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Year 3 > Neuro Core Conditions > Flashcards

Neuro Core Conditions Flashcards

1
Q

3rd most common cause of death?

A

Stroke

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2
Q

What % of strokes are ischaemic?

A

70%

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3
Q

Who has strokes?

A

> 40
M>F
Asian and Black African populations

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4
Q

Mortality following stroke?

A

20-25%

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5
Q

Causes of stoke in young patients?

A 
Thrombophilias 
Vasculitis 
SAH
Venous sinus thrombosis 
Carotid artery dissection
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6
Q

Causes of stroke in older people?

A

Thrombus in situ
Athero-thromboembolism (AF, infective endocarditis, MI)
CNS bleed
Sudden BP drop (>40mmHg)
Vasculitis (giant cell arteritis, venous sinus thrombosis)

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7
Q

Risk factors for stroke?

A 
>65
FHx
Ethnicity 
Hx
HTN
Smoking 
Obesity 
DM 
Heart disease 
Peripheral vascular disease 
Polycythaemia vera 
Carotid artery occlusion 
Hyperlipidaemia 
Excess alcohol 
Clotting disorders 
COCP
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8
Q

Symptoms of stroke?

A

FAST
Cerebral hemisphere infarcts –> contralateral hemiplegia, sensory loss, homonymous hemianopia , dysphasia
Brainstem infarct –> quadriplegia, disturbed gaze/vision, locked in syndrome, lateral medullary syndrome
Lacunar infarcts –> pure motor/sensory or mixed signs, ataxia, dysphagia

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9
Q

Differentials for stroke?

A 
CNS tumour 
Sub/epidural haematoma 
SAH
Todd's palsy 
Drug OD 
ACS
Bell's palsy 
BPPV 
Brain abscess 
Inner ear labrinthytis 
MI 
TIA
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10
Q

Investigations for stroke?

A 
FBC, ESR, BM, lipid profile
CXR + ECG for heart disease
CTH if GCS<13
Carotid duplex US 
MRI in some cases
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11
Q

Treatment for stroke?

A

Restore O2 and get blood glucose between 4-11
If patient has HTN emergency with encephalopathy/nephropathy/HF/MI/aortic dissection/(pre) eclampsia/ICH then give antihypertensives
Aspirin, clopidogrel
Alteplase (thrombolytic)
IC stenting
Surgery for supratentorial haemorrhage with mass effect, posterior fossa or cerebellar haematoma

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12
Q

Who gets TIA?

A

Rare <60
Uncontrolled HTN
M>F
Asian and black African populations

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13
Q

What % of stroke patients have a TIA first?

A

15%

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14
Q

Causes of TIA?

A 
Embolic (usually) from carotid bifurcation, heart (AF)
Thrombotic 
Haemorrhagic (rarely)
Atherosclerosis 
Leukaemia 
Sickle cell 
Polycythaemia 
Thrombosysthaemia
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15
Q

Risk factors for TIA?

A 
>65
FHx
Hx
HTN
DM
Obese
Smoking/alcohol
Ethnicity 
Heart/peripheral vasc disease
Polycythemia vera 
Carotid artery occlusion 
COCP
Hyperlipiaemia 
Clotting disorders
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16
Q

Symptoms of TIA due to carotid clot?

A 
Unilateral, motor weakness 
Dysarthria 
Amaurosis fugax 
Aphasia 
Hemiparaesis 
Hemisensory loss
Hemianopic vision
B/W dysphasia
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17
Q

Symptoms of a vertibrobasilar TIA?

A 
Diplopia 
Vertigo 
Vomiting 
Choking 
Dysarthria 
Ataxia 
Hemisensory loss 
Hemianopic vison 
Tetraparaesis
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18
Q

How long must a TIA take to resolve?

A

24 hours

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19
Q

Differentials for TIA?

A 
Stroke 
IC lesion 
Todd's 
Syncope due to arrhythmias
Temporal arteritis
Migraine
Retinal or vitreous haemorrhage 
Focal epileptic seizure 
Labrynthine  disorders 
Psych disorder 
Metabolic disturbance
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20
Q

Investigations for TIA?

A 
Urinalysis for glucose 
FBC, ESR, U+E, fasting lipids and glucose, LFTs, TFTs
ECG 
Cardiac monitoring for paroxysmal AF 
Carotid/vertebral doppler 
CT/MRI
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21
Q

Treatment for TIA?

