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Priority 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

Symptoms of extradural brain injury

A 
"Talk and die" - a brief loss of consciousness after injury followed by a lucid period
Headache
Vomiting
Confusion
Seizures
Focal neurology
Boggy scalp haematoma
Dilated pupils
Death can result from rapidly rising intra-cranial pressure
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2
Q

Causes of extradural brain injury

A

Blunt head trauma causing arterial bleeding e.g. MMA
RTA, fall, assault
Majority occur with associated skull fractures and scalp haematomas

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3
Q

Management of subarachnoid haemorrhage

A

Intracranial aneurisms - coil
Until treated: strict bed rest, well controlled BP, avoid straining
Main goal of surgery is to prevent re-bleeds

Vasospasm prevention:
21 day course of nimodipine 60mg 4hrly oral/NG (CCB)
Hypovolaemia
Induced-hypertension and haemodilution

Hydrocephalus:
External ventricular drain or LT VP shunt

Treat hyponatraemia with fluid restriction

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4
Q

Define primary brain injury

A

Intra-axial
Diffuse:
Shearing forces e.g. rotational, causing axon damage and rupture of small vessels
Focal:
As brain hits skull parenchymal contusion - coup is direct impact of brain of the skill at the site of injury, contre-coup is injury from brain rebounding off opposite side of skull

Laceration within the skull:
Brain impinges on sharp of bony edge within skull, e.g. sphenoid ridge

Extra-axial:
Bleeds

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5
Q

ABCD2 score

A

> 4 = risk of future stroke

Age - >60 = 1
BP - >140/90mmHg = 1
Diabetes - 1

Clinical features:
Unilateral weakness = 1
Speech disturbance without weakness = 1

Duration:
>60 mins = 2
10-60 mins = 1

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6
Q

Management of migraine

A

Abortive:
NSAIDs or sumatriptan

Prophylaxis:
Beta blocker, CCB, etc.
Topiramate, carbamazepine

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7
Q

Causes of subdural brain injury

A

Acute:
Trauma causing shearing of bridging veins e.g. acceleration/deceleration of RTA, falls, assaults

Chronic:
Trivial injury in elderly, patients on anticoagulation or alcoholic patients moths or weeks before causing a small tear in a cerebral vein (low-pressure venous bleed)

Paeds:
Shaken baby syndrome (fragile bridging veins)

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8
Q

Presentation of stroke

A

UMNL:
Pyramidal weakness, hyperreflexia, spasticity, upgoing plantars,

Focal neurology based on arterial supply:
MCA - eyes look at lesion

RHS stroke:
Sensory inattention, hemi-spatial neglect, LSW and hemisensory loss

LHS stroke:
Dysphagia, RSW and hemisensory loss

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9
Q

Symptoms of venous sinus thrombosis

A

Young women
Sudden headache
Visual loss or change

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10
Q

Investigations for trigeminal neuralgia

A

MRI necessary to exclude secondary cause

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11
Q

Management of tension headache

A

Stress relief and rest
Paracetamol/NSAIDs
Prevention with amitriptyline

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12
Q

Thrombectomy in stroke

A

<6hr onset
Often do thrombolysis then consider surgical removal of thrombus via catheter in groin

Criteria:
Patients with ischaemic stroke due to proximal MCA, carotid T, distal MCA & basilar occlusion
Patients presenting within 6 hours
Patients with significant neurological deficit (NIHSS ≥ 6)
Minimal ischaemia visible on brain imaging at time of presentation

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13
Q

Management of subdural brain injury

A

Acute:
Release of clot through craniotomy

Chronic:
Release of clot or fluid collection through burr-holes

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14
Q

Define stroke

A

Sudden interruption in vascular supply to the brain
Resulting in rapidly developing focal neurological deficit
>24h

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15
Q

Types of head injury

A

Closed (concessional)
Open (penetrating or blunt)
Acceleration, deceleration or rotational injury

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16
Q

Tension headache symptoms

A 
S - bilateral
O - chronic, usually at end of the day
C - tight band, non-pulsatile
R -
A - scalp muscle tednerness
T - chronic
E - stress
S - mild-to-moderate (able to continue with ADLs)
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17
Q

Management of trigeminal neuralgia

A

Carbamazepine

2nd line topimarate, gabapentin or ablative surgery

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18
Q

Pathophysiology of stroke

ischaemic vs. haemorrhagic

A

Ischaemic:
Arterial occlusion
Thrombotic (20%, rupture of atherosclerotic plaque in an ICA)
Embolic (80%, left heart if AF, or infective endocarditis, long bone fracures)

