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Year 3 MedEd > Neuro3 > Flashcards

Neuro3 Flashcards

Acute Neurology

1
Q

What is the scoring for the “eyes” in the GCS?

A

4- spontaneous movement
3- eyes open to vocal
2- eyes open to pain
1- no response

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2
Q

What is the scoring for the “verbal” in the GCS?

A 
5- speaks coherently
4- confused
3- mumbles random words
2- makes random noises
1- no response
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3
Q

What is the scoring for the “motor” in the GCS?

A 
6- normal movement
5- moves towards localised pain
4- extends away from localised pain
3- abnormal flexion
2- abnormal extension
1- no response
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4
Q

What is the definition of a stroke?

A

A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24 hrs

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5
Q

What is the definition of a transient ischaemic attack?

A

A sudden onset focal neurological deficit of presumed vascular origin which resolves fully within 24 hrs

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6
Q

What are the two types of strokes?

A

Ischaemic (80%)

Haemorrhagic (20%)

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7
Q

What are the causes of ischaemic stroke?

A

Thrombosis
Embolic (eg. AF)
Hypotension

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8
Q

What are the causes of haemorrhagic stroke?

A

Hypertension
Charcot-Bouchard microaneurysm
Amyloid angiopathy
AV malformations

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9
Q

What are some non-common causes of strokes?

A

Vasculitis
Cocaine use
Trauma
Tumour

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10
Q

What are the risk factors for a stroke?

A 
Age
BP
Cardiac disease
DM
Exercise
FHx
Hyperlipidaemia
Smoking
(ABCD...)
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11
Q

What is the epidemiology of a stroke?

A

3rd commonest cause of death after heart attack and cancer
M>F
Age >70
Hx of TIA

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12
Q

What are the clinical features of a cerebrovascular accident (CVA)?

A 
Sudden onset
Weakness
Sensory/visual/speech impairment
Impaired co-ordination
Head/neck pain
Memory often intact
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13
Q

What are the UMN lesion signs?

A 
Spasticity/clonus
Weak arm extensors, leg flexors
Hyper-reflexia
Upgoing plantars
Pronator drift
No fasciculations, muscle wasting
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14
Q

What are the LMN lesion signs?

A 
Hypotonia
General weakness
Hyporeflexia
Normal plantar response
Fasciculations, muscle wasting
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15
Q

What are the signs of an anterior cerebral artery infarct?

A 
Contralateral hemiparesis
Lower limb > upper limb
Abulia (absence of willpower to act decisively)
Confusion
Gait apraxia
Frontal release sign
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16
Q

What are the signs of a middle cerebral artery infarct?

A

Contralateral hemiparesis
Upper limb > lower limb
Contralateral hemisensory loss
Apraxia
Hemineglect
Receptive/expressive dysphagia (if left sided)
Quadrantanopia (if Meyer’s/Baum’s loop affected)

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17
Q

What is the presentation if Meyer’s loop is affected?

A

Contralateral homonymous superior quadrantanopia

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18
Q

What is the presentation if Baum’s loop is affected?

A

Contralateral homonymous inferior quadrantanopia

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19
Q

What are the signs of a posterior cerebral artery infarct?

A

Macular sparing homonymous hemianopia

Visual agnosia

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20
Q

What are the signs of a basilar artery infarct?

A

Cranial nerve pathology (III-XII)
Visual impairments
Cerebellar pathology
Impaired consciousness

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21
Q

What are the signs of a superior cerebellar artery infarct?

A

Dizziness

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22
Q

What are the signs of an anterior inferior cerebellar artery infarct?

A

Dizziness

Deaf

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23
Q

What are the signs of a posterior inferior cerebellar artery infarct?

A

Dizziness
Dysphagic
Dysphonic
(Lateral medullary syndome)

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24
Q

What are the signs of a lacunar infarct?

A

Internal capsule- pure motor deficit
Pontine- dizziness/vertigo, bilateral affects
Thalamus- affects consciousness
Basal ganglia- dyskinaesia

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25
Q

What are the signs of an intracerebral haemorrhage?

A

Headache and meningism
Focal neurological signs
Raised ICP
Seizures

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26
Q

What are the characteristics of a TIA?

