Neuro week: headaches, strokes & falls Flashcards
Risk factors for stroke
- diabetes
- artherosclerosis, other vascular disease
- age
- smoking, alcohol, recreational drugs
- hypertension
- high cholesterol
- IHD
- A fib
Differential diagnoses of stroke
- migraine
- hemiparesis after seizure
- cerebral abscess
- tumour
- subdural haematoma
- MS
- head injury
- hypertensive encephalopathy
Differential diagnoses of TIA
- hypoglycaemia
- migraine
- focal epilepsy
- MS
- peripheral nerve lesion
- psychological
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
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
What is Todd’s paresis
Paresis following a focal seizure
Effects of TACS
All 3
- unilateral weakness/ sensory loss of face, arm leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
Effects of PACS
2 out of 3
- unilateral weakness/ sensory loss of face, arm leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
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
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
What type of stroke might be treated with thrombolysis with alteplase
Ischaemic stroke
What type of stroke might be treated with aspirin, anticoagulants
Acute ischaemia stroke
Acute venous stroke
Stroke secondary to arterial dissection
What kind of stroke requires a surgical decompressive hemicraniectomy
MCA infarction
What other factors need to be controlled in a person who has had a stroke
- oxygen
- blood sugar
- blood pressure
What level should blood glucose aim to be maintained at
4-11 mmol/L
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
