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Neuro Flashcards

1
Q

What is a stroke

A

Rapid onset of neurological defecit caused by an infarction

- Lasting >24hrs

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2
Q

What are the 2 types of strokes

A

Ischaemic

Haemorrhagic

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3
Q

Causes of ischaemic strokes (4)

A
  1. occlusion of small vessels
  2. Cardiac emboli
    • IE
    • AF
    • MI
  3. Atherothromboembolism
  4. Hypoxic
    • Sepsis
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4
Q

Risk factors for stroke

A 
Obesity
Smoking 
Diabetes
AF
Family hx
Age 
Combined pill 
Vasculitis
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5
Q

What is white on a CT

A

Fresh blood
bone
calcium

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6
Q

What is dark on a CT

A

Air
fat
old blood
water

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7
Q

Sx of anterior circulation stroke

A 
Hemiplegia 
Weakness
Hemisensory loss
Speech problems 
Amarausis fugax
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8
Q

Sx for prosterior circulation

A
  • CN palsy
  • Contralateral motor/sensory loss in brainstem stroke
  • Cerebellar dysfunction
  • Blindness
  • Vertigo
  • Nausea/vomitting
  • Swallowing issues
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9
Q

Haemorrhagic stroke causes

A 
Trauma 
Aneurysm rupture
Carotid artery dissection 
SAH 
Tumour
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10
Q

Stroke investigations

A

CT - GOLD
- Bleeds appear as white
areas

ECG - Atrial fibrillation

Bloods
Glucose - hypoglycaemia
FBC - Polycythaemia 
          Thrombocytopenia
ESR - Vasculitis
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11
Q

What constitutes an urgent head CT

A 
- Pt presenting in 
  thrombolysis time frame 
- Recent head injury 
- Severe headache at sx 
  onset 
- Pt on anti-coag 
- Decrease consciusness 
  (GCS < 13)
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12
Q

Stroke differential diagnosis

A 
Hypoglycaemia 
Subdural haemorrhage 
Head injury 
Intracranial tumour 
Hepatic encephalopathy 
- Wernickes E
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13
Q

Time frame fir thrombolysis tx

A

4.5 hrs of onset
- IV Tissue plasminogen
activator

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14
Q

CI to thrombolysis

A 
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
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15
Q

Stroke tx if intracranial haemorrhage is ruled out and time of onset is unknown
- Ischaemic

A
  1. 300MG Asprin

2 weeks

  1. Clopidogrel - long term
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16
Q

Thrombolysis pathway for ischaemic stroke

A
  • CT head
  • If within < 4.5 hrs
  • IV Alteplase
    • -> 24hrs –> Clopidogrel
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17
Q

Haemorrhagic stroke tx

A

Surgical - clipping
coiling

Reverese anticog

Lifestyle advice

Tx BP - Long term

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18
Q

Stroke secondary prevention

A 
Clopidogrel - 75mg
Atorvastatin - 80mg
Stenting in CAD pts - carotid
Tx modifiable RF
- HTN
- DM
- Smoking 
- Alcohol
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19
Q

What is a transient ischaemic attack

A

Temporary focal cerebral ischaemia without infarction

  • Lasting <24hrs
  • Complete clinical recovery
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20
Q

What is a crescendo TIA

A

2 or more TIAs in a week

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21
Q

TIA causes

A
  • Emboli from the carotis

arteries

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22
Q

TIA differential diagnosis

A
  • Hypoglycaemia
  • Focal epilepsy
    Shaking limbs
  • Todd’s paralysis
    Transient arm/leg
    weakness after seizure
  • GCA
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23
Q

What risk tool is used to assess if a pt is going to have a further stroke following a TIA

A 
ABCD2
Age
BP
Clinical features
- Unilateral weakness
- Speech disturbance 
Duration of sx 
DM

> 3 - Assesment within 24hrs

< 3 - Assesment within 1
week

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24
Q

Amourosis fugax presentation

A

Clot passing through retinal artery
- Curtain descending over
vision
- double blindness