A

Usually lasts 10-15 minutes
By definition can last up to 24hr
Amaurosis fugax
Global events like syncope/dizziness is atypical

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27
Q

What are the investigations for a stroke?

A 
CT head
Bloods
ECG
CTA
Carotid Doppler
MRI
MRA (gold standard, way too expensive)
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28
Q

What is the hyperacute management for a Pt with an ischaemic stroke presenting <4.5 hrs?

A

ABCDE
-maintain airway
-maintain BP (to prevent brain hypoperfusion)
-maintain glucose
CT Head
IV alteplase (0.9mg/kg) thrombolysis (if no contraindication)

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29
Q

What are the contraindications for thrombolysis?

A 
Haemorrhagic stroke
Recent trauma/surgery
Varices/portal hypertension
GI bleeds
Known clotting disorder
BP >180/105
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30
Q

What is the acute management for a Pt with an ischaemic stroke?

A 
Conservative:
-SALT assessment
-GCS monitoring
Medical:
-300mg aspirin daily
-heparin (VTE prophylaxis)
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31
Q

What is the primary prevention for a stroke?

A

Control risk factors

  • stop smoking
  • lower hypertension
  • control diabetes/hyperlipidaemia
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32
Q

What is the secondary prevention for a stroke?

A

75mg aspirin for 2 weeks
Switch to clopidogrel/dipyramidole
Give lifelong anticoagulation (aspirin)

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33
Q

What is the surgical prevention for a stroke?

A

Carotid endarterectomy

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34
Q

When would you perform a carotid endarterectomy?

A

If the carotid stenosis is >70% on Doppler scanning

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35
Q

What is the general management of haemorrhagic strokes?

A 
Refer to ICU/stroke unit
Monitor glucose/GCS etc
Antipyretic- paracetamol
BP monitor- labetalol/nicardipine
Coagulopathy- reverse warfarin/heparin/dabigatran
DVT prophylaxis- heparin/enoxaparin
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36
Q

How is warfarin reversed?

A

Phytomenadione
Fresh frozen plasma/prothrombin complex concentrate
Platelet transfusion

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37
Q

How is heparin reversed?

A

Protamine sulphate

Platelet transfusion

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38
Q

How is dabigatran reversed?

A

Idarucizumab

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39
Q

How are thrombolytic agents reversed?

A

Fresh frozen plasma/prothrombin complex concentrate
Crypoprecipitate
Platelet transfusion

40
Q

What are the complications of CVAs?

A 
Aspiration
Cerebral odemea
Immobility
Infection
DVT
Seizures
Cardiovascular events
Death
41
Q

What is the prognosis of a CVA?

A

10% mortality in 1 month
10% recurrence in 1 year
Haemorrhagic has a worse prognosis

42
Q

What is used to calculate the risk of a TIA progressing into a stroke?

A

ABCD2 score

43
Q

What should you do if the ABCD2 score is >=4?

A

Refer to a stroke specialist

44
Q

What does an ABCD2 score >=6 indicate?

A
  1. 1% risk of stroke in 2 days

35. 5% risk of stroke in 1 week

45
Q

What is a seizure?

A

Abnormal excessive synchronised discharge of cerebral neurons

46
Q

What is epilepsy?

A

Tendency for recurrent unprovoked seizures

>2 seizures to be classed as epilepsy

47
Q

What is the aetiology of epilepsy?

A

70% idiopathic

30% secondary to brain injury, tumour, stroke, infection, head injury, autoimmune

48
Q

What are the risk factors for epilepsy?

A

FHx
Childhood infections
Neurodevelopmental disorders eg. autism
Metabolic disease eg. storage disorders, PKU

49
Q

What is the classification of epilepsy?

A

Focal

Generalised

50
Q

What is the difference between a partial and complex seizure?

A

Partial- no LoC

Complex- LoC

51
Q

What are the types of generalised seizures?

A 
Tonic-clonic
Absence
Myoclonic
Tonic
Atonic
52
Q

What is the description of a tonic-clonic seizure?

