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MRCS A > Neuro - stroke, MMA, VST + brain haemorrhages > Flashcards

Neuro - stroke, MMA, VST + brain haemorrhages Flashcards

1
Q

Def stroke

A

Acute focal neurological deficit
CV in origin
Persisting >24hrs

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2
Q

Def TIA

A

Acute focal neuro deficit persisting <1hr
No longlasting signs on MRI

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3
Q

Def amaurosis fugax

A

Sudden transient LOV in 1 eye

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4
Q

RF stroke - irreversible (4)

A

age
PMHx/FHx
Hyper-coagulable states
AF

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5
Q

RF stroke - reversible (8)

A

HTN
Hypercholesterol
DM
Smoking
Alcohol
Poor diet/exercise
Obese
COCP

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6
Q

What are the 2 broad categories of stroke + prevelance

A

Ischaemic - 85%
Haemorrhagic - 15%

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7
Q

What is an ischaemic stroke due to

A

Arterial embolus from distal site
Or aa thrombosis from carotid/vertebral/basilar aa

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8
Q

What are the 2 types of haemorrhagic stroke

A

SAH - 5%
Intra-cerebral - 10%

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9
Q

Where has stroke happened in TACS

A

Proximal MCA occclusion

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10
Q

TACS

A

all 3 of:
High dysfunction
Homonous hemianopia
Hemiplegia + sensory loss

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11
Q

Where has stroke happened PACS

A

Distal MCA/or ACA occlusion

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12
Q

PACS

A

2/3 of:
High dysfunction, homonymous hemianopia, hemiplegia/sensory loss
Higher dysfunction alone

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13
Q

Where has stroke happened - LACS

A

Lacunar branch of MCA

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14
Q

LACS

A

2/3 of: face, arm, legs
Pure motor
Pure sensory
Pure sensorimotor
Ataxic hemiparesis

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15
Q

where has stroke happened - POCS

A

PCA occlusion

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16
Q

POCS

A

CN palsy + contralat deficit
Bilat motor or sensory deficit
Eye movement problems
Cerebellar dysfunction
Isolated homonous hemianopia

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17
Q

% who die from TACS in a year

A

60%

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18
Q

% dead from PACS in a year

A

15%

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19
Q

% dead from LACS in a year

A

10%

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20
Q

What is NHISS

A

15 item neuro exam assessing stroke on various levels

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21
Q

Ix stroke

A

Bloods - FBC, U+E, gluc, lpipids, coag, ESR
Imaging - MRI (gold standard)/ CT
ECG

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22
Q

Acute Mx stroke

A

A-E
Withold antiplatelets until CT headh
Arrange thrombolysis if <4.5hrs

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23
Q

Thrombolysis

A

Check C/I
Alteplase 0.9mg/kg 10% bolus 1 min
Remainder over 60 mins

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24
Q

What Mx stroke if thrombolysis C/I

A

300mg aspirin daily

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25
Q

2’ prevention stroke

A

lifestyle mods
antiHTN therapy
Aspirin 300mg od 2w
Clopidogrel 75mg life
statin
LMWH stated day 3 post stroke

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26
Q

Non-pharma Mx stroke

A

SALT (assess within 2w)
physio
OT
Nursing + SSKIN

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27
Q

Driving + stroke

A

No driving 4 w

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28
Q

complications stroke

A

Malignant MCA syndrome
DVT/PE
Aspiration pneumonia
P sores
Depression
Incontinence

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29
Q

What is malignant MCA syndrome?

A

Rapid neuro deterioration due to effects cerebral oedema

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30
Q

PS Malignant MCA syndrome

A

Incr aggression/restlessness
Decr GCS
Haemodynamic instability/thermal instability
Incr ICP

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31
Q

Mx malignant MCA syndrome

A

Decompressive hemicraniotomy

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32
Q

High risk features TIA (3)

A

Rec TIA
AF/TIA whilst anti-coag’d
ABCD score 4 or more

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33
Q

ABCD scores

A

Age >60
BP >140/90
Unilateral weakness = 2 points
Speech disturbance w/o weakness = 1 point
>60mins - 2 points
10-59 mins = 1point
Diabetes = 1 point

34
Q

Mx - high risk TIA (3)

A

Statin
300mg aspirin
specialist clinic within 24hrs

35
Q

Mx - low risk TIA (3)

A

Statin
300mg aspirin
specialist clinic within 1 week

36
Q

What is done at specialist TIA clinic

A

Carotid USS
If stenosis >50% - carotid endarterrectomy offered

37
Q

What is venous sinus thrombosis

A

Venous infarction –> vascular congestion –> haemorrhagic necrosis

38
Q

When to suspect venous sinus thrombosis

A

If thunderclap headache + incr ICP
W/ no signs meningtitis + + no changes on CT

39
Q

What are the 2 types venous sinus thrombosis?

