Neuro Flashcards
What is a stroke
Rapid onset of neurological defecit caused by an infarction
- Lasting >24hrs
What are the 2 types of strokes
Ischaemic
Haemorrhagic
Causes of ischaemic strokes (4)
- occlusion of small vessels
- Cardiac emboli
- IE
- AF
- MI
- Atherothromboembolism
- Hypoxic
- Sepsis
Risk factors for stroke
Obesity Smoking Diabetes AF Family hx Age Combined pill Vasculitis
What is white on a CT
Fresh blood
bone
calcium
What is dark on a CT
Air
fat
old blood
water
Sx of anterior circulation stroke
Hemiplegia Weakness Hemisensory loss Speech problems Amarausis fugax
Sx for prosterior circulation
- CN palsy
- Contralateral motor/sensory loss in brainstem stroke
- Cerebellar dysfunction
- Blindness
- Vertigo
- Nausea/vomitting
- Swallowing issues
Haemorrhagic stroke causes
Trauma Aneurysm rupture Carotid artery dissection SAH Tumour
Stroke investigations
CT - GOLD
- Bleeds appear as white
areas
ECG - Atrial fibrillation
Bloods Glucose - hypoglycaemia FBC - Polycythaemia Thrombocytopenia ESR - Vasculitis
What constitutes an urgent head CT
- Pt presenting in thrombolysis time frame - Recent head injury - Severe headache at sx onset - Pt on anti-coag - Decrease consciusness (GCS < 13)
Stroke differential diagnosis
Hypoglycaemia Subdural haemorrhage Head injury Intracranial tumour Hepatic encephalopathy - Wernickes E
Time frame fir thrombolysis tx
4.5 hrs of onset
- IV Tissue plasminogen
activator
CI to thrombolysis
Intracranial bleed clotting disorder recent surgery acute pancreatits severe liver disease onset > 4.5hrs ago unclear time of sx onset seizures at onset low platelets Warfarin/Heparin Known aneurysm Active bleed - GI - Urinary
Stroke tx if intracranial haemorrhage is ruled out and time of onset is unknown
- Ischaemic
- 300MG Asprin
2 weeks
- Clopidogrel - long term
Thrombolysis pathway for ischaemic stroke
- CT head
- If within < 4.5 hrs
- IV Alteplase
- -> 24hrs –> Clopidogrel
Haemorrhagic stroke tx
Surgical - clipping
coiling
Reverese anticog
Lifestyle advice
Tx BP - Long term
Stroke secondary prevention
Clopidogrel - 75mg Atorvastatin - 80mg Stenting in CAD pts - carotid Tx modifiable RF - HTN - DM - Smoking - Alcohol
What is a transient ischaemic attack
Temporary focal cerebral ischaemia without infarction
- Lasting <24hrs
- Complete clinical recovery
What is a crescendo TIA
2 or more TIAs in a week
TIA causes
- Emboli from the carotis
arteries
TIA differential diagnosis
- Hypoglycaemia
- Focal epilepsy
Shaking limbs - Todd’s paralysis
Transient arm/leg
weakness after seizure - GCA
What risk tool is used to assess if a pt is going to have a further stroke following a TIA
ABCD2 Age BP Clinical features - Unilateral weakness - Speech disturbance Duration of sx DM
> 3 - Assesment within 24hrs
< 3 - Assesment within 1
week
Amourosis fugax presentation
Clot passing through retinal artery
- Curtain descending over
vision
- double blindness
TIA management
- ABCD2
- Asprin 300mg
Clopidogrel 75mg - LT - Secondary prevention for
Stroke
TIA - driving notes
- NO DRIVING for 4 WEEKS
- Don’t need to tell DVLA
after 1 single TIA
TIA investigations
Carotis artery doppley
24hr ECG
- Atrial fibrillation
Intracanial haemorrhage risk factors
- HTN
- Excess alcohol
- Increase Age
- Smoking
Intracranial bleeds causes
- HTN
- Micro-aneurysms
Charcot - bouchard - Vasculitis
- Vascular tumour
- Secondary to ischaemic
stroke - Head injury
Intracranial haemorrhage pathology
Bleeding raises ICP - Tissue death - Herniation Falx cerebri/Tentorium cerebelli Foramen magnum
Intracranial haemorrhage presentation
Severe headache sudden LOC seizures weakness vomitting
SAH aetiology
- Berry aneurysm rupture
2. Arterivenous malformations
What increases the risk of a berry aneurysm rupture
- Marfans syndrome
- Rupture with Increased
ICP - PCA junction with ICA
- ACA junction with anterior
cerebral artery - Birfucation of MCA