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2a rrs > neuro strokes TIAs > Flashcards

neuro strokes TIAs Flashcards

1
Q

what is a TIA

A

focal sudden onset neurological deficit
lasting less than 24hrs
w complete clinical recovery
iscahemia without infarction

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2
Q

RFs for TIA

A 
age
HTN
PAST TIA
smoking
diabetes
clot disorder
hyperlipidaemia
vascuitis - GCA
SLE
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3
Q

causes of a TIA

A

atherothromboembolism from carotid = most common
cardioembolism - AF, valvue disease
hyperviscosity - polycythaemia, sickle cell, myloma
hypoperfusion - cardiac dyssrhythmia, postural hypOtenision

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4
Q

what causes the cerebral dysfunctino in a TIA

A

lack of oxygen and nutrient to brain - resolves before irreversible cell death hence short lived symptoms

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5
Q

CFs TIA

A

sudden loss of fuction -few mins - complete recovery
ANT CIRCULATION - amaurosis fugax, hemiparesis
BOTH = Hemisensory loss
POST CIRCULATION - vom vertigo ataxia tetraparesis diplopia

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6
Q

what is the important buzzword in TIA

A

amaurosis fugax - curtain falling over one eye

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7
Q

Ix for TIA

A

no brain scan changes
carotid doppler and CT angiography
ECG - AF ? - cardio embolism?

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8
Q

Mx TIA

A 
avoid stroke risk - dual antiplatelets, aaspriin -- clopidogrel
HTN control 
Diabetes 
diet
statins
stop smokiong
exercise 
LIFE STYLE MODIFICATIONS
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9
Q

how assess likelyhood of TIA –> stroke

A 
ABCD2 Score = 6+ specialsist - REFFERRAL 4+ see in  24hrs rest = 7days
Age>65 =1 
Blood pressure>140/90 =1 
clinical 
unilateral weakness =2 
speech and no weakness =1 
Diabetic =1 
Duration of symptoms 
less than 1 hour =1 
more than hour =2
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10
Q

DDX of a TIA

A

migraine with aura
Todds paralysis
hypoglycaemia

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11
Q

types of stroke and commonest

A

ischaemic (commonist)
heamorrhagic
other - vasculitis , arterial dissection)

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12
Q

what is a stroke

A

rapid onset symptoms over 24hrs

neurological deficit casued by focal cerebral spinal or retinal infarcition

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13
Q

cuses of a ischaemic stroke

A

cardiac emboli
atherosclerosis
hypoperfusion

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14
Q

causes of haemorrhagic stroke

A

trauma

anneurysm rupture

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15
Q

example of a aneurysm rupture leading to a stroke

A

charot bouchard anneurysm- basal ganglia

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16
Q

other causes of strokes

A

vasculitis (GCA)
hyperviscosity (sickle cell, polycythaemia)
large artery stenoisis

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17
Q

Rf of stroke

A 
DM smoking previous TIA 
heart disease (AF- blood stasis)
alcohol
COCP 
polycythameia
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18
Q

CFs of ACA stroke

A 
gait ataxia 
leg and truncal weakness and sensory loss
oluntary leg movement
incontinence
akinetic mutaism
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19
Q

CFs of MCA stroke

A 
unilat weakness and sensory loss
face drop
hemianopia contralat
receptive and affective aphasia
(ARMS ALSO)
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20
Q

CFs of PCA

A

Homonymous hemianopia with macular sparing

Prosopagnosia - facial recognition ish

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21
Q

CFs of POST circulation strooke

A

cerebellar syndrome - vertigo vom headache ataxia
“locked in” motor deficit - rest fine
brain stem stroke?

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22
Q

Stroke in lenicular region

which artery supplies this

A

Internal capsule is MCA supplied

Full contralateral hemiplegia, dysarthia, dysphagia

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23
Q

Dx of stroke

A

bloods - FBC - thrombocytopenia, polycythaemia
URGENT CT SCAN HEAD - BEFORE THROMBOLYSIS incase its haemorrhagic = death
ECG - AF?
Echo- patent formamen ovale? allow passage thrombi R to L – brain

24
Q

Mx of strokes ischaemic

A 
CT scan = ISCHAEMIC
less than 4.5hrs
thrombolysis - IV altepase
\+clop later
more than 4.5hrs
Aspirin 2 weeks 
\+ clop lifelong later
25
Q

Mx of strokes haemorrhagic

A 
antithrombosis
BBs / ARB's
Beriplex if warfarin related (faster acting than vit K)
surgey - clot evation
REHAB OCC THERAPY etc
26
Q

CI for thrombolysis w alteplase

A

operation in last 3 months
previous history of active malignancy
warfarin
low platelets

27
Q

what does alteplase do and when used

A

tissue plasminogen activator - precursor to plasmin that degrades clots
used in thrombolysis in ischeamic strokes

