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Pathologies ADULTS > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the presentation for intracranial bleeds?

A

Sudden onset of headache

Can also have;
Seizures 
Weakness
vomiting 
reduced consciousness
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2
Q

What are the numbers in the GCS scoring system?

A

Eyes

Spontaneous = 4
Speech = 3
Pain = 2
None = 1

Verbal response

Orientated = 5
Confused conversation = 4
Inappropriate words = 3
Incomprehensible sounds = 2
None = 1

Motor response

Obeys commands = 6
Localises pain = 5
Normal flexion = 4
Abnormal flexion = 3
Extends = 2
None = 1
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3
Q

What causes subdural haemorrhage and where is it located?

A

rupture of the bridging veins in the outermost meningeal layer between the dura mater and arachnoid matter

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4
Q

What does a subdural haemorrhage look on CT?

A

Crescent shape and not limited by cranial sutures.

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5
Q

What causes Extradural haemorrhage and where is it usually found?

A

Caused by the rupture of the middle meningeal artery in the temporo-parietal region, also often associated with temporal bone fractures.

Occurs between the skull and dura matter

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6
Q

What does extradural haemorrhage look like on CT?

A

Bi-convex shape and limited by cranial sutures

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7
Q

Typical history of subdural haemorrhage

A

elderly or alcoholic patients as they have more atrophy in their brains making vessels more likely to rupture.

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8
Q

Typical history for extradural haemorrhage

A

young patient with traumatic head injury that has an ongoing headache.

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9
Q

What is an intracerebral haemorrhage?

A

bleeding into brain tissues

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10
Q

What is subarachnoid haemorrhage?

A

bleeding in to the subarachnoid space usually as a result of ruptured cerebral aneurysm.

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11
Q

typical history of subarachnoid haemorrhage

A

sudden onset occipital headache that occurs during strenuous activity such as weight lifting or sex.

Also particularly associated with cocaine and sickle cell anaemia

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12
Q

What are the symptoms for sub arachnoid haemorrhage?

A

Thunderclap headache

  • neck stiffness
  • photophobia
  • vision changes
  • neurological symptoms such as speech changes, weakness, seizures and loss of consciousness
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13
Q

What investigations will be done for subarachnoid haemorrhage? and what will be positive results

A

CT - blood will cause hyperattenuation in the subarachnoid space

Lumbar puncture - CSF contains raised red cell count and Xanthochromia (yellow colour of CSF due to bilirubin)

Angiography also used to locate the source of bleed

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14
Q

Management of subarachnoid haemorrhage

A
  • Surgical intervention: using coil to seal off the artery OR clipping which puts a clip on the aneurysm to seal it
  • Nimodipine is a calcium channel blocker that is used to prevent vasospasm.
  • Lumbar puncture or insertion of shut to treat hydrocephalus
  • Anti-epileptic medication to treat seizures
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15
Q

What is hydrocephalus?

A

build up CSF in the brain or spinal cord as a result of over-production of CSF or a problem with draining or absorbing CSF

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16
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

Fever, photophobia or neck stiffness

A

Meningitis or encephalitis

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17
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

New neurological symptoms

A

haemorrhage, malignancy or stroke

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18
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

Dizziness

A

Stroke

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19
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

Visual disturbances

A

temporal arteritis or glaucoma

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20
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

headache worse on coughing or straining

A

raised intracranial pressure

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21
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

headaches based on postural, worse of standing, lying or bending over

A

raised intracranial pressure

22
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

Vomitting

A

raised intracranial pressure or carbon monoxide poisoning

23
Q

HEADACHES what could some of these symptoms suggest (alongside headaches):

Pregnancy

A

Pre-eclampsia

24
Q

What finding on a fundoscopy examination can indicate raised intracranial pressure (ICP)? and what pathologies does raised ICP indicate?

A

Papilloedema is seen in examination

Raised ICP can be due to brain tumour, benign intracranial hypertension or an intracranial bleed.

