Neuro core conditions Flashcards
What is a TIA?
An acute loss of cerebral or ocular function
symptoms last less than 24 hours
caused by an inadequate cerebral or ocular blood supply due to ischaemia or embolism
How long do the symptoms of a TIA usually last?
minutes
may last a few hours
What are the 2 main types of ischaemic stroke?
Thrombotic ischaemic stroke
embolic stroke
What is a thrombotic ischaemic stroke?
blood clot spontaneously forms in the brain
common complication of atherosclerosis
What is an embolic stroke?
part of the fatty material from an atherosclerotic plaque or a clot in larger artery or the heart breaks off and travels to the brain
What are embolic strokes common complications of?
AF
Atherosclerosis of the carotid arteries
What % of strokes are ischaemic?
85
What are the 2 types of hemorrhagic stroke?
Intracerebral and subarachnoid
What is a intracerebral haemorrhagic stroke and what causes them?
Bleeding from a blood vessel within in the brain
High blood pressure
What is a subarachnoid haemorrhagic stroke?
bleeding from a blood vessel between the surface of the brain and the arachnoid tissue
What are the risk factors for strokes?5
high BP age DM smoking alcohol
What are the FAST symptoms and signs of a stroke? And how do you elicit them?
FACIAL WEAKNESS
- ask person to smile or show their teeth
will be facial asymmetry
ARM WEAKNESS
Lift arm to 90 or 45 (if lying)
will fall or drift down
SPEECH PROBLEMS
slurred
struggles to find the name of commonplace objects
What are the features of a sudden onset focal neurological deficit (found in strokes)? 8
usually unilateral
facial weakness
unilateral weakness and sensory loss of upper and/or lower limb
speech problems
visual defects
disorders of perception
disorders of balance
coordination disorders
What investigations do you do in suspected stroke?
CT scan
How do you calculate the risk of stroke following a TIA?
ABCD2 score:
A- age >60 -1 point
B- BP 140/90 -1 point
C- clinical features:
- unilateral weakness- 2 point
- speech disturbances without weakness- 1 point
D-duration of symptoms
- =/>60mins - 2points
- 10-59 mins - 1 point
D- Diabetes - 1 point
People are at high risk of a stroke if they have a score of 4 or more
AF
more than 1 TIA a week
TIA whilst on anticoagulants
How do you manage people at high risk of a stroke post TIA?
refer within 24 hours
Give statin- e.g. simvastatin
If they aren’t currently on any blood thinners immediately give clopidogrel or aspirin
DON’T start anti-platelet treatment until haemorrhagic stroke has been ruled out
How do you manage a haemorrhagic stroke?
Control bleeding
anticonvulsants to control bleeding e.g. diazepam
antihypertensives- to stem the growth of the haematoma
osmotic diuretics- to decrease intracranial pressure in the subarachnoid space
What is the management for secondary prevention of strokes?
Manage: AF, diabetes, hypertension
Antiplatelet drug
statin
What are the neurological complications of strokes? 9
Neurological problems: balance movement tone sensation
Disturbances of spatial awareness- neglect
Visual agnosia- disturbance of perception
aphasia, dysarthria, apraxia of speech
Where is pain felt as a complication of stroke?
Pain:
Neuropathic
shoulder pain and subluxation
MSK pain
What are the mental health complications of stroke?6
Depression anxiety emotionalism disturbed social interaction attention and concentration problems memory problems
What are the causes of a subarachnoid haemorrhage? (SAH)
aneurysmal rupture
traumatic brain injury- most common
What causes a spontaneous SAH? 5
Bleeding from a berry aneurysm - 85%
Non-aneurysmal peri-mesencephalic haemorrhage-10%
vascular abnormalities- 5%:
arteriovenous malformation
vasculitis
abnormal blood vessels associated with a tumour
What is the mean age for SAH?
50