A 
No driving for 1 month 
Admit to hospital if:
On warfarin (CTH)
ABCD2 score >4
Uncontrolled AF

Antiplatelet + anticoag
Warfarin for AF

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22
Q

What % of strokes are due to SAH?

A

5%

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23
Q

Who gets SAH?

A

Younger patients (50)
50% die
F>M
Rare in children

24
Q

Causes of SAH?

A

Saccular berry aneurysm (70%)
AVM (10%)
No arterial lesion found (15%)
Rare associations (5%) - bleeding disorders, mycotic aneurysms from endocarditis, acute bacterial meningitis, tumours

25
Q

Risk factors for SAH?

A 
Large aneurysms
Smoking 
HTN
Alcohol 
Genetics 
10% of AD PCK patients have berry aneurysms
26
Q

Symptoms of SAH?

A 
Sudden thunderclap headache
Vomiting 
Sentinel bleeds 
Expansion of aneurysm 
Dizzy 
Orbital pain 
Diplopia 
Visual loss 
Sensory/motor disturbances 
Seizures 
Ptosis 
Bruits 
Dysphasia 
Neck stiffness
Focal neuro signs 
Complete/partial CNIII palsy (due to PCmmA rupture)
27
Q

Differentials for SAH?

A 
Meningitis 
Trauma
Cluster headahce 
Encephalitis 
First seizure in adulthood 
IC haemorrhage 
Ischaemic stroke 
TIA
28
Q

Investigations for SAH?

A

ABG
ECG
CTH and CT angio
-ve CTH = LP (use spectrophotometry to detect xanthochromia)

29
Q

Treatment for SAH?

A 
Prevent further bleeding 
Nimodipine Ca antagonists (reduce vascular spasm)
Phenytoin (prevent seizure spread)
Nitroprusside (vasodilator)
Labetolol
Clip aneurysm
Endovascular embolisation 
Secondary prevention advice
30
Q

What % of those with DM for >25 years have peripheral neuropathy?

A

50%

31
Q

Who gets peripheral neuropathy?

A

Older patients

32
Q

Causes of peripheral neuropathy?

A 
DM
B12/folate def
Chemo
Antiretrovirals 
Metrodinazole 
Thalidomide 
Phenytoin 
Insecticides 
Solvents 
Cancer
Alcohol
CKD 
Guillan-Barre syndrome 
Trauma and nerve compression
Shingles 
HIV 
Lyme
RhA 
Sjorgens 
SLE 
Sarcoidosis 
Coeliac
Charcot Marie Tooth syndrome 
Freidriech ataxia 
Idiopathic
33
Q

Risk factors for periph neuropathy?

A 
Alcohol
DM 
Kidney/liver/thyroid disease 
Repetitive physical stress
Age 
FHx
HTN
Peripheral vascular disease 
Smoking
34
Q

Symptoms of peripheral neuropathy?

A 
Tingling, numbness 
Loss of coordination 
Burning/shooting pains (worse at night)
Dificulty walking/picking stuff up 
Affects hands/feet first 
Muscle weakness 
Falling 
Difficulties with small movements (buttoning shirts)
Swallowing problems 
Cachexia 
Muscle twitching/cramps/paralysis
Dizzy/fainting 
Reduced sweating 
Heat intolerance 
Urinary incontinence 
Bloating 
Constipation/diarrhoea
Impotence
35
Q

Differentials for peripheral neuropathy?

A 
Acromegaly 
Acute inflam demyelinating polyadiculoneuropathy 
Alcohol related neuropath
CMT disease 
Coagulopathies 
Drug induced paraneoplastic syndromes 
Heavy metal toxicity 
Herpes 
Labert-Eaton myasthenic syndrome 
MG 
Nerve compression 
Post-surgical vagotomy 
Vit B6 intox
36
Q

Investigations for peripheral neuropathy?

A 
BM, vit B12, foalte, 
U+E creatinine 
Nerve conduction studies 
Electromyography
Nerve/skin biopsy
37
Q

Treatment for peripheral neuropathy?

A 
Underlying cause 
Physio
Surgery 
Anticonvulsants (gabapentin, carbamazepine)
Elastic stockings 
Fludrocortisone 
Eating small frequent meals 
Sleeping with head raised 
Walking aids 
Occupational therapy
38
Q

Who has epilepsy/seizures?

A

Children or >60
Learning difficulties
30% have a 1st degree relative affected

39
Q

Causes of seizures?

