetic hemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery or trauma within past 2 weeks
What its the thrombolysis window for stroke?
Within 4.5 hours
What is the criteria for thrombectomy in stroke?
- Within 6 hours
- Proximal infarct
What are some examples of CNS stroke mimics?
- Migraine
- Todd’s paresis
- Mass effect of lesion
- Exacerbation of neurological condition
- Syncope
- Encephalitis
What are some examples of metabolic stroke mimics?
- Hypoglycaemia (first to rule out; ruled out with ROSIER)
- Electrolyte imbalance
- Hepatic encephalopathy
- Sepsis
When should referral to specialist for TIA occur?
- Within 24 hours if within 7 days or crescendo TIA
- Within a week if more than 7 days
What is a crescendo TIA
More than 1 TIA in a week
What can be given for secondary prevention of stroke if clopidogrel is contraindicated?
- DAPT
- Aspirin and modified release dipyramidole
What dementia subtype is associated with MND?
Frontotemporal
