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Stage 3: FOCP > Neuro week: headaches, strokes & falls > Flashcards

Neuro week: headaches, strokes & falls Flashcards

1
Q

Risk factors for stroke

A
  • diabetes
  • artherosclerosis, other vascular disease
  • age
  • smoking, alcohol, recreational drugs
  • hypertension
  • high cholesterol
  • IHD
  • A fib
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2
Q

Differential diagnoses of stroke

A
  • migraine
  • hemiparesis after seizure
  • cerebral abscess
  • tumour
  • subdural haematoma
  • MS
  • head injury
  • hypertensive encephalopathy
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3
Q

Differential diagnoses of TIA

A
  • hypoglycaemia
  • migraine
  • focal epilepsy
  • MS
  • peripheral nerve lesion
  • psychological
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4
Q

Symptoms of strokes in vertebral/ basilar arteries

A

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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5
Q

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
A

Onset while standing up

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6
Q

What is Todd’s paresis

A

Paresis following a focal seizure

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7
Q

Effects of TACS

A

All 3

  1. unilateral weakness/ sensory loss of face, arm leg
  2. homonymous hemianopia
  3. higher cerebral dysfunction (dysphasia, visuospatial disorder)
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8
Q

Effects of PACS

A

2 out of 3

  1. unilateral weakness/ sensory loss of face, arm leg
  2. homonymous hemianopia
  3. higher cerebral dysfunction (dysphasia, visuospatial disorder)
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9
Q

Effects of LACS

A

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

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10
Q

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

A
  • 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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11
Q

What type of stroke might be treated with thrombolysis with alteplase

A

Ischaemic stroke

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12
Q

What type of stroke might be treated with aspirin, anticoagulants

A

Acute ischaemia stroke
Acute venous stroke
Stroke secondary to arterial dissection

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13
Q

What kind of stroke requires a surgical decompressive hemicraniectomy

A

MCA infarction

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14
Q

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

A
  • oxygen
  • blood sugar
  • blood pressure
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15
Q

What level should blood glucose aim to be maintained at

A

4-11 mmol/L

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16
Q

CVS reasons for falls

A
  • orthostatic hypotension
  • neurally-medicated syncope (carotid sinus syndrome)
  • cardiac syncope (arrhythmias)
  • aortic stenosis
17
Q

Respiratory reasons for falls

A
  • COPD

- respiratory infections eg pneumonia

18
Q

Endocrine reasons for falls

A
  • hypoglycaemia

- diabetes

19
Q

Neurological reasons for falls

A
  • mental confusion
  • Parkinson’s
  • stroke
20
Q

MSK reasons for falls

A
  • arthritis

- poor mobility

21
Q

Genitourinary reasons for falls

A
  • UTIs

- kidney problems

22
Q

Which type of migraine is associated with increased vascular risk

A

Migraine with aura

23
Q

Symptoms of migraine

A
  • Gradual onset, throbbing unilateral pain

* Photophobia, phonophobia, nausea, vertigo, ocular pain

24
Q

Symptoms of tension headache

A

• Bilateral, constant

25
Q

Symptoms of cluster headache

A
  • Unilateral nasal discharge, eye watering, ocular pain

* Usually has circadian pattern (often at same time each night)

26
Q

Symptoms of SAH

A
  • Acute thunderclap headache, throbbing
  • Usually occipital area
  • Onset with exertion
  • Neck stiffness/pain
  • Loss of consciousness
  • Vomiting
27
Q

Risk factors for SAH

A

Age >40

Hypertension

28
Q

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

A
  • Worse on leaning forwards
  • Present all/ most of the time
  • Morning sickness
  • Blurred vision (papilledema)
29
Q

Why should LFT be included in tests for patients with headache

A

Headache may be caused by elevated liver enzymes

30
Q

Why should TFT be included in tests for patients with headache

A

Hypothyroidism can cause headaches

31
Q

Why should B12 be included in tests for patients with headache

A

B12 deficiency may cause peripheral neuropathy

32
Q

What are the cerebellar symptoms

DANISH

A
  • Dysdiadokoninesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
33
Q

How does SAH potentially cause meningitis

A

Acute entry of blood into meninges

thus SAH must be included in differential diagnosis with triad of meningitis symptoms

34
Q

Where does pain from a SAH usually radiate to

A

Neck

35
Q

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

A

Brain tumour

would also present with papilloedema and other focal neurological signs

36
Q

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

A

anything that causes raised ICP

  • subdural hematoma
  • tumour
37
Q

Is haemorrhagic or ischaemic stroke more common

A

Ischaemic (accounts for 87% of cases)

38
Q

Sinister causes of headache: VIVID

A

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

39
Q

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

A

Carotid artery dissection

Stage 3: FOCP (47 decks)

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