A

Cortical venous thrombosis
Dural venous sinus thrombosis

40
Q

Sx cortical venous thrombosis

A

Headache (thunderclap)
focal signs
seizures
fever
encephalopathy

41
Q

Sx dural venous sinus thrombosis - cavernous sinus

A

Ocular pain (incr on movement)
Proptosis
Ophthalmoplegia
Papilloedema
Fever

42
Q

Sx saggital/lateral dural sinus vv thrombosis

A

Sx of Incr ICP

43
Q

Ix venous sinus thrombosis

A

CT = norm
LP = incr ICP
MRI angio = diagnosis

44
Q

RF venous sinus thrombosis (7)

A

OCP
Pregnancy
Malig
Thrombophilia
Head injury
Recent LP
Infection

45
Q

Cause - deep intra cerebral haemorrhage (2)

A

Rupture microaneurysms - Charcot Bouchard
Degen small deep aa

46
Q

Who suffers from lobar intra-cerebral haemorrhage

A

Normotensive indivs >60

47
Q

Ix intracerebral haemorrhage

A

CT- can see immediately
MRI - can see after 2hrs

48
Q

Mx intracerebral haemorrhage

A

NO antiplatelet/coags
Reverse coag
Lower BP within 1hr using IV betalol
Rx to neurosurgery

49
Q

PS - SAH (5)

A

thunderclap headache
Vom after headache
Incr drowsiness/coma
Photophobia
Focal signs may point to lesion

50
Q

O/E SAH

A

Neck stiffness
+ve Kernigs sign
Papilloedema

51
Q

2 vascular abnormalities that predispose to SAH

A

Berry aneurysm
AV malformations

52
Q

Most common location Berry aneurysm

A

ACA

53
Q

which conditions are associated w/ increased development of berry aneurysms

A

PKD
ED
Marfans

54
Q

What can PCA Berry aneuysms lead to

A

Painful CN3 palsy

55
Q

Ix SAH

A

Bloods: FBC, U+E, LFT, ESR, clotting
CT -
LP if CT norm
CT/MRI angio

56
Q

LP findings SAH

A

CSF will be xanthochromic

57
Q

Mx SAH

A

4 w bed rest
HTN control
Nimodipine
IV fl
Analgesia/anatiemetics
Stool softeners

58
Q

Neurosurgery Mx SAH

A

Coiled by IR

59
Q

What % SAH rebleed within weeks

A

10-20%

60
Q

What % of pt w/ SAH develop hydrocephalus

A

11%

61
Q

Role of nimodipine in Mx SAH

A

Prevents vasospasm
Which reduces mortality

62
Q

% death from SAH immediately

A

30%

63
Q

When do berry aneurysms rebleed after SAH

A

3-4 days

64
Q

when do AVM bleed after sah

A

years after

65
Q

why do you get hydrocephalus after SAH

A

due to fibrosis in CSF pathway

66
Q

what is a subdural haemorrhage

A

collection of blood in subdural space between arachnoid and dura

67
Q

cause acute subdural haemorrhage

A

severe acceleration - deceleration head injury

68
Q

PS acute subdural haemorrhage

A

Young adults
Dilated pupil
Decreased GCS

69
Q

Mx acute subdural haemorrhage

A

craniotomy + early evacuation of clot
ICP monitoring

70
Q

Consequences of acute subdural haemorrhage (3)

A

epilepsy
neuro disability
death

71
Q

RF subacute subdural haemorrhage (3)

A

elderly
alcohol abuse
coagulopathy

72
Q

PS subacute subdural haemorrhage

A

3w after insult
headache
drowsy
confusion
stupor/coma

73
Q

Mx subacute subdural haemorrhage

A

craniostomy/craniotomy

74
Q

Ix subdural haemorrhage

A

CT

75
Q

CT findings - acute subdural haemorrhage (4)

A

cresent shape
incr density (white)
midline shift showing compression of ventricles

76
Q

CT findings - chronic subdural haemorrhage

A

Blood darker
lentiform

77
Q

Norm ICP

A

0-10mmHg

78
Q

Causes of raised ICP

A

Tumour
Trauma
ischaemia
infection
cytotoxic - cell death
obstructive hydrocephalus

79
Q

PS raised ICP (9)

A

Headache - worse on lying, PS on waking and worsened by straining
vom
seizure
irritability
GCS decline
progressive dilatation of pupil on affected side
cushing reflex
cheyne stokes breathing
papilloedema

80
Q

Mx raised ICP

A

A-E
elevate head 30’
mannitol 0.2./kg IV over 15 mins
CCS
fl restirct
neurosurgery

MRCS A (36 decks)

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