Haemorrhagic:
HTN, AVMs, aneurysmal, CAA, anticoagulation therapy, haemophilia, recreational drugs

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19
Q

Headache red flags

A

Specific:
Sudden onset -SAH
“Thunderclap” - SAH
First & worst - SAH
Unilateral with eye pain - glaucoma/cluster headache
Scalp tenderness in >50s - GCA
Worse on coughing/in the morning/bending forward -raised ICP

General headache red flags:
Neurological deficit
Meningism (photophobia, neck stiffness)
Decreased consciousness
Not usual pattern of headaches
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20
Q

Investigations for stroke

A 
Screening tools: FAST/ROSIER
ABCDE
Bloods
ECG
CXR
CT Head +/- CTA
MRI if ischaemic stroke 
Follow up: 
Bloods, carotid USS, echo
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21
Q

Investigations for venous sinus thrombosis

A

Bloods

MRI venogram to diagnose

22
Q

Cluster headache symptoms

A

S - unilateral, around one eye
O - quick develops, 1-2x/day, 15m-2hr
C - sharp stabbing pain
R -
A - facial/eyelid swelling/redness, Horner’s syndrome, runny nose, watery eyes, conjunctival injection/ redness, restlessness/agitation
T - clusters lasting several wks, clusters ~1yrly
E - ?alcohol may trigger, hyperbaric chamber relieves
S - severe (pt restless & agitated)

23
Q

Causes of subarachnoid haemorrhage

A

Traumatic:
Trauma, skull fractures, TBI

Non-traumatic:
Arterial aneurysm rupture

Congenital “weak area”
Atherosclerosis
Local high flow
Infection (mycotic aneurisms)

Associations:
PKD, Ehler’s Danlos, CoA

24
Q

Investigations for cluster headache

A

CT can be done to rule out SOL

Exclude acute glaucoma differential

25
Q

Describe decerebrate posturing

A

Central tegmental tract damage/damage to upper brain stem (midbrain, pons)
Arms adducted, extended, internally rotated
Wrists pronated and fingers flexed
Legs stiffly extended
Ankles plantar flexed

26
Q

Migraine symptoms

A 
S- Unilateral
O - Sudden or ~1hr onset, lasts 4-72hrs
C - Throbbing pain
R - Back of head & down neck (rule out meningism - infection, SAH)
A - N&V, photophobia, phonophobia, aura
T - Some constant, some wax & wane
E- physical activity, improved with rest
S - severe
27
Q

Investigations for intracranial pressure headaches

A

CT head
LP

LP raised lymphocytes (normal glucose and protein) - viral
LP raised neutrophils (low glucose and high protein) - bacterial

28
Q

Investigations for migraine

A

None required

CT if uncertain

29
Q

Define secondary brain injury

A 
Cerebral oedema
Ischaemia
Infarction
Herniation
Hydrocephalus
TBI
SAH
30
Q

Define transient ischaemic attack

A

Transient episode of neurological dysfunction caused by ischaemia, without infarction

Emergency - high risk of stroke in the first few days after

31
Q

Intracerebral brain injury symptoms

A 
Progression over minutes to hours
Impaired consciousness
Focal neurology (e.g. hemiplegia)
Headache
N&V
32
Q

Causes of head injury

A

Falls
Assault
RTA
Alcohol

33
Q

Management of cluster headache

A

100% oxygen
Sumatriptan
Prophylaxis with verapamil (CCB)

34
Q

Medical optimisation post-stroke

A

Aspirin 300mg PO asap or 24hrs after thrombolysis if a haemorrhage is excluded, for 2wks

Statin after 48hrs if cholesterol >3.5 mmol/L (risk of haemorrhagic transformation)

Anticoagulants (clopidogrel 75mg daily) after 2wks (minimise risk haemorrhagic transformation)

35
Q

Thrombolytic therapy in stroke

A

<4.5hrs onset (<3hr if diabetic)
No haemorrhage on CT
BP <185/110
Alteplase (tPA) recommended by NICE

Risks:
Haemorrhage, hypotension (monitor)

Benefits:
No effect on mortality, but effect on disability
1 in 8 cured, 1 in 3 get better, 1 in 18 get worse

