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ACC > Neuro Core Conditions > Flashcards

Neuro Core Conditions Flashcards

1
Q

What is a TIA?

A

Brief episode of neuroscience dysfunction caused by focal/retinal ischaemia with symptoms lasting less than 1hour

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2
Q

What are the causes of a TIA?

A

Large artery atherosclerosis (CAD)
Small vessel disease
Embolism from cardiac source (AF)

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3
Q

What are the symptoms of an anterior circulation TIA?

A

Amaurosis Fugax
Dysphasia/dysarthria
Weakness of CT side
Sensory loss of CT side

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4
Q

What are the symptoms of an posterior circulation TIA?

A

Diplopia
Bilateral motor/sensory deficits
Vertigo
Cortical blindness

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5
Q

What risk scoring system is used when assessing stroke risk after a TIA?

A 
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
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6
Q

If someone has a moderate/high ABCD2 score what should be done?

A

Aspirin 300mg daily
Specialist assessment, investigation (brain imaging) & secondary prevention
Within 24hours

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7
Q

What investigations should be carried out for a suspected TIA?

A

Bloods: FBC, U&E, Glucose, Lipid profile, LFTs
ECG
Imaging: Carotid & brain (MRI)- within 24hours

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8
Q

What is the treatment of TIA?

A

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

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9
Q

What are the causes of a SAH?

A

Rupture of aneurysm 80%
AV malformation
Trauma
Infection: Meningitis, endocarditis

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10
Q

What are the risk factors of SAH?

A

Autosomal dominant PCKD
Cocaine use
Elastic lamina
CT disorders (M, ED)

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11
Q

What is the pathophysiology of an SAH?

A

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

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12
Q

What are the signs & symptoms of an SAH?

A 
Sudden explosive thunderclap occipital headache
Decreased consciousness
Hemiparesis
Neck stiffness
\+ve Kernig's sign
Papilloedema
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13
Q

What are the symptoms of a sentinel bleed from an SAH?

A 
Small leaks from aneurysm/expansion
Headache
Dizziness
Orbital pain
Diplopia &amp; visual loss
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14
Q

What are the investigations for an SAH?

A

CT
Angiography
LP- CI in Raised ICP
CSF exam- Xanthochromia

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15
Q

What are the complications of an SAH?

A

Vasospasm-TIA/Stroke
Brain oedema
Secondary acute hydrocephalus
Re-bleeding

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16
Q

What is the treatment of SAH?

A 
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

17
Q

How is meningitis treated?

A

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

18
Q

What is the difference between bacterial meningitis & meningococcal disease?

A

Meningitis: Infection of the meninges by bacteria travelling from mucosal surfaces via the bloodstream
Meningococcal: Systemic bacterial infection by N.meningitidis

19
Q

What are the most common causes of bacterial meningitis in children & neonates?

A

N: Group B Strep, E. Coli, Strep Pneumoniae, Listeria
C: N.meningitidis, Strep Pneumoniae, H.influenzae

20
Q

What is the pathophysiology of meningitis?

A

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

21
Q

What is the pathophysiology of septicaemia?

A

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

22
Q

What are the signs & symptoms of meningitis?

A 
Fever 
Irritability
Lethargy
Resp symptoms
Vomiting
LATE: Bulging fontanelle, altered mental status, headache, neck stiffness, photophobia, petechial rash
23
Q

What are the signs & symptoms of septicaemia?

A 
Fever
Cold hands &amp; feet
Pallor
Skin mottling
Extremity pain
LATE: Shock, confusion, petechial rash, neck stiffness, reduced consciousness, rapid change in condition
24
Q

What are the investigations for meningitis?

A

Bloods: Glucose, FBC, PT/INR, U&E, CRP
ABG
LP: WCC, Total protein, gram stain, microscopy & culture, bacterial PCR, Glucose

25
Q

What are the contraindications of LP in ?meningitis?

A 
Signs of raised ICP
Shock
Extensive/spreading purpura
Convulsions
Coagulation abnormalities
26
Q

What specific signs might be seen in meningitis?

A

Kernig’s: Unable to extend leg at the knee when hip is flexed
Brudzinski’s: Knees and hips flex when neck is flexed

27
Q

What are the signs & symptoms of a venous sinus thrombosis?

A 
Headache, unilateral, acute
Facial pain
Seizure
Photophobia
Ophthalmoplegia/ diplopia
Pulsatile proptosis
Horner's syndrome
28
Q

What are the causes of venous sinus thrombosis?

A 
Secondary infection
Metastatic disease
Carotid cavernous venous fistula
Pituitary adenoma
Thrombus
Aneurysm of internal carotid artery
29
Q

How is venous sinus thrombosis investigated?

A 
Bloods: FBC, CRP, ESR, U&amp;E, Coag screen
Cultures for infection
CT
MRI venography
LP
30
Q

How is venous sinus thrombosis treated?

A

Anticoagulation: Heparin
Surgery
Abx: Vancomycin

31
Q

What are the signs & symptoms of a space occupying lesion?

A 
Raised ICP: Headache, papilloedema, vomiting, posture related headache
Hydrocephalus
Seizure/epilepsy starting in middle age
Oedema
Angiogenesis

ACC (21 decks)

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