Neuro peer teaching Flashcards by E Horton

what percentage of strokes are ischemic

85%

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haemorrhagic stroke symptoms

Raised ICP - nausea vomiting seizures

Plus neurological dysfunction

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TIA definition

a transient episode of neurological defecit caused by temporary focal ischaemia without acute infarction

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Ischaemic stroke risk factor

hypertension
AF
age
diabetes

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frontal lobe function

Prefrontal cortex - personality, decision making, emotional processing
precentral gyrus - contralateral motor control

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parietal lobe function

postcentral gyrus - sensory cortex -

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occipital lobe function

sight - visual comprehension, colour, reading comprehension

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temporal lobe function

Hearing, memory formation

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Broca’s area

production of speech

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Wernicke’s area

comprehension of speach

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Anterior cerebral artery stoke - which area of brain and symptoms

Frontal lobe/parietal lobe

contralateral weakness and sensory loss lower limb more than upper

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Middle Cerebral Artery stroke - which lobes of brain and what symptoms

temporal/parietal/occipital

contralateral limb weakness upper more than lower
aphasia
contralateral homonymous hemianopia

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posterior cerebral artery - which area of brain and what symptoms

occipital
contralateral homonymous hemianopia with macular sparing
visual agnosia

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Weber’s stroke area supply and symptoms

midbrain/cerebral peduncle and ipsilateral third nerve palsy (down and out eye, loss of
efferent pupilary light reflex and ptosis)

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ophthalmic artery stroke area supply and symptoms

optic nerve and amaurosis fugax - transient

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basilar artery stoke symtoms

locked-in syndrome unable to move limbs

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Bamford classification + interpretation

Look speak move

homonymous hemianopia
dysphasia/higher cognitive function
weakness/sensory loss

All 3 = total anterior infarct (anterior + middle cerebral arteries)
⅔ = partial anterior infarct
ONLY weakness/ONLY sensory loss = lacunar infarct
ONLY homonymous hemianopia = posterior circulation infarct

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stroke investigation 1st and 2nd line

1st non contrast CT head
2nd MRI/CT angiogram

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Stroke scoring system

rosier score

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TIA management

within 1 week - 300mg aspirin, assessment within 24 hours
over 1 week - special assessment within 7 days

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TIA imaging

diffusion weighted MRI

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TIA prevention long term

first 21 days aspirin+clopidigral
after 21 just clopidogrel
If AF - DOAC - rivaroxaban/apixaban

Always High dose statin

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ischaemic Stroke management

non-contrast CT head
aspirin 300mg

within 4.5 hours - alteplase (thrombolysis)
If after 4.5 - if possibility of salvage on CT perfusion still give

mechanical thrombectomy possible if before 6 hours, or 24 if salvage possible on CT perfusion

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ischaemic stroke secondary prevention

clopidogrel 75mg
if AF: DOAC - rivaroxaban/apixaban
statin

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extradural haemorhage

convex (lemon shaped) middle meningeal artery short lucid interval trauma craniotomy and evacuation

subdural haemorhage

concave bridging vessels long lucid interval young or old surgical decompression and burr hole

subarachnoid haemorhage

in Dural space (spaceman) berry aneurism rupture (autosomal dominant polycystic kidney disease) thunderclap headache oral nimodipine plus clipping/coiling

Seizure definition

sudden uncontrolled disorganised electrical activity in the brain that can cause temporary changes in behaviour, muscle tone and consciousness

epilepsy definition

a neurological disorder that causes seizures

status epilepticus definition

Single seizure lasting more than 5 minutes 2 or more seizures within a 5 minute period

Focal seizure definition

seizure activity in one lobe of brain

status epilepticus treatment

buccal midazolam/IV lorazepam - IV if access, buccal pre hospital (try 2 dose 5 minutes apart) then IV phenytoin/sodium valproate Then call anaesthetics

focal Seizure prevention

Levetiracetam/lamotrigine

Tonic clonic Seizure prevention

Men - sodium valproate Women - Levetiracetam/lamotrigine

myoClonic Seizure prevention

Men - sodium valproate Women - Levetiracetam

tonic/atonic Seizure prevention

Men - sodium valproate Women - lamotrigine

Absence seizures prevention

Ethosuximide

meningitis/encephalitis symptoms

Fever, headache, nausea, photophobia, purpuric (non-blanching) rash (meningitis) drowsiness, seizures (encephalitis more common

Meningitis signs

Kernig's sign - straighten knee causes pain Brudzinski's - flex neck knee comes up

bacterial LP

Turbid colour, low glucose, high protein, high WCC

Viral LP

high white cell count - lymphocytic predominance

GP suspects Meningitis

IM Benpen

hospital meningitis treatment

IV cefotaxime/ceftriaxone IV dexamethasone once organism confirmed

LP contraindications

Raised ICP Anticoagulant therapy (i.e. Warfarin) Thrombocytopenia or other clotting disorders Suspicion of a spinal abscess Risk of herniation eg congenital abnormality

Encephalitis causation organise and treatment

HSV 1 treatment is acyclovir

Most common brain tumour in adults

glioblastoma - central tumour

most common tumour in children

astrocytoma

3rd nerve palsy symptoms

down and out eye, loss of efferent pupilary light reflex and ptosis

what causes a 3rd nerve palsy

weber's stroke

POSTERIOR inferior Cerebellar Artery infarct symptoms

ataxia, nystagmus pain/temperature sensation loss (ipsilateral face, contralateral limb

ANTERIOR inferior Cerebellar artery infarct symptoms

ataxia, nystagmus pain/temperature sensation loss (ipsilateral face, contralateral limb Deafness facial paralysis

Migraine symptoms

unilateral throbbing headache (lasts 1-72 hours) aura Nausea/vomiting photophobia phonophobia

Migraine triggers

Chocolate Hunger Oral contraceptive Caffeine OL (alcohol) A Travel Excersice

Migraine acute management

Tripan eg sumatriptan ibuprofen

Migraine prophylaxis

propranolol amitriptyline topiramate

cluster headache symptoms

15 minute long severe pain around eye with swelling

cluster headache acute management

oxygen and subcut triptan

Cluster headache prophylaxis

verapamil (calcium channel blocker)

temporal arteritis symptoms

Older Pt Unilateral Jaw claudication Tender scalp + palpable temporal artery Raised ESR

temporal arteritis management

URGENT glucocorticosteroids (prednisolone) + ophthalmology review

trigeminal neuralgia symptoms

Unilateral electric shock pains Evoked by light touch

trigeminal neuralgia treatment

carbamazepine