Neuro Flashcards
Where abouts are neurones most affected in MND?
Anterior horn
How does weakness initially present in MND?
Starts in one area and gradually spreads
What are some UMN symptoms seen in MND?
Hypertonia
Hyperreflexia
Up going plantars
Weakness
What are some LMN symptoms seen in MND?
Muscle wasting
Fasciculations
Reduced tone
Reduced reflexes
If you were to see foot drop in an MND patient, what area would you suspect to be affected?
Lumbar
What are the bulbar signs in MND?
Difficulty speaking and eating
Jaw jerk
Name some non-motor signs of Parkinsons
- Drooling
- Depression
- Problems with smell
- Sleep problems
- Memory problems
Is Parkinsons usually uni or bilateral?
Unilateral
Acute causes of headache (5)
- Meningitis
- Encephalitis
- Sinusitis
- Subarachnoid haemorrhage
- Extradural haemorrhage
- Acute glaucoma
Chronic causes of headache (5)
- Migraine
- Tension headache
- Trigeminal neuralgia
- Giant cell arteritis
- Medication overuse headache
What MUST be done in all people with trigeminal neuralgia?
MRI head
What treatment is given for trigeminal neuralgia?
Anti-epileptics
e.g. carbamazepine, phenytoin
What Ix must be done in someone who has suspected giant cell arteritis?
ESR
CRP raised
Temporal artery biopsy?
What treatments are given for giant cell arteritis?
Prednisolone
PPI / Bisphosphonates (protective)
What symptom is really important to look out for if someone has giant cell arteritis?
Visual loss
Name as many risk factors for stroke as you can
- Hypertension
- DM
- Obesity
- Smoking
- COCP
- AF
- CV disease
- Hyperlipidaemia
- Alcohol
- Previous TIA
- Clotting problems
- Peripheral vascular disease
What scoring system is used for TIA?
ABCD2
What drug treatment is given for Mx of TIA?
Clopidogrel (75mg)
What artery is affected in amourosis fugax?
Retinal artery
Mx of an ischaemic stroke?
300mg aspirin
Thrombolysis
Name the drug used as thrombolysis
Alteplase
When can you use thrombolytic drugs (alteplase)?
If it is = 4.5 hours since presentation and HAEMORRHAGE HAS BEEN RULED OUT
Define a stroke
Sudden onset of focal neurological signs of vascular origin, lasting >24h
Someone presents with facial, leg and arm weakness, amaurosis fugal and impaired language - where is the stroke likely to be?
Carotid
Someone presents with dysarthria, dysphagia, diplopia, dizziness, ataxia and diplegia - where is the stroke likely to be?
Posterior circulation
What risk score is used to calculate risk of stroke if someone has a TIA?
ABCD2
Management of TIA?
Aspirin Admit Treat BP Order CT Do ABCD2
Someone has high risk TIA 2 weeks previously. What treatment should they be started on?
Clopidogrel
Why would you do a carotid doppler in someone who has high risk TIA?
To look for stenosis of the internal carotid artery
What intervention should someone with carotid stenosis + stroke/TIA have?
Carotid endarterectomy and carotid stent
What 3 investigations does someone with a TIA need?
- MRI
- 24 hour ECG
- Carotid doppler
Differentials for stroke (may mimic it)?
Seizure Tumour/abscess Migraine Metabolic Functional Spinal cord Peripheral nerve Cranial nerve
Someone presents and you aren’t sure whether they have had a stroke or not. Should you admit them and if so where?
Yes, to the acute stroke unit
What time frame do you HAVE to do a CT head in if suspected stroke?
24 hours
Name some indications for immediate head CT (6 examples)
- Less than 4.5 hours from onset
- Taking anticoagulants
- Known bleeding disorder
- Decreasing consciousness
- Fluctuating symptoms
- Papilloedema
- Severe headache with symptoms
What bloods must you do in stroke? (7)
- FBC
- ESR
- Clotting
- U and E
- LFTs
- Glucose
- Cholesterol
What raised blood would indicate further, non-stroke investigations?
ESR
If a patient has raised ESR with neuro symptoms, what do you need to exclude?
Endocarditis
Myoxoma
Vasculitis
What drug is used as thrombolysis?
Alteplase
What is the key time frame for thrombolysis?
4.5 hours !!!!!!!
