Neuro Core Conditions Flashcards
What is a TIA?
Brief episode of neuroscience dysfunction caused by focal/retinal ischaemia with symptoms lasting less than 1hour
What are the causes of a TIA?
Large artery atherosclerosis (CAD)
Small vessel disease
Embolism from cardiac source (AF)
What are the symptoms of an anterior circulation TIA?
Amaurosis Fugax
Dysphasia/dysarthria
Weakness of CT side
Sensory loss of CT side
What are the symptoms of an posterior circulation TIA?
Diplopia
Bilateral motor/sensory deficits
Vertigo
Cortical blindness
What risk scoring system is used when assessing stroke risk after a TIA?
ABCD2 A- Age >60 B- BP >140s >90d C- Unilateral weakness, speech impairment with no weakness, other D- Duration: >60mins, 10-59mins, <10mins D- Diabetes High risk Score: 6-7 Crescendo TIA: >2 TIAs in a week treated as high risk regardless
If someone has a moderate/high ABCD2 score what should be done?
Aspirin 300mg daily
Specialist assessment, investigation (brain imaging) & secondary prevention
Within 24hours
What investigations should be carried out for a suspected TIA?
Bloods: FBC, U&E, Glucose, Lipid profile, LFTs
ECG
Imaging: Carotid & brain (MRI)- within 24hours
What is the treatment of TIA?
Stenosis: Carotid endarterectomy within 7days IF: TIA in carotid territory & not severely disabled
Clopidogrel 300mg loading, then 75mg daily
Atorvastatin 20-80mg daily
Secondary prevention: Aspirin
Lifestyle modification
What are the causes of a SAH?
Rupture of aneurysm 80%
AV malformation
Trauma
Infection: Meningitis, endocarditis
What are the risk factors of SAH?
Autosomal dominant PCKD
Cocaine use
Elastic lamina
CT disorders (M, ED)
What is the pathophysiology of an SAH?
Berry: Within the circle of willis, symptoms due to pressure on structures or rupture
AVM: Fistula between artery and vein causing high flow through AVM & high pressure arterialisation of draining veins
Cavernous haemangioma: Tangle of low pressure dilated vessels without a major feeding artery
What are the signs & symptoms of an SAH?
Sudden explosive thunderclap occipital headache Decreased consciousness Hemiparesis Neck stiffness \+ve Kernig's sign Papilloedema
What are the symptoms of a sentinel bleed from an SAH?
Small leaks from aneurysm/expansion Headache Dizziness Orbital pain Diplopia & visual loss
What are the investigations for an SAH?
CT
Angiography
LP- CI in Raised ICP
CSF exam- Xanthochromia
What are the complications of an SAH?
Vasospasm-TIA/Stroke
Brain oedema
Secondary acute hydrocephalus
Re-bleeding
What is the treatment of SAH?
Admit to ICU Cardiopulmonary support Surgery: Clipping, coil embolisation CCB: Nimodipine Laxative: Senna/Docusate Analgesia: Oxycodone Nitropresside LP/ventricular drainage
AVM: Ablation, surgery, stereotactic RT
How is meningitis treated?
Oxygen
IV access & fluids: 0.9% NaCl
N. Meningitidis: IV Penicillin
<3months: Cefotaxime & Amoxicillin
>3months: Ceftriaxone
Dexamethasone QDS 4days after LP if abnormal CSF results
Vasoactive therapy: NorA if not reacting to fluid bolus
What is the difference between bacterial meningitis & meningococcal disease?
Meningitis: Infection of the meninges by bacteria travelling from mucosal surfaces via the bloodstream
Meningococcal: Systemic bacterial infection by N.meningitidis
What are the most common causes of bacterial meningitis in children & neonates?
N: Group B Strep, E. Coli, Strep Pneumoniae, Listeria
C: N.meningitidis, Strep Pneumoniae, H.influenzae
What is the pathophysiology of meningitis?
1) Meningococcus travels from the blood to the CSF
2) Initiates endotoxin & inflammatory mediated CSF response
3) Results in leakage of protein & fluid from cerebral vasculature
4) Results in cerebral oedema & cerebral vascular thrombosis
5) Causes raised ICP & reduced cerebral perfusion w/potential brain death
What is the pathophysiology of septicaemia?
1) Endotoxin release causes vascular permeability with proteins & water going from IV space to EV space
2) Inflammatory mediated targeted at endothelial blood vessel lining
3) Causes reduced circulating volume, hypoV, reduced CO
4) Endotoxins also affect myocardial cells
5) DIC caused by coagulation cascade & down-regulation of anticoagulant & fibrinolytic pathways
What are the signs & symptoms of meningitis?
Fever Irritability Lethargy Resp symptoms Vomiting LATE: Bulging fontanelle, altered mental status, headache, neck stiffness, photophobia, petechial rash
What are the signs & symptoms of septicaemia?
Fever Cold hands & feet Pallor Skin mottling Extremity pain LATE: Shock, confusion, petechial rash, neck stiffness, reduced consciousness, rapid change in condition
What are the investigations for meningitis?
Bloods: Glucose, FBC, PT/INR, U&E, CRP
ABG
LP: WCC, Total protein, gram stain, microscopy & culture, bacterial PCR, Glucose
What are the contraindications of LP in ?meningitis?
Signs of raised ICP Shock Extensive/spreading purpura Convulsions Coagulation abnormalities
What specific signs might be seen in meningitis?
Kernig’s: Unable to extend leg at the knee when hip is flexed
Brudzinski’s: Knees and hips flex when neck is flexed
What are the signs & symptoms of a venous sinus thrombosis?
Headache, unilateral, acute Facial pain Seizure Photophobia Ophthalmoplegia/ diplopia Pulsatile proptosis Horner's syndrome
What are the causes of venous sinus thrombosis?
Secondary infection Metastatic disease Carotid cavernous venous fistula Pituitary adenoma Thrombus Aneurysm of internal carotid artery
How is venous sinus thrombosis investigated?
Bloods: FBC, CRP, ESR, U&E, Coag screen Cultures for infection CT MRI venography LP
How is venous sinus thrombosis treated?
Anticoagulation: Heparin
Surgery
Abx: Vancomycin
What are the signs & symptoms of a space occupying lesion?
Raised ICP: Headache, papilloedema, vomiting, posture related headache Hydrocephalus Seizure/epilepsy starting in middle age Oedema Angiogenesis
