All 3 1. unilateral weakness/ sensory loss of face, arm leg 2. homonymous hemianopia 3. higher cerebral dysfunction (dysphasia, visuospatial disorder)

2 out of 3 1. unilateral weakness/ sensory loss of face, arm leg 2. homonymous hemianopia 3. higher cerebral dysfunction (dysphasia, visuospatial disorder)

1 of the following 1. unilateral weakness/ sensory loss of face, arm leg 2. hemiplegia (complete paralysis) 3. ataxic hemiparesis (loss of motor control) 4. dysarthria 5. dysphagia 6. paresthesia NO EFFECT ON HIGHER FUNCTION

Neuro week: headaches, strokes & falls Flashcards by Sherilyn Chew

Risk factors for stroke

diabetes
artherosclerosis, other vascular disease
age
smoking, alcohol, recreational drugs
hypertension
high cholesterol
IHD
A fib

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Differential diagnoses of stroke

migraine
hemiparesis after seizure
cerebral abscess
tumour
subdural haematoma
MS
head injury
hypertensive encephalopathy

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Differential diagnoses of TIA

hypoglycaemia
migraine
focal epilepsy
MS
peripheral nerve lesion
psychological

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Symptoms of strokes in vertebral/ basilar arteries

Affects CN nuclei, cerebellum

diplopia, disorders of eye movements
nystagmus, vertigo, vomiting
dysarthria, dysphagia, bulbar weakness
ipsilateral LMN facial weakness
contralateral hemiparesis, quadriparesis
respiratory failure, coma

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Which of the following is more suggestive of syncope than seizure

cyanosis
confusion and amnesia after event
onset while standing up
history of recent stroke

Onset while standing up

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What is Todd’s paresis

Paresis following a focal seizure

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Effects of TACS

All 3

unilateral weakness/ sensory loss of face, arm leg
homonymous hemianopia
higher cerebral dysfunction (dysphasia, visuospatial disorder)

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Effects of PACS

2 out of 3

unilateral weakness/ sensory loss of face, arm leg
homonymous hemianopia
higher cerebral dysfunction (dysphasia, visuospatial disorder)

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Effects of LACS

1 of the following

unilateral weakness/ sensory loss of face, arm leg
hemiplegia (complete paralysis)
ataxic hemiparesis (loss of motor control)
dysarthria
dysphagia
paresthesia

NO EFFECT ON HIGHER FUNCTION

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What is included in the ROSIER scale (recognition of stroke in emergency room)

no history of syncope
asymmetrical face weakness
asymmetrical arm weakness
asymmetrical leg weakness
aphasia or dysarthria
visual field defect
asymmetrical sensory defect
hemiparetic/ ataxic gait
limb ataxia
eye movement abnormality

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What type of stroke might be treated with thrombolysis with alteplase

Ischaemic stroke

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What type of stroke might be treated with aspirin, anticoagulants

Acute ischaemia stroke
Acute venous stroke
Stroke secondary to arterial dissection

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What kind of stroke requires a surgical decompressive hemicraniectomy

MCA infarction

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What other factors need to be controlled in a person who has had a stroke

oxygen
blood sugar
blood pressure

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What level should blood glucose aim to be maintained at

4-11 mmol/L

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CVS reasons for falls

orthostatic hypotension
neurally-medicated syncope (carotid sinus syndrome)
cardiac syncope (arrhythmias)
aortic stenosis

Respiratory reasons for falls

COPD

- respiratory infections eg pneumonia

Endocrine reasons for falls

hypoglycaemia

- diabetes

Neurological reasons for falls

mental confusion
Parkinson’s
stroke

MSK reasons for falls

arthritis

- poor mobility

Genitourinary reasons for falls

UTIs

- kidney problems

Which type of migraine is associated with increased vascular risk

Migraine with aura

Symptoms of migraine

Gradual onset, throbbing unilateral pain

* Photophobia, phonophobia, nausea, vertigo, ocular pain

Symptoms of tension headache

• Bilateral, constant

Symptoms of cluster headache

* Unilateral nasal discharge, eye watering, ocular pain | * Usually has circadian pattern (often at same time each night)

Symptoms of SAH

* Acute thunderclap headache, throbbing * Usually occipital area * Onset with exertion * Neck stiffness/pain * Loss of consciousness * Vomiting

Risk factors for SAH

Age >40 | Hypertension

Accompanying features of a headache that might suggest a space occupying lesion or hydrocephalus

* Worse on leaning forwards * Present all/ most of the time * Morning sickness * Blurred vision (papilledema)

Why should LFT be included in tests for patients with headache

Headache may be caused by elevated liver enzymes

Why should TFT be included in tests for patients with headache

Hypothyroidism can cause headaches

Why should B12 be included in tests for patients with headache

B12 deficiency may cause peripheral neuropathy

What are the cerebellar symptoms DANISH

* Dysdiadokoninesia * Ataxia * Nystagmus * Intention tremor * Slurred speech * Hypotonia

How does SAH potentially cause meningitis

Acute entry of blood into meninges | thus SAH must be included in differential diagnosis with triad of meningitis symptoms

Where does pain from a SAH usually radiate to

Neck

What is an unlikely differential in someone whose initial presentation is headache

Brain tumour | would also present with papilloedema and other focal neurological signs

Differential diagnoses for anyone who has headache that is worse on bending

anything that causes raised ICP - subdural hematoma - tumour

Is haemorrhagic or ischaemic stroke more common

Ischaemic (accounts for 87% of cases)

Sinister causes of headache: VIVID

Vascular: SAH, hematoma, cerebellar infarct, cerebral venous sinus thrombosis Infection: meningitis, encephalitis Vision threatening: giant cell arteritis, acute glaucoma, cavernosus sinus thrombosis ICP raised: SOL, hydrocephlus, cerebral oedema, malignant hypertension Dissection: carotid dissection

If a patient presents with a CN12 palsy (deviated tongue) and a headache, what is the likely diagnosis

Carotid artery dissection