Neuro Flashcards
what differentiates between stroke and TIA?
Stroke, symptoms lasting for > 24 hours
TIA, symptoms lasting < 24 hours
what is crescendo TIA
> 2 TIA in 1 week
aetiology of ischaemic infarction
small vessel occlusion or thrombosis in situ
cardiac emboli –> AF, endocarditis
atherothoromboembolism eg carotids
vasculitis
aetiology of haemorrhagic infarction
CNS bleeding –> HTN, ruptured aneurysm, anticoagulation, thrombolysis
what are some rapid recognition screening tools which can be used to identify stroke
in primary care - FAST - face, arm, speech, test (any focal neuro loss)
in ER - ROSIER
what are the different types of stroke according to oxford/Bamford classification for ischaemic stroke
total anterior circulation syndrome
Partial anterior circualtion syndrome
Posterior circulation syndrome
Lacunar syndrome
what are the criteria for total anterior circulation syndrome
must have all 3
1) unilateral weakness +/- a sensory deficit of face, arm or leg
2) homonymous hemianopia
3) high cognitive unction - dysphagia, visuospatial disorder
what are the criteria for partial anterior circulation syndrome
must have 2
1) unilateral weakness +/- a sensory deficit of face, arm or leg
2) homonymous hemianopia
3) high cognitive unction - dysphagia, visuospatial disorder
what are the criteria for posterior circulation syndrome
1 of the following:
cerebellar or brainsteam syndrome - Webner’s syndrome etc
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
loss of consciousness
isolated homonymous hemianopia
Conjugate eye movement disorder – gaze palsy
Cerebellar dysfunction – ataxia, nystagmus, vertigo
clinical features of TIA
• Suspect TIA if sudden onset focal neurological deficit which has completely resolved within 24 hrs Unilateral weakness or sensory loss. Dysphasia. Ataxia, vertigo, or incoordination. Syncope. Sudden transient loss of vision in one eye (amaurosis fugax). Homonymous hemianopia. Cranial nerve defects.
clinical features of stroke
o Weakness − sudden loss of strength in the face or limbs.
o Sensory loss – paraesthesia or numbness.
o Speech problems such as dysarthria.
o Visual problems – normally homonymous hemianopsia
o Dizziness, vertigo or loss of balance — isolated dizziness is not usually a symptom of TIA.
o Specific cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis).
o Inattention/neglect
o Confusion, altered level of consciousness and coma.
o Difficulty with fine motor co-ordination and gait.
o Neck or facial pain (associated with arterial dissection).
o Initially flacid and no reflexes then Spasticity +/- clonus, ↑ tendon reflexes
o Weakness in extensors of arms and flexors of legs = hemiplegic gait – UMN lesion
o Posterior circulation strokes:
Acute, persistent continuous vertigo
Dizziness with nystagmus
N+V
Head motion intolerance
New gait unsteadiness
what are the criteria for Lacunar syndrome
1 of the following
- unilateral weakness +/- sensory deficit of face and arm and leg or all 3
- pure sensory stroke
- ataxic hemiparesis
what are some differentials for stroke
Bell’s palsy - don’t have forehead sparing
migraines - with aura, aura without headache etc
Metabolic causes - hypo/hypergycaemia, hypocalcemia
MS
epilepsy
blackouts/syncope
subdural haemorrhage (trauma-related)
what are the criteria for immediate CT head (next available slot or within 1 hour)?
- indications for thrombolysis or early anticoagulation treatment
- on anticoagulant treatment/known bleeding tendency
- GCS < 13
- unexplained progressive or fluctuating symptoms
- papilloedema, neck stiffness or fever
- severe headache at onset of stroke symptoms
what is the management of an ischaemic stroke
thrombolysis with altepase (IV) - within 4.5 hours of symptoms onset
CT head again at 24 hours after alteplase
aspirin 300mg from Day 2 for 2 weeks
SALT team involvement for swallowing assessment
early mobilisation
screen for malnutrition
what happens if alteplase cannot be given
300mg aspirin for 2 weeks
what specialist managements are there for stroke
maintenance or restoration of homeostasis
- O2 if stats < 95%
- BM between 4 -11
- IV insulin and glucose for DM pts
- antihypertensive therapy only in hypertensive emergency
- consider BP reduction to 185/110 to lower
Pharmacological management of ischaemic stroke
aspirin 300mg for 2 weeks from alteplase then switch to clopidogrel 75mg long-term
statin - start 48 hours after alteplase if not already on it
warfarin/dabigatran if potential causes of cardiac thromboembolism (AF, prosthetic valves)
defer antihypertensive for 1-2 weeks as inc BP can be physiological
what are some management for hemorrhagic stroke which can be carried by the neurosurgeons?
decompressive hemicraniectomy for MCA infarct
intracerebral haemorrhage - surgery for hydrocephalus, combination of prothrombin and Vit K in patients on anticoagulants
definition of meningitis
viral or bacterial infection to the meninges of the brain
what is the bacterial cause of meningitis in neonates
Listeria
Group B streptococcus
what is the bacterial cause of meningitis in infants/young children
H.influenza
strep. pneumoniae
what is the bacterial cause of meningitis in adult
strep. pneumoniae
Neisseria meningitis
what are some viral causes of meningitis
herpes
enterovirus
varicella zoster