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Neurology Flashcards

1
Q

Give me an explanation of brain death

A

Irreversible damage to the brain stem leading to loss of the ability to ever regain consciousness or breath for themselves

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2
Q

What are the NiCE Guillermo for BP control within the first 24 hours of acute ischaemic stroke

A

Do not lower bp

Unless preggo, ThrombolySis, dissection, cardiac failure

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3
Q

What are the nice guidelines for bP control in thrombolysis

A

BP

Systolic <180
Diastolic < 110

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4
Q

Eligibility time criteria for thrombectomy and thrombolysis

A

Thrombectomy - 6 hour

Thrombolysis- 4. 5 hours

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5
Q

Evidence for craniotomy in malignant MCA infarct

A

Destiny trial: patients > 60 had high chance of survival but with severe functional debilitation

Hamlet: SH with 48 hours associated with reduction in mortality and increased function al independence

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6
Q

What are the risk factors for vasospasm post SAH

A 
Smoking
Htn 
Low GCS
High blood volume
Cocaine
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7
Q

What strategies are used for vasospasm post SAH

A

Nimodipine
Statins
Increased Map

Avoid - hypotension hypoxia hypothermia hypovolaemia

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8
Q

What colour and T is fluid on MRI

A

White - T2

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9
Q

How is an mri generated

A

Powerful magnet is applied to align protons in tissue water
Protons are displaced from their alignment by radio frequency pulse and when this finishes the protons realign. This realignment releases radio frequency signals which are detected, processed and turned into an image

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10
Q

What are the contraindications to MRI

A 
Cochlear implants
Pacemaker
Some metallic heart valves
Metallic foreign bodies in eye 
Ferromagnetic clips
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11
Q

What monitoring considerations are needed for mri

A 
Mri compatible equipment 
Fibre optic or carbon fibre cable
Visual alarms used as noisy 
Braided short mri compatible ecg leads in a small triangle 
et- co2 delay due to length of tubing
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12
Q

What is the difference between a lundgberg A and B wave

A

Lundgberg A waves are sustained waves due to reflex cerebral vasodilation in response to reduce MAP and usually reflect seizure activity.
B waves occurs in cycles and are present in health

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13
Q

Define MND

A

A group of progressive neurological diseases that destroy motor neurones. This includes Amyotrophic lateral sclerosis, progressive bulbar palsy, spinal muscular atrophy etc and are inherited or sporadic

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14
Q

Management of mND

A

Riluzole- reduce the release of gluatamate and live 10% longer

Gene therapy for SMA

Botox and bacflofen

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15
Q

What pathologies cause intensive care associated weakness

A

Critical Illness polyneuropathy
Critical illness myopathy
Critical illness neuromyopathy

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16
Q

What medications are associated with iCU related weakness

A

Corticosteroids
Paralysis agents
High dose vasopressors
Aminoglycosides

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17
Q

What features of weakness are used to diagnose iCU related illness

A

Onset after critical illness
Generalised symmetrical flaccid weakness sparing cranial
Dependant on mechanical ventilation with failure to mobilise
Critical Illness not Related to the weakness

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18
Q

What would you see on electromyography with cip and cim

A

Cip: spontaneous fibrillation potentials with long duration and high amplitude

Cim: spont fibrillation potentials with short and low amplitude

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19
Q

What would you see on ncs with cip and cim

A

Cip: reduced motor and reduced sensory amplitude action potentials with normal conduction

Cim: reduced motor with normal sensory action potential amplitude action potentials with normal conduction

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20
Q

WhAt drug should be avoided with iCU related weakness

A

Suxamethonium

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21
Q

Methods of measuring ICP

A

Intra ventricular catheter
Subdural pressure transducer
Intraparenchymal monitor

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22
Q

What is a raised ICP

A

22 mmhg

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23
Q

What determines A and B on an ICP wave form

A

A arterial pressure

B intracranial compliance

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24
Q

What would be an explanation for an ICP waveform having reduced amplitude but unchanged morphology

