Neurological Flashcards
What is a TIA?
A transient ischaemic attack is a similar presentation to a stroke, but it resolves in 24hrs.
How common is stroke?
How common is TIA?
150,000 people have a stroke in UK each year
20,000 people have TIA in UK each year
Who does stroke/TIA affect?
Can affect anyone
Most cases in people aged >65
What causes a stroke/TIA?
Infarction due to ischaemia (80%) Intracerebral haemorrhage (20%)
Caused by:
- small vessel occlusion it thrombosis in situ
- cardiac emboli
- Atherothromboembolism
- CNS bleeds
- other: sudden⬇️ in BP as in sepsis watershed stroke; carotid artery dissection; vasculitis; subarachnoid haemorrhage
What are the risk factors for stroke/TIA?
Hypertension Smoking Diabetes ⬆️ Lipids Family history
Cardiac risk factors: AF; valve disease; peripheral vascular disease, previous stroke
Ethnicity - higher risk in blacks and Asians
What are the symptoms of stroke/TIA?
Weakness of arm/leg/both- ranging from total paralysis of one side of body to mere clumsiness of one hand
Weakness and twisting of one side of the face- can cause drooling
Problems with balance coordination, vision, speech, communication, or swallowing
Dizziness or unsteadiness Numbness in a part of the body Headache Confusion Loss of consciousness
What are the signs of a stroke on examination?
Bleeding = meningism, headache, coma Ischaemia = carotid bruit, AF, IHD, past TIA
Dysphasia affects large proportion of stroke patients
What are the 3 different areas mainly affected by infarcts and how do they present?
Cerebral Hemisphere infarcts (50%) = contralateral hemiplegia which is initially flaccid (floppy limb falls like a dead weight when lifted) and then becomes spastic, contralateral sensory loss, homonymous hemianopia, dysphagia.
Brainstem Infarction (25%) = a wider range of effects which include quadriplegia, disturbances of gaze and vision, locked-in syndrome, later medullary syndrome from vertebrobasilar occlusion
Lacunar infarcts (25%) = small infarcts around the basal ganglia, internal capsule, thalamus and pons, may cause pure motor, pure sensory, mixed motor and sensory signs, or ataxia, intact cognition and consciousness.
What are the possible differential diagnoses of stroke/TIA?
Head injury ⬆️/⬇️ glucose Space occupying lesion Hemiplegic migraine Todd's palsy Infections: encephalitis; abscesses, HIV Drugs: opiate overdose
What investigations are necessary to diagnose a stroke/TIA?
Pulse (AF), BP, ECG
Blood glucose (hypo/hyperglycaemia)
Urgent CT
Blood tests: FBC, ESR, sylhilis test
What are the treatments for stroke/TIA?
Stroke- Thrombolysis if onset was less than 4.5 hours ago
- NBM if unsafe swallow
- Antiplatelet agents - only when haemorrhagic stroke excluded
TIA - control CV risk factors
- start Antiplatelet drugs, clopidogrel/aspirin, consider warfarin and consider carotid endarterectomy
What is a subarachnoid haemorrhage?
Spontaneous bleeding into the subarachnoid space
Can be caused by berry aneurysm
Popular sites: junction of posterior communicating and internal carotid artery, junction of anterior communicating and anterior cerebral or bifurcation of middle cerebral artery
How common is subarachnoid haemorrhage?
9/100000/year
Who does it affect?
Typical age 35-65
What causes a subarachnoid haemorrhage?
Rupture of saccular aneurysms (80%)
Arteriovenous malformations (15%)
No cause found
What are the risk factors for subarachnoid haemorrhage?
Smoking Alcohol misuse Hypertension Bleeding disorders Micotic aneurysms
What are the symptoms of a subarachnoid haemorrhage?
Sudden thunderclap headache Vomiting Collapse Seizures Coma may follow
What are the signs of a subarachnoid haemorrhage on examination?
Neck stiffness
Kernigs sign
Retinal/subhyloid/vitreous bleeds
What are the possible differential diagnoses of subarachnoid haemorrhage?
