Neuro Flashcards
Carotid Disease
Vascular Disorder
Carotid artery narrowing or stenosis, MCC atherosclerotic
break off of fibrous cap => thrombosis or embolization
RF
- Fam hx, HLD, smoking, HTN, DM, older age
- hx of PAD or CAD
Sxs
- Dizziness, syncope
- amaurosis Fugax - sudden, painless, loss of vision in eye
- unilateral muscle weakness
- Aphasia, tinnitus
- PE - carotid bruit
Dx
- Doppler US - level of stenosis >70% is severe
- Angiography - if findings are unclear
Tx
- Operate if
- >70% stenosed
- post transient TIA or CVA
- Carotid endarterectomy - first line
- Stents - if can’t do CEA
- Smoking cessation
- antiplatelet - Plavix, aspirin, statin
Subarachnoid Hemorrhage
Stroke
Bleeding into the CSF - outside brain parenchyma
Eti:
- Traumatic injury
- Aneurysms - MCC saccular cerebral aka berry aneurysms
- most on anterior Half
- Marfan’s syndrome
- Rupture with ICP
- Arteriovenous Malformation
Sxs:
-
Sudden onset severe headache - THUNDERCLAP* headache
- worse headache of life
- Nuchal rigidity - blood irritating meniges
- Seizures
- N/V
- Decr LOC
Dx
-
Non contrast CT** - gold
- most are negative if < 2 hrs, most sensitive > 12 h
- if negative - do CSF
- CSF via LP
- Xanthochromia - yellowish blood
- Fresh Red blood
- C/i if ele ICP (??)
Tx:
- emergency surgery
- Clip artery - pressure
- Catheter to insert coil to promote clot formation
- BP control - CCBs to prevent vasospasms
Epidural Hematoma
Transient LOC from injury => LUCID => HA, unilateral weakness
traumatic IC hemorrhage after skull fracture => MC Middle menigeal artery => blood fills space btwn dura and skull
Dx
- non contrast CT - unilat convexity - lens usually temporal region => Lemon
Tx
- small - observation
- severe - surgery => burr hole, trephination, craniotomy, craniectomy
- Surgical craniotomy
- ICP management - mannitol, hyperventilate, steroids, or ventricular shunt
Subdural Hematoma
Head injury from fall => Sudden blow tears blood vessels, usu eldery w/ multiple falls => presents w/ neurological sx (AMS/neuro signs) => etoh or elderly
Sxs:
- injury to bridging veins - acute = 48 hrs
- subacute 3- 14 days
- chronic > 2 wks = elderly
- Blood collects btwn dura and arachnoid mater
Dx
- non contrast CT - crescent shape concave hyper density
Tx
- Small - observation
- Severe
- Burr hole trephination - blood suctioned through hole
- Craniotomy - section of skull removed, replaced shortly after procedure
- Craniectomy - section of skull removed for extended period of time - rarely used
Changes in Speech
ddx
Aphasia - inability to comprehend or formulate language
- Post Op CVA - trouble speaking, numb/drooping face, weak in one arm
- Multiple Sclerosis - speech lesions
- Intracerebral Hemorrhage
- Migraine - transient
- Carotid disease
- Recurrent laryngeal nerve injury - thyroid sx damage, hoarsness and aphonia
- Apraxia of Speech - neurogenic communication - motor programming sys for speech production
Dysarthria - motor speech disorder from neurological injury
- TBI, thrombotic/embolic injury
- Parkinsonism, ALS, MS, Huntington’s disease, Friedreich’s ataxia
- Wilson’s dz, hypoxic encephalopathy, central pontine myelinosis
- Tumor
- Cerebral palsy
- Guillain-Barré
- Lyme
- Stroke
- Intracranial htn
- tay sachs
Change in Vision
ddx
Perioperative vision loss = rare
- MCC postop corneal abrasion
- MCC permanent POVL - central retinal artery occlusion, ischemic optic neuropathy
Perioperative visual changes - transient to irreversible blindness
- Transient - intraoperative of ocular ointment, excessive drying
-
Complete or partial visual loss - embolic events, acute anemia, hypotension
- anterior ischemic optic neuropathy - poor circ to posterior ciliary blood vessels = painless abrupt reduction in vision and optic disc pallor
Dx
- complete hx and eye exam
- pupils and optha
- color vision and amsler grid
- ESR, CBC, Fasting BG, CRP, VDRL, ANA
- BP measurement
Spinal Cord Injuries
Motor and Sensory Loss
Anterior Cord Syndrome
- loss of pain and temp below level w/ preserved joint position and vibration sense
Central Cord Syndrome
- loss of pain and temp sensation at level of lesion, where spinothalamic fibers cross the cord.
- Variable sensory loss in lower body
Complete Cord Transection
- Rostral zone of spared sensory levels - reduced sensation caudally, no sensation below injury
- urinary retention and bladder distention
Brown-Sequard Syndrome = hemisection of cord
- loss of joint position and vibration sense on same side of lesion
- pain and temp loss on opposite side, few levels below lesion
Neuropathies
Motor and Sensory Loss
Distal sensory polyneuropathy
- Stocking glove snesory loss = axonal neuropathies
Axonal Neuropathies
- DM
- Etoh
- B12 deficiency
- Syphillus
- HIV
- Lyme
- Uremia
- Chemo
- Vasculitis
- Paraneoplstic neuropathy
- Amyloidosis
Other sensory etis
- Sjogren’s Syndrome
- GBS
- chemo
- Vit B6 toxicity