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25
TIA management
- ABCD2 - Asprin 300mg Clopidogrel 75mg - LT - Secondary prevention for Stroke
26
TIA - driving notes
- NO DRIVING for 4 WEEKS - Don't need to tell DVLA after 1 single TIA
27
TIA investigations
Carotis artery doppley 24hr ECG - Atrial fibrillation
28
Intracanial haemorrhage risk factors
- HTN - Excess alcohol - Increase Age - Smoking
29
Intracranial bleeds causes
- HTN - Micro-aneurysms Charcot - bouchard - Vasculitis - Vascular tumour - Secondary to ischaemic stroke - Head injury
30
Intracranial haemorrhage pathology
``` Bleeding raises ICP - Tissue death - Herniation Falx cerebri/Tentorium cerebelli Foramen magnum ```
31
Intracranial haemorrhage presentation
``` Severe headache sudden LOC seizures weakness vomitting ```
32
SAH aetiology
1. Berry aneurysm rupture | 2. Arterivenous malformations
33
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
34
SAH Presentation + signs
``` Thunderclap headache - occipital - severe pain Vomitting Collapse Seizure ``` ``` Neck stiffness Kernig's sign Brudzinski's sign Retinal and viterous bleeds Diplopia Vision loss ```
35
Kernig's sign
Can't extend leg when hip is flexed
36
Brudzinski's sign
When neck is flexed patient flexes hip and knees
37
SAH common assosciations
Cocaine | Sickle cell anaemia
38
SAH investigations
``` CT - < 24 hrs - Hyper-attenuation Star shaped lesions - Blood fills in gyrus patterns ``` Lumbar puncture - > 12hrs after headache - Xanthochromia - L4/L5
39
What causes subdural haemorrhages
Bleeding of bridging veins between cortex + venus sinsues - saggital sinus Between Dura and Arachnoid mater - Head trauma - Dural metasteses
40
Subdural haemorrhage risk groups
Elderly - Brain atrophy - Bridging veins more vulnerable Alcoholics + Epilleptics - Falls - Alcohol is also an anti coagulant
41
Subdural haemorrhage presentation
- Fluctuating consciousness - Drowsy - Headache - Personality change ``` Signs: Increase ICP Seizures Unequal pupils Haemiparesis ```
42
Subdural haemorrhage investigations
CT - Clot +/- Midline shift - CRESENT shape MRI - Smaller haematoma
43
Subdural haemorrhage tx
Haematoma > 10mm or midline shift - Surgery Craniotomy Burr holes
44
What is an extradural haemorrhage
Middle meningeal artery - Blood collects between skull and dura mater
45
Extradural haemorrhage aetiology
Traumatic head injury - Fracture of temporal bone - Rupture of MMA
46
Extradural haemorrhage investigations
CT head - Biconcave haematoma - Lemon Limited by cranial sutures
47
Tx for increased ICP
IV Mannitol
48
What is Epilepsy
recurrent tendancy to spontaneous intermittent abnormal electrical activity in a part of the brain
49
Epilepsy aetiology
``` Flashing lights Idiopathic Cortical scarring - Head injury years before - CVD infarction - CNS Infection Tumour Alcohol ```
50
Excitatory and Inhibitory NT and receptors in the brain
Excitatory Glutamate --> NMDA receptor Ca2+ enters Inhibitory GABA --> GABA receptors Cl- enters
51
What is the prodrome
Prodrome - - Not part of the seizure - Causes change in mood - Lasts hours/days
52
What is the Aura
Aura - - Part of a seizure - 30-120 seconds - Tounge biting - Strange gut feeling - Deja vu - Strange smells * Focal seizure - Temporal
53
What is a primary generalised seizure + features
Electrical activity throughout the whole cortex - Loss of consciousness - Bilateral motor manifestations
54
Descibe a tonic clonic sezure
Tonic phase - stiff limbs Clonic phase - Rhythmic muscle jerking - LOC - Eyes open + tounge bitten - Incontinence - Post-ictal Drowsiness Confusion Coma
55
Descibe Absence seizures