A

Reduced CSF

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25
What causes a sinosidal slow waveform on icp
Respiration
26
What causes a lundgberg a wave on an ICP trace
Increase in cerebral blood flow in response to reduced cerebral perfusion
27
How do lundberg a waves on an icp waveform differ from lundberg b
A > 50 mmhg in amplitude B 20-50 A 5-20 mins B 1 min B is unstable icp from vasospasm or REM
28
Scoring systems for SAH
Fischer scale | World federation of neurosurgeons
29
Benefit of coiling over clipping for SAH
Reduction in death Lower rate of epilepsy Increased bleeding in 1st yr
30
Target systolic BP and CPP after a TRaumatic brain injury
SBP >100 50-70 years old >110 if <50 or > 70 CPP of 60-70
31
What are the 4 non radiological early predictors of poor prognosis in TBI
GCS Age Absent pupillary reflexes Hypotension
32
Preconditions for brain stem testing
deeply unconscious, mechanically ventilated and not making respiratory effort Irreversible brain damage of known aetiology Not due to reversible influences - drugs, hypothermia etc
33
State the afferent and efferent cranial nerve for the pupillary response
2 afferent | 3 efferent
34
State the afferent and efferent cranial nerve for the corneal reflex
5 | 7
35
State the afferent and efferent cranial nerve for the occulovestivular reflex
8 | 3 4 6
36
State the afferent and efferent cranial nerve for the response to painful stimuli
5 | 7
37
State the afferent and efferent cranial nerve for the gag reflex
9 | 10
38
State the afferent and efferent cranial nerve for the cough reflex
10 | 10
39
How is the apnoea test performed in brain stem testing
The patient is pre oxygenated and minute ventilation is reduced to give Pco2 6.0 - 7.4 Disconnect vent and attach to waters circuit Observe for >5 mins for resp effort and at the end, abg to look for a 0.5 rise in pco2
40
What is the Bamford/ Oxford classification
Posterior circulation syndrome - 1 of loc/ homo hemi/ cerebella Partial anterior circ syndrome - 2 of weak/ homo hemi/ high cerebral Total anterior circ syndrome - weak/ homo hemi/ high cerebral
41
Treatment of stroke | And Bp
200mg aspirin 2/52 Then statin at 2/52 Treat BP > 200/120
42
When thrombolyse stroke
<4.5 hours | Treat HTN >185/110
43
When vasospasm after a sah
4-14 days
44
Diagnosis of vasospasm on TCD
>120 or ratio >3 MCA to Ica
45
When does hydrocephalus occur after SAH
<3 days
46
Signs of a venous sinus thrombosis
3rd and 6th nerve palsy
47
Who benefits from decompression after a stroke
``` <48hrs of symptoms < 60 Large MCA Low GCS >15 nihss ```
48
What is the Asia classification
``` A Complete B Incomplete - no motor C Incomplete - MRC <3 D Incomplete - MRC > 3 E Normal ```
49
3 ligaments of the spine from skin to bone
Anterior longitudinal Posterior longitudinal Ligamentum flavum
50
What dose the posterior / dorsal column do
Light tough vibration and proprioception
51
What does the corticospinal column do
Motor control
52
What does the spinothalamic column do
Pain and temperature
53
Transection of the spine at which level gives autonomic dysfunction And what symptoms occur
T6 Uninhibited sympathetic response Vasoconstriction below Vasodilation above Brady
54
Transaction at which spinal level means you need ventilation
C3- diaphragm C3-5 gives partial phrenic 80% need ventilation T8 does cough from intercostal
55
3 types of herniation
Subfalcine (under falx cerebri) Transtentorial (through tentorial cerebelli) Tonsilar (through foramum magnum) I
56
Stage 1 therapy for raised icp
``` Head elevation 15-30 Optimise ventilation and lower pco2 Sedation and paralysis Analgesia Cpp 50-70 Euvolaemia ```
57
Stage 2 therapy for raised icp
``` Inotropes Manitol Hypertonic na Loop diuretics Hypothermia Increase sedation CSF drainage CPP >60 ```
58
What I a raised icp
> 22
59
Stage 3 therapy for raised icp
Barbiturates | Decompression.
60
SAH map and BP targets
100- 160 systolic BP | Map <110
61
How long do you give nimodipine for
60mg 4 hourly 21 days
62
Complications and time frames of SAH
Obstructive Hydrocephalus - first 3 days Re bleeding - 72 hours Seizures - suggest re-bleed Vasospasm - 4-10 days
63
What should the pco2 and ph be prior to Brains stem testing
> 6 Ph <7.4
64
Define GBS
Acute inflammatory demyelinating polyneuropathy | Autoimmune response to preceding illness (campylobacter, hsv, cmv)
65
Worrying spirometry in GBS
<15mls \kg
66
Features GBS
Areflexia Progressive distal weakness Autonomic dysfunction
67
BP treatment in inter cerebral haemorrhage
< 6 hours aim 130-150 | > 6 hours treat if >200
68
What is the antibody test in GBS
Anti GM1 antibodies
69
Normal ICP pressure
5-15
70
Indications for icp monitoring
Tbi Hydrocephalus High risk hydrocephalus (SAH/ tumour) Idiopathic intracranial HTN
71
Types of icp monitor
Intraventricular catheter Subdural pressure transducer Intraparenchymal monitor
72
Icp waves
P1 - arterial pulsation P2 - intracranial compliance P3- aortic closure
73
Define myasthenia Gravis
Autoimmune disease with antibodies against the post synaptic ach receptors on the NM junction

Icm (16 decks)

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