28
Q

which artery most common site for strokes

A

middle cerebral artery

29
Q

brocas vs wernickes

A

brocas - cant speak can undertand - superior

wernickes - can speak cant understand = infereior

30
Q

what is a extradural haemorrhage

A

rapid collection of blood in extradural space - between dura mater and bone

31
Q

what causes an extradural haemorrhage

A

head injury
fracture of temporal/ parietal bone — rupture of middle meningeal artery
most commonly at pterion (side of temple thin and above middle meningeal artery)

32
Q

what are symtpoms of extradural haemorrhage

A

LOC initially
then LUCID interval (hours or days)
then rapid increase in ICP - rapid deterioration
=altered conciousness
N+V seizures confusion coma headaches pappiloedema (ICP signs)
ipsilat pappilary dilatation
bilat weakness

33
Q

feautures of raised ICP hedache

A

headache, worst at night and in mornings, worst when lie down or cough or exercise.
relieved by vomiting,
assosiated with papilloedma

34
Q

signs of ICP

A

ipsilateral pappilary dilatation
brainstem compression signs - death

pappiloedema, lack of conciousness

35
Q

how assess conciousness

A

glasgow coma scale
lower = less concious
decreases as ICP increase

36
Q

Dx of extradural haemorrhage

A

CT scan - Egg shaped - EGGstra dural
biconvex hypodense haematoma
Xray - skull fracture?
NO LP- CONING - TENTORIAL HERNIATION

37
Q

Tx- extradural haemorrhage

A

Stabilize - airway care
neurosurgery - craniotomy, clot evacuation
mannitol - decrease ICP and swelling

38
Q

why no lumbar puncture in extra dural haemmohrhage

A

high ICP therefore removal of CSF decreases p and CSF move down pressure gradient causing tentorial herniation - death

39
Q

what is sub dural haemorr

A

bleeding between dura mater and arachnoid mater - follows rupture of a bridging brain

40
Q

Cfs of subdural haemorrhage

A 
fluctuating symptoms 
gradual increase in ICP over weeks 
headache 
vom
confusion
seizures
SIGN - papilloedema
41
Q

why is presentation gradual in subdural haemorrage

A

days/weeks as heamotoma forms it increaes oncotic p so water moves IN from brain (low p in veins hence SLOW)
increases ICP - midline shift

42
Q

DDx of subdural haemorrage

A

stroke
extradural haemorrage
dementia
subarachnoid haemorr

43
Q

RFs of subdural haemmorage

A

elderly - brain atrophy= veins less suported
alcohol abuse
shaken baby syndrome
ACCEL DECEL injury (WHIPLASH)

44
Q

Dx Subdural haemorrhage

A

CT - Sickle Shaped Subdural (SSS)
hyperdense
CAN cross suture lines

45
Q

Mx - subdural haemmorrhage

A

neurosurgery - clot evac =1st craniotomy =2nd

IV mannitol = decrease ICP

46
Q

What is subarachnoid haem

A

bleeding into subarachnoid space - increaste ICP and prevents blood INTO brain
(betwen arachnoid layer of meninges and pia mater

47
Q

most common cause of Subarach haem

A

berry anneurysm rupture

48
Q

where do berry anneruysms occur

and who predisposed

A

at bifurcation of arteries
marfans
bifurcation of aorta
PKD

49
Q

Causes of subarachnoid haemmorrhage

A

1 berry anneuyrsm rupture

  1. arteriovenous malformation
  2. trauma
50
Q

Rfs

A

HTN
fam Hx
anneurysm preisposed risk (Marfans, PKD, ehlers danlos)

51
Q

presentation of subarachnoid haemmorrhage

A 
THUNDERCLAP HEADACHE sudden onset
(decreased ICP signs and sympotms)
seizures decreased conciousness N + V
MENINGISM - STIFF NECK = nuchal rigidity
PRODROME = SENTINEL HEADACHE
52
Q

signs of subarachnoid haemmorrhage

A

pos meningisms - KERNIGS sign (pain extending knee on thigh flex at hip)
neck stiffness
brudzinskis (flex neck = flex knees n hips)
CNS DEFICITS - 3rd Nerve palsy and pupil changes (post communic artery)

53
Q

what is prodrome for subarachnoid haemmorrhage

A

sentinel headache

54
Q

diagnosos of subarachnoid haemmorrhage

A

CT - white starshaped

LP - wait 12 hrs - xanthochromic CSF - yellow due to bilirubin

55
Q

Tx of subarachnoid haemmorrhage

A

dexamethasone - for swelling
control HTN
neurosurgey (clipping or coiling)
nimodipine - decrease vasospasm risk = hydrocephalus

56
Q

complication with subarachnoid haemmorrhage

A

hydrocephalus - vasospasm as blood vessels pooled in blood = decrease blood suply to brain = irritates meninges = scarriing and inflam = CSF obstruct = dilated ventricles

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