``` Childhood disorder - Activity Stares + pales - Brief < 10 seconds - ECG --> 3-Hz spike - No memory - Often have tonic clonic seizures in adulthood ```
56
Describe a partial/focal seizure
Originate in networks linked to 1 hemisphere + often seen in underlying structural disease
57
Seizures investigations
- Clinical dx > 2 unprovoked seizures occuring > 24hrs after - Electrocencephalogram
58
Focal seizures tx
1. Carbamazepine Lamotrigine 2. Sodium valporate
59
Generalised tonic clonic seizures tx
1. Sodium valporate | 2. Carbamazepine
60
Status epilepticus - description - aetiology - tx
- Seizures with no recovery of consciousness - Seizures > 30 mins - Stopping anti-epileptic tx - Alcohol abuse - Poor compliance to therapy - Lorazepam - Phenytoin - Phenobarbital
61
Sodium valporate S/E
``` Teratogenic Liver damage Hepatitis Hair loss Tremor ```
62
Carbamezapine S/E
Agranulocytosis Aplastic anaemia Induce P450 - Drug interactions
63
Migrane - Duration - Site - Character - Severity - Triggers - Associated sx - Acute tx
- 4-72 hrs - Unilateral - Throbbing - Moderate to severe - Chocolate mneumonic ``` - Nausea Vomitting Photophobia Phonophobia Aura ``` - Sumatriptan
64
Primary headaches
Migrane Tension Cluster
65
Secondary headaches
Medical overuse SAH Meningitis
66
Chocolate mneumonic | - Migranes
``` C - Chocolate H - Hangovers O - Orgasms C - Cheese O - Oral contraceptive L - Lie ins A - Alcohol T E - Excercise ```
67
Tension headaches - Duration - Site - Character - Severity - Triggers - Associated sx - Acute tx
- Mins to days - Bilateral - Pressing tight band - Mild to moderate - no triggers - no assosc sx - Paracetamol Normal everyday headaches
68
Cluster heacache - Duration - Site - Character - Severity - Triggers - Associated sx - Acute tx
- 15 to 180 mins - Retro-orbital Unilateral - Boring/hot poker - V. severe - No triggers - Miosis Ptosis Nocturnal pain Vomitting Lacrimation Blood shot - Sumatriptan 100% O2
69
Trigeminal neuralgia - Duration - Site - Character - Severity - Triggers - Associated sx - Acute tx
- Few seconds - Unilateral V1/V2/V3 distribution - Stabbing pain - Severe - no triggers - no assosciated sx - Carbamazepine Phenytoin
70
What is multiple sclerosis
Chronic AI demyelination of CNS - Oligodendrocytes | - Disseminated in time and space
71
What is Uhthoff's phenomenon
- Increase temp causes worsening of pre-existing sx - Hot bath - Excercise
72
What is Lhermitte's phenomenon
- Electric shock sensation down spine when neck is flexed
73
What does MND in cranial nerve nuclei lead to
Mixed UMN + LMN sx
74
What does MND in the anterior horn cells lead to
LMN signs
75
Meningitis aetiology
Children - Neisseria meningitides - Strep pneumoniae - Haemophilius Infuenza Neonates: - E-coli - Strep agalactiae Group B haemolytic strep
76
Common bacteria for meningitis in pregnant women
Listeria monocytogenes | - found in cheese
77
Meningitis presentation
- Fever - Neck stiffness - Photophobia - Papilloedema Blurred vision/Headache - Headache - Rash
78
When is there no rash in meningitis
Viral
79
Meningitis investigations
Lumbar puncture Bloods - Glucose/CRP/FBC - Clutures
80
Meningitis tx - GP - Hospital - Pregnant
GP - IM Benzylpenicillin Hospital - Cefotaxime / Ceftriaxone Immunocompromised/pregnant - Cefotaxime + Amoxicillin (Covers listeria)
81
Meningitis prophylaxis
Ciprofloxacin
82
CI to Lumbar puncture
``` Drowsy Signs of raised ICP Seizures Immunocompromised Hx of CNS disease ```
83
Encephalitis tx
Aciclovir - High dose
84
What is encephalitis
Inflammation of brain parenchyma - Mainly viral - Herpes simplex - CMV - Mumps - Enterovirus

Phase 2a (11 decks)

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