A

Prodrome- auras
Tonic- stiffening of muscles
Clonic- contractions
Post-ictal- drowsy state

53
Q

What is the description of a absence seizure?

A

Loss of consiousness
Cessation of activity
Brief upward rolling of eyes

54
Q

What is the description of a myoclonic seizure?

A

Jerking of specific muscle groups

55
Q

What is the description of a tonic seizure?

A

Bear hugging posture

56
Q

What is the description of a atonic seizure?

A

Complete loss of muscle tone

57
Q

What is the presentation of a temporal focal seizure?

A

Automatisms
Hallucinations
Dysphagia

58
Q

What is the presentation of a frontal focal seizure?

A

Jacksonian march
Todd’s palsy
Leg motor disturbance

59
Q

What is the presentation of a parietal focal seizure?

A

Sensory deficits

60
Q

What is the presentation of a occipital focal seizure?

A

Visual deficits

61
Q

What are the investigations for epilepsy?

A 
Bloods
-glucose (severe hyper/hypoglycaemia)
-WCC (CNS infx)
EEG
CT/MRI head
62
Q

What is the management for a focal seizure?

A

Carabamazepine/lamotrigine

63
Q

What is the management for a generalised seizure?

A

Sodium valproate

64
Q

What is status epilepticus?

A

A continous seizure lasting >30 minutes

65
Q

What is the management for status epilepticus?

A 
Secure airway
High flow O2
Assess cardiac and resp function
Check blood glucose
Secure IV access in both arms

IV lorazepam
IV phenytoin/phenobarbital
General anaesthetic eg. midazolam
Seek expert advice

66
Q

What are the complications of epilepsy?

A

SUDEP (sudden death in epilepsy)
Status epilepticus
Fractures
Drug SEs

67
Q

What is a dissociative seizure?

A

Seizure with no identifiable organic cause
Often last much longer than epilepsy
Variable in presentation
Patients most likely able to recall event
Clinical diagnosis

68
Q

What is hydrocephalus?

A

Enlargement of the cerebral ventricular system

69
Q

What are the types of hydrocephalus?

A

Communicating/non-obstructive
Non-communicating/obstructive
Hydrocephalus ex vacuo

70
Q

What are the causes of communicating hydrocephalus?

A

SAH
Meningitis
Normal pressure hydrocephalus

71
Q

What are the causes of obstructive hydrocephalus?

A

3/4th ventricle lesion
Cerebral aqueduct stenosis
Posterior cranial fossa tumour

72
Q

What is hydrocephalus ex vacuo?

A

Compensatory enlargement of the ventricles due to parenchymal atrophy

73
Q

What are the clinical features of hydrocephalus?

A 
Acute drop in consciousness
Diplopia
Palsy
Behavioural changes
Seizure
Raised ICP
74
Q

What are the clinical features of hydrocephalus in neonates?

A

Increased head circumference

Sunset sign

75
Q

What is seen in normal pressure hydrocephalus?

A

Hakim’s triad

  • wet (urinary incontinence)
  • wacky (dementia)
  • wobbly (gait disturbance)
76
Q

What are the investigations for hydrocepalus?

A

CT scan
CSF
LP (therapeutic in NPH)

77
Q

What is the management for hydrocephalus?

A

Interventricular shunts

78
Q

What is spinal cord compression?

A

Injury to the spinal cord with neurological symptoms dependant on the site and extent of injury

79
Q

What are the common causes of spinal cord compression?

A 
Trauma
Metastases
Inflammatory disease
Spinal stenosis -> cauda equina
Spinal abscess
Pott's disease
80
Q

What are the risk factors of spinal cord compression?

A

Bone disease
Vertebral disc disease
Cancer

81
Q

What are the clinical features of spinal cord compression?

A

Back pain
Spastic paresis (bilateral, lower limbs)
Sensory loss
Incontinence

82
Q

What are the clinical features of cauda equina?

A 
Flaccid paresis
Loss of bowel/bladder control
Saddle paraesthesia
Radicular back/leg pain
Areflexia
83
Q

What are the clinical features of Brown-Sequard syndrome?