A 
Primarily idiopathic 
Ischaemia
Venous thrombosis 
Head injury 
Meningitis/encephalitis 
Provoked seizures 
Autoimmune 
Brain tumour 
Isoniazid 
Alcohol (withdrawal)
Hypoglycaemia 
Imbalanced Na or Ca
40
Q

Risk factors for seizures?

A 
Age
M>F
FHx
Head trauma 
Stroke 
Brain infections 
Prolonged febrile seizures of childhood 
Congen abnormalities of brain structure 
Lack of O2 to brain 
CP 
Illicit drugs
41
Q

Symptoms of seizures?

A 
Amnesia 
Falls 
Tonic-clonic 
Blank spells 
Incontinence 
Confusion/impaired awareness
Visual/auditory/gustatory/olfactory hallucinations
42
Q

Differentials for seizures?

A 
Syncope 
Arrhythmias 
TIA 
Migraine 
BPPV 
Hypoglycaemia 
Acute encephalopathy 
Narcolepsy 
Sleep apnoea 
Panic attacks
43
Q

Investigations for seizures?

A 
EEG 
MRI/CTH 
BM, U+E, Ca, LFTs, FBC
12 lead ECG 
Neurophysiological assessment
44
Q

Treatment for seizures?

A

Phenytoin
Carbamazepine
Na valproate
Broad spectrum AEDs may work for treatment resistant epilepsy
Drug treatment should be monitored and weaned off
Relaxation and CBT may help

45
Q

Which is more common, viral or bacterial meningitis?

A

Viral

46
Q

Who gets meningitis?

A

Babies
Young children
Elderly
Can be anyone

47
Q

Causes of meningitis for neonates?

A 
Group B strep 
Listeria monocytogenes 
E coli 
H Flu B 
N Meningitis 
Strep pneumoniae
48
Q

Causes of meningitis for adults?

A 
S pneumoniae 
H flu type B
N meningitidis 
Gram -ve bacilla 
Staph 
Strep 
L Monocytogenese
49
Q

Causes of meningitis for elderly or immunocompromised?

A

S Pneumoniae
L monocytogenes
TB
Gram -ve

50
Q

Risk factors for meningitis?

A 
CSF shunts 
Dural defects 
Spinal procedures 
Bacterial endocarditis 
DM 
Alcohol
Prem birth 
PROM 
IVDU
Malignancy 
Thalassaemia, sickle cell, splenectomy 
CF
51
Q

Symptoms of meningitis?

A 
Meningitism 
Fever 
Headache 
Altered mental state 
Shock 
Septicaemia 
Kernig's sign 
Brudzinski's sign
PAresis 
Focal neuro def 
Seizures 
Viral may be more mild
52
Q

Symptoms of meningitis in neonates?

A 
Non-specific 
Resp distress 
Fever 
Apnoea 
Bradycardia 
Hypotension 
Difficulty feeding 
Irritable
53
Q

Differentials for meningitis?

A 
Other causes of infection/pyrexia
IC abscess 
Encephalitis
SAH
Tumours 
Delirium tremens 
HSV 
Paediatric febrile seizures
54
Q

Investigations for meningitis?

A

LP (unless at risk of herniation - then CTH)
Gram stain, Ziehl-Neelson, cytology, virology, glucose, protein, culture, rapid antigen testing, PCR, Indian ink (cryptococci)
Blood cultures, FBC, BM, coag, U+E
Urine dip/culture
MRI

55
Q

General teatment for meningitis?

A

Fluids
Antipyrexics
Antiemetics

56
Q

Treatment for viral meningitis?

A

Analgesia
Aciclovir if due to herpes
Ganciclovir if due to CMV (only if congenital or AIDS related as ganciclovir is v toxic)

57
Q

Treatment for bacterial meningitis?

A

Benzylpenicillin STAT if suspicion of meningococcal + non-blanching rash
Blind therapy initially (3rd gen ceph or amoxicillin if listeriosis is suspected)
Meningococcal - benzylpenicillin or cefotaxime for at least 7 days, rifampicin for 2 days to eliminate nasal carraige
Pneumococci - Cefotaxime for 10-14 days
H flu type B - Cefotaxime (10 days) + rif 4 days prior to discharge
Group B strep - Benzylpenicillin + gentamicin or cefotaxime alone for 14 days
Listeriosis - Amoxicillin and gentamicin for 10-24 days

Year 3 (9 decks)

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