No antiplatelets for 24 hours following IV thrombolysis to avoid bleeding complications

36
Q

Intracerebral brain injury causes

A 
HTN damage to blood vessels e.g. perforating lenticulostriate arteries
Cerebral amyloid angiopathy
Micro-aneurysms
Anticoagulation
Bleeding disorder
Tumours
Trauma
No underlying cause
37
Q

Management of extradural brain injury

A

Neurosurgical emergency
Bone flap or burr hole over suspected site
Evacuate clot
Control bleeding (diathermy, silver clips, under running)
Mannitol IVI while being transferred

38
Q

Management for TIA

A

Aspirin 300mg daily (unless bleeding disorder/on anticoagulants/already taking aspirin regularly, CI)

Admit for assessment / observation if >1 TIA (crescendo TIA)

Secondary prevention:
Clopidogrel 74mg OD (as 1st line as in stroke) (or aspirin + dupyridamole if cannot tolerate)
Carotid endarterectomy if >50% stenosis (some people say >70%)

39
Q

Symptoms of trigeminal neuralgia

A

Stabbing, shooting pain down face/jaw line

Triggered by chewing/talking

40
Q

Describe decorticate posturing

A

Damage to one or both corticospinal tracts
Flexors predominate in upper limb (rubrospinal)
Arms adducted, flexed, internally rotated to lie across chest
Wrists and fingers flexed
Legs stiffly extended
Ankles plantar flexed

41
Q

Intracerebral haemorrhage management and prevention of complications

A

Emergency management:
Reverse anticoagulants
Neurosurgical referral
Resus and ABCDE

Medical management:
BP lowering
Reversal of anticoagulants (warfarin, dibigatran)

Prevention of complications:
IPC
Nutrition
Monitor for expansion of haematoma and oedema

42
Q

Secondary prevention of stroke

A

Clopidogrel 75mg OD for life (dipyridamole and aspirin, or apixaban / DOAC if stroke and AF)

Lifestyle:
Smoking diabetic control, HTN, high cholesterol and AF

Correction of medical RFs:
BP, cholesterol, AF, DM

Carotid endarterectomy and angioplasty

43
Q

Classification of headaches

A 
Acute: 
Trauma
Cerebrovascular (SAH/ICH/infarction)
Meningitis
Systemic infection
Acute angle-closure glaucoma
Chronic/recurrent:
Tension
Migraine
Cluster
Raised ICP (SOL, hydrocephalus)
Temporal arteritis
Drugs
44
Q

Venous stroke symptoms

A

Raised ICP due to obstruction or focal neurological deficits

Seizures due to venous infarction and venous haemorrhage

45
Q

Intracerebral injury management

A

Optimise physiology

Surgical treatment if:
Young
Superficial bleed
Critically raised ICP
Major deficit
46
Q

Symptoms of subdural brain injury

A 
Slowly progressive and fluctuating symptoms (also delayed in chronic subdural bleeds)
Progressive mental deterioration
Drowsiness progressing to coma
Focal neurology (e.g. hemiplegia)
Headache
Vomiting
47
Q

Investigations for TIA

A

CTH if on warfarin/DOAC/bleeding disorder to rule out ICH

48
Q

Symptoms of subarachnoid haemorrhage

A 
Acute onset thunderclap headache (occipital or unilateral)
LOC, then wake (arterial rupture but when ICP > systolic BP bleeding is tamponaded) 
N&V
Seizures
Meningism 
Positive Kernig's sign 
Focal neurology
Cerebral salt wasting - hyponatraemia
49
Q

Define primary and secondary headaches

Give examples of each

A

Primary:
Disturbance of pain networks in absence of damage
Migraine, tension, cluster, analgesia overuse

Secondary:
Underlying cause identifiable on LP, scans
SAH, meningitis, GCA, idiopathic intracranial HTN, low pressure headaches, malignant HTN, sinusitis

50
Q

Differentials of stroke

A 
Hypoglycaemia
Migraine
Epilepsy
MS
Tumours
Syncope
CNS infections
Head injury
51
Q

Investigations for tension headache

A

None required

52
Q

Venous stroke causes

A 
Infective
Inherited or acquired thrombophilia
Dehydration
Inflammatory (Behcet's, Wegener's, SLE)
Haematology (sickle cell, PRV, thrombocytopenia, PNH),
Malignancy
Head injury
Neurosurgery
LP
Combined OCP

Priority 1 (17 decks)

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