NEURO Flashcards
Is the eye supplied by the internal or external carotids
Internal carotid - opthalmic branch
What does the external carotid supply
Scalp - temporal artery Face - facial artery Maxilla - maxilla artery Tongue - lingual artery Glands - superior thyroid artery
Anterior cerebral artery stroke signs
Contralateral weakening, sensory, motor loss in legs
Weak symptoms potentiall in arma
Middle cerebral artery stroke signs
Contralateral weaking, sensory, motor loss in arms and face
Posterior cerebral artery stroke
Contralateral visual field loss - macular sparing
eg. R hem = left homonymous hemianopia
The internal cartoids supply…..
The anterior 2/3 of cerebral hemispheres and basal ganglia
Post cerebral artery is mainly supplied by basilar (i.e. vertebral artieries)
What causes horners syndrome
Damage to sympathetic innervation to the pupil = dont get dilator contraction (so dilated pupil) - only get parasympathetic innervation = small, constricted pupil
Vascular event in basilar artery could cause this bc of ischemia to descending hypothalamic nerves to cervical ganglia
List some signs of lateral medullary syndrome
(where one of the vertebral arteries is blocked, and so the lateral medulla is ischemic plus you lose supply to the inferior cerebellar surface
Vertigo Vomitting Horners syndrome Nystagmus Ipsilateral ataxia soft palate paralysis Dysphagia
Signs of vertebrobasilar occlusion
- Visual changes (inferior cerebral surfaced - PA)
- Brainstem/ CN signs - hiccups (vagus), coma, horners syndrome, any CN change, vertigo
- Cerebellar signs - ataxia, nystagmus, vertigo
Outline the protocol for investigating and managing a suspected stroke
- Confirm it is a suspected stroke (with usual sympt and signs)
- Brief med history - identify any diseases or causes that could cause bleeding - sickle cell, TTP, haemophillia etc, are they on anticoagulants for cardiac disease? Have they ever had an MI or PVD? IHD? Diabetic?
- CT scan (w/in 1 hour) to rule out haemorrhagic stroke
- Once haemorrhagic ruled out, and if <4.5 hours from onset -> Aspirin, 300mg loading + thrombolysis - alteplase
- Second CT within 24 to identify any bleeds
What is the primary prevention of stroke
Lower BP Control diabetes - blood sugar Cholesterol control - statin Quit smoking Diet and exercise
Secondary prevention of stroke
Antiplatelet meds - eg clopidogrel
Anticoagulants - for cardio (AF causes)
Control usual risk factors (hyptn etc)
Statins
What is a sign of cardiac causes of stroke on CT
bilateral infarcts
List some of the cardiac causes of stroke, what percentage of strokes do these cause
30% AF - thrombus thrown from atria VF - thrombus thrown from ventricle MI - cardiogenic shock - thrombus thrown from ventricle Valve defect/ prosthetic valve Infective endocarditis
IHD & anticoagulants - warfarin - may cause bleed
IHD & antiplatelets - may cause bleed
What percentage of pts with a TIA go on to have a stroke within 1 week
1 in 12
~8%
Define stroke
Stroke is defined as “a clinical syndrome, caused by cerebral infarction or
haemorrhage, typified by rapidly developing signs of focal and global disturbance of
cerebral functions lasting more than 24 hours or leading to death
Define TIA
”an acute loss of cerebral or ocular
function with symptoms lasting less than 24 hours caused by an inadequate
cerebral or ocular blood supply as a result of low blood flow, ischaemia, or
embolism associated with disease of the blood vessels, heart or blood”
When should you suspect stroke
Acute onset
Focal neurological deficit, lasting 24 hours
Cannot be explained by hypoglycaemia or other stroke mimics
How would you assess a TIA risk of becoming a stroke
Assess Risk Using ABCD2 Score
A — Age: 60 years of age or more (1 point)
B — BP (at presentation) 140/90 mm Hg or greater (1 point)
C — Clinical features
Unilateral weakness, 2 points
Speech disturbance without weakness, 1 point.
D — Duration (60 minutes or longer, 2 points, 10–59 minutes, 1 point)
D — presence of diabetes: 1 point.
> 4 - high risk of early stroke, assessed by specialist within 24 hours
6 strongly predicts stroke within 2 days
Other factors: AF, TIA while anticoagulate, more than 1 TIA within a week
Below 4 - specialist referral within 7 days Start statin (e.g. simvastatin 40 mg) Antiplatelet drug (unless they are taking an anticoagulant): Clopidogrel 300mg (off-label use) or aspirin 300mg * Treat BP (if raised) No driving until seen by a specialist (when definitive guidance will be given)
What type of intracranial haemorrhage is associated with a lucid interval
Epidural haemorrhage/ haematoma
May last a few hours or days
What are the risk factors for sub arachnoid haemorrhage
Berry aneurysm Smoking Alcohol misuse Hypertension Bleeding disorders Family history Coarction of the aorta
Symptoms of subarachnoid haemorrhage
Thunderclap headache Vomitting (brainstem compression) Collapse (brainstem compression) Seizures (brainstem compression) Coma (Reticular formation) Drowsiness (Frontal lobe/ brainstem)
What are common sites of herniation in the brain
Cigulate, uncus, tonsils
How would you identify the type of MS patient had from the history
Relapsing and remitting
Disease period followed by complete recovery, or with some residual deficit. Periods between disease are defined by no disease progression.
Primary progressive.
No relapse. Patient has disease all the time. No periods of disease free state. Progressive.
Secondary progressive.
Relapse and remitting course followed by progressive.
Progressive and relapsing.
Disease is always present and progressive. Periods of remittance after a exacerbation but it does not go back to baseline and continues to progress between relapse.
List some defining features of MND
No sensory loss Fasiculations Foot drop Proximal myopathy Pyramidal drift No eye involvement No sphincter involvement
What would be required to make a definitive diagnosis of ALS
Upper and lower MN signs in 3 separate regions
List some differentials for MND
Hereditary spastic paralegia
Polyneuropathies
MS
What are the signs of an UMN lesion
everything goes up
positive babinski’s sign
hyper reflexive
increased muscle tone (spasticity w/ pyramidial)
What medical treatment can be given for MND
Riluzole
What disease is commonly associated with MS
Frontotemporal dementia
What are the causes of MND
Largely unknown
Genetic
Pathogenic immune response
What is the commonest peripheral neuropathy
Symmetrical
List the common mononeuropathies
Carpal tunnel syndrome (median nerve) Ulnar neuropathy (entrapment at the cubital tunnel) Peroneal neuropathy (entrapment at the fibular head)
Cranial mononeuropathies (III or VII cranial nerve palsy)
- idiopathic - immune mediated - ischemic
List the symptoms of a motor mononeuropathy
Fasiculations Paralysis Weakness Atrophy pes cavus
What is L-dopa prescribed with?
Co-careldopa
L dopa + dopa-decarboxylase inhibitor
What are the three cardinal symptoms of parkinsons
Bradykinesia
Hypertonia - Rigidity - (+ tremor = cog wheel)
Resting tremor - pill-rolling
Signs of cauda equina
Loss of bladder or bowel control - do PR to check sphincter tone
Back pain, radiating down legs
Asymmetrical, atrophic, areflexive paralysis of the legs
Sensory loss in root distrubution
Decreased sphincter control