A

Ipsilateral proprioception loss
Ipsilateral light sensation loss
Ipsilateral paralysis
Contralateral pain loss

84
Q

What are the investigations for spinal cord compression?

A

Bloods
-FBC, ESR, B12, syphilis serology, U+E, LFT, PSA
Radiology
MRI- definitive

85
Q

What is Guillain-Barre syndrome?

A

Acute inflammatory demyelinating polyneuropathy

86
Q

What is the aetiology of GBS?

A

Unclear

Link with campylobacter jejuni and lymphoma

87
Q

What are the clinical features of GBS?

A

Progressive ascending paraesthesia and paresis
Can lead to respiratory distress
Can involve cranial nerves

88
Q

What is the Miller-Fisher variant?

A

GBS with the following triad:
Ophthalmoplegia
Ataxia
Areflexia

89
Q

What are the investigations for GBS?

A

Lumbar puncture
-high protein, normal cell count and glucose
Nerve conduction studies
-reduced conduction velocity
Bloods
-Anti-ganglioside antibodies in MF variant + 25% of GBS
Spirometry
-fixed vital capacity: ventilatory weakness
ECG
-may develop arrhythymia

90
Q

A patient is rushed into hospital having collapsed on the street. After assessing airways, breathing and circulation you now assess their disability. They have not opened their eyes since arriving and only mumble incoherently when told to open their eyes. They do not respond to vocal commands to move however when you squeeze the patient’s trapezius muscle, they move to the appropriate shoulder to slap your hand away and briefly open their eyes.
What is their GCS score?

A. 2
B. 5
C. 8
D. 9
E. 13
A

C. 8

E- 3
V- 2
M- 5

91
Q

An 85-year-old woman presents to A+E struggling to talk. Her husband brought her in 30 minutes ago after she was unsteady on her feet and fell over. You assess her consciousness and find she has a GCS of 15. On examination you find she has right-sided hemiparesis with positive Babinski sign. You assess her blood pressure and find it to be 170/100.
What is the most appropriate next step?

A. ACEi IV
B. Alteplase IV
C. Urgent CT head scan
D. Aspirin 300mg oral
E. Urgent carotid doppler
A

C. Urgent CT head scan

92
Q

A 65-year-old man presents with sudden onset left sided weakness. He is obese, type II diabetic and has high cholesterol. On examination you find a left-sided hemiparesis with his arm more affected than the leg. There is also an equal hemisensory loss. He is unable to see anything at the bottom of his vision on his left-hand side.
Which vascular territory has likely been affected?

A. Right middle cerebral artery
B. Right anterior cerebral artery
C. Left middle cerebral artery
D. Right carotid artery
E. Right posterior cerebral artery
A

A. Right middle cerebral artery

93
Q

A 25 year old woman has an episode of altered consciousness lasting a few minutes. She has no memory of the event but just beforehand she developed a sense of déjà vu and had a rising feeling in her stomach.
What is the most likely cause?

A. Absence seizure
B. Vasovagal episode
C. Complex partial seizure
D. Simple partial seizure
E. Cardiac arrhythmia
A

A. Absence seizure

94
Q

A 15 year old girl who is a known epileptic has arrived at hospital having a seizure. The seizure started over 30 minutes ago while she was having dinner and has not regained consciousness since. Her mother says she has had 3 seizures over the past 3 months before being diagnosed with and treated for epilepsy, but none were as bad as this. Life support examination reveals that the airways are open, patient is breathing and pulse is 110 bpm. Her GCS is 8/15. You set up two IV lines ready for the patient to be managed.
What is the most appropriate next step?

A. Perform an EEG
B. Check glucose
C. Perform CT scan
D. Give IV lorazepam
E. Give IV thiopentone
A

D. Give IV lorazepam

95
Q

A 26-year-old man was admitted for severe food poisoning and put on antibiotics, a week later in his hospital bed he’s started to notice pins and needles across his lower limb, and he’s been feeling weak in that region also. What’s the most likely diagnosis?

A. Guillain Barre Syndrome
B. Meningism
C. Antibiotic allergy
D. B-12 deficiency
E. Stokes-Adams attack
A

A: Guillain Barre Syndrome

Year 3 MedEd (29 decks)

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