Meningitis
Migraine
Intracerebral bleed
Cortical vein thrombosis
What investigations are necessary to diagnose subarachnoid haemorrhage?
CT within 48hrs
LP if CT is negative and >12h headache onset
- CSF in subarachnoid haemorrhage is bloody early on and then xanthochromic (yellow) after several hours due to bilirubin
What are the treatments of subarachnoid haemorrhage?
Refer to neurosurgery immediately
Maintain cerebral perfusion by keeping well hydrated
Nimodipine (ca2+ antagonist that reduces vasospasms)
Pain relief
Anticonvulsants and antiemetics
Surgery- endovascular coiling or neurosurgical clipping
What is peripheral neuropathy?
Damage to one or more of your peripheral nerves meaning impulses traveling from CNS to PNS are disrupted
Symptoms depend on which nerves affected (sensory, motor or autonomic)
How common is peripheral neuropathy?
2/100 people
Increases with age
Who does peripheral neuropathy affect?
Can affect anyone
Most commonly diabetics
What are the causes and risk factors of peripheral neuropathy?
Hyperglycaemia - in poorly controlled diabetes
Dietary deficiencies - B12 or folate
Medicines - chemotherapy and HIV therapy
Toxins - insecticides or solvents
Cancers
Alcohol excess
CKD- poorly functioning kidneys leads to salts and chemicals imbalance in bloodstream➡️PN
Injuries- broken bones and compression injuries can put direct pressure on PNs
Infections - eg Guillain-Barré syndrome
Connective tissue diseases
Inflammatory conditions
What are the symptoms of peripheral neuropathy?
Sensory neuropathy:
- tingling and numbness
- loss of sensation to pain, temperature
- loss of coordination
- burning/shooting pains
- feet and hands often affected first
Motor neuropathy:
- muscle weakness (can lead to falling, breathing & swallowing problems)
- muscle wasting
- muscle twitching (fasiculations) and cramps
- muscle paralysis
Autonomic Neuropathy:
- dizziness&fainting (lack of BP control➡️lowBP)
- reduced ability to sweat ➡️ inability to tolerate heat
- urinary incontinence - loss of bladder control
- bloating, constipation/diarrhoea
- impotence
What investigations are necessary to diagnose peripheral neuropathy?
Nerve conduction tests Electromyography- tests electrical activity of muscles Nerve biopsy Skin biopsy X-Ray/CT for underlying cause
What is the treatment for peripheral neuropathy?
Depends on underlying cause
Diabetes - controlling blood sugars
Vitamin deficiencies - consuming more vitamins
What is epilepsy?
Epilepsy is the recurrent tendency to have spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting in seizure
How common is epilepsy?
1% of population
Who does epilepsy affect?
Most commonly starts in children/over 60’s
More common in people with learning disability
Feature of >200 genetic disorders
What causes epilepsy?
Most idiopathic Cerebrovascular disease Head injury Cranial surgery CNS infections - meningitis/encephalitis Neurogenerative diseases Autoimmune diseases Brain neoplasm Genetic diseases
What are the risk factors for epilepsy?
Stress
Poor sleep
Alcohol misuse
All these lower seizure threshold
What are the symptoms of epilepsy?
Sudden falls Involuntary jerky movements of limbs whilst awake Blank spells Olfactory, gustatory, visual, auditory hallucinations Unexplained urinary incontinence simple partial seizures Epigastric fullness sensation Deja vu Premonition Extreme emotions Inability to understand or express language Loss of memory
What are the signs of epilepsy on examination?
Usually unremarkable
Check for neurological/cerebrovascular signs
What are the possible differential diagnoses of epilepsy?
Syncope Cardiac arrhythmia TIA Migraine Non- epileptic seizures Paroxysmal vertigo Acute encephalopathy Sleep disorders Hyperventilation Panic attacks
What are the 3 diagnostic questions?
Are they really seizures?
What type of seizures are they?
Are there any triggers?
