Neuro Core Conditions Flashcards
3rd most common cause of death?
Stroke
What % of strokes are ischaemic?
70%
Who has strokes?
> 40
M>F
Asian and Black African populations
Mortality following stroke?
20-25%
Causes of stoke in young patients?
Thrombophilias Vasculitis SAH Venous sinus thrombosis Carotid artery dissection
Causes of stroke in older people?
Thrombus in situ
Athero-thromboembolism (AF, infective endocarditis, MI)
CNS bleed
Sudden BP drop (>40mmHg)
Vasculitis (giant cell arteritis, venous sinus thrombosis)
Risk factors for stroke?
>65 FHx Ethnicity Hx HTN Smoking Obesity DM Heart disease Peripheral vascular disease Polycythaemia vera Carotid artery occlusion Hyperlipidaemia Excess alcohol Clotting disorders COCP
Symptoms of stroke?
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
Differentials for stroke?
CNS tumour Sub/epidural haematoma SAH Todd's palsy Drug OD ACS Bell's palsy BPPV Brain abscess Inner ear labrinthytis MI TIA
Investigations for stroke?
FBC, ESR, BM, lipid profile CXR + ECG for heart disease CTH if GCS<13 Carotid duplex US MRI in some cases
Treatment for stroke?
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
Who gets TIA?
Rare <60
Uncontrolled HTN
M>F
Asian and black African populations
What % of stroke patients have a TIA first?
15%
Causes of TIA?
Embolic (usually) from carotid bifurcation, heart (AF) Thrombotic Haemorrhagic (rarely) Atherosclerosis Leukaemia Sickle cell Polycythaemia Thrombosysthaemia
Risk factors for TIA?
>65 FHx Hx HTN DM Obese Smoking/alcohol Ethnicity Heart/peripheral vasc disease Polycythemia vera Carotid artery occlusion COCP Hyperlipiaemia Clotting disorders
Symptoms of TIA due to carotid clot?
Unilateral, motor weakness Dysarthria Amaurosis fugax Aphasia Hemiparaesis Hemisensory loss Hemianopic vision B/W dysphasia
Symptoms of a vertibrobasilar TIA?
Diplopia Vertigo Vomiting Choking Dysarthria Ataxia Hemisensory loss Hemianopic vison Tetraparaesis
How long must a TIA take to resolve?
24 hours
Differentials for TIA?
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
Investigations for TIA?
Urinalysis for glucose FBC, ESR, U+E, fasting lipids and glucose, LFTs, TFTs ECG Cardiac monitoring for paroxysmal AF Carotid/vertebral doppler CT/MRI
Treatment for TIA?
No driving for 1 month Admit to hospital if: On warfarin (CTH) ABCD2 score >4 Uncontrolled AF
Antiplatelet + anticoag
Warfarin for AF
What % of strokes are due to SAH?
5%