25
Q

What is tension headache? what causes it and what is it associated with?

A

Due to muscle ache in the frontalis, temporalis and occipitalis muscles.

Associated with stress, depression, alcohol, skipping meals and dehydration.

26
Q

what cause the headache in sinusitis? and where is the location of the pain?

A

headache is associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses.

Produce facial pain behind the nose, forehead and eyes. There is often tenderness over the affected sinus which helps to establish the diagnosis.

27
Q

is majority of sinusitis viral or bacterial?

A

Viral

28
Q

Treatment for sinusitis

A

Nasal irrigation with saline, prolonged symptoms can be treated with steroid nasal spray and antibiotics is occasionally required.

29
Q

What can cause hormonal headache? What is the treatment solution?

A

tension like headaches caused by Low oestrogen levels.

seen around menstrual period, menopause and pregnancy (worse in first few weeks and improves in last 6 months).

Oral contraceptive pills can improve this.

30
Q

What is cervical spondylosis? what symptoms does it present?

A

Condition caused by degenerative changes in the cervical spine.

Causes neck pain, that is usually made worse by movement and often presents with headache.

NOTE important to exclude other causes of neck pain such as inflammation, malignancy and infection. IMPORTANT to exclude spinal cord or nerve root lesions.

31
Q

What does trigeminal neuralgia present as and what triggers it? What is the first line treatment for it?

A

Intense facial pain that comes on spontaneously and last between seconds to hours.

Triggers include cold weather, spicy food, caffeine and citrus fruits. Also seen in MS patients.

First line treatment is carbamazepine.

32
Q

What are the different types of migraine?

A
  • Migraine with aura
  • Migraine without aura
  • Silent migraine (migraine with aura but without a headache)
  • Hemiplegic migraine (can mimic stroke so it is exclude stroke fast)
33
Q

How long does the headaches from migraine last and what are some of the typical features?

A

Headaches last between 4 and 72 hours.

Typical features include:

  • Moderate to severe intensity
  • Pounding or throbbing in nature
  • Usually unilateral but can be bilateral
  • Discomfort with lights (photophobia)
  • Discomfort with loud noises (Phonophobia)
  • With or without aura
  • Nausea and vomiting
34
Q

What does it mean by aura? and what are the different types of aura?

A

Aura describes visual changes.

Different types of aura:

  • Sparks in vision
  • blurring vision
  • Lines across vision
  • Loss of different visual fields
35
Q

What are the symptoms of hemiplegic migraine?

A
  • Typical migraine symptoms
  • Sudden or gradual onset
  • Hemiplegia (unilateral weakness of limbs)
  • Ataxia
  • Changes in consciousness
36
Q

What are the tiggers for migraine?

A 
Stress
Bright lights
Strong smells
Certain foods (e.g. chocolate, cheese and caffeine)
Dehydration
Menstruation
Abnormal sleep patterns
Trauma
37
Q

What are the 5 stages of migraine?

A

1) Premonitory or prodromal stage (can begin 3 days before the headache)
2) Aura (lasting up to 60 minutes)
3) Headache stage (lasts 4-72 hours)
4) Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
5) Postdromal or recovery phase

38
Q

What tool is used for recognition of stroke in emergency room?

A
  • ROSIER (it is based on clinical features and duration - score above 0 means likely stroke)
39
Q

What is the initial steps in treating patients who has stroke?

A
  • Admit patients to a specialist stroke centre
  • Exclude hypoglycaemia
  • Immediate CT brain to exclude primary intracerebral haemorrhage
  • Aspirin 300mg stat (after the CT) and continued for 2 weeks
40
Q

What is TIA?

A

sypmtoms of stroke that resolve within 24 hours.

Transient neurological dysfunction secondary to ischaemia without infarction

41
Q

What is a crescendo TIA?

A

it is when there are two or more TIA within a week - carries high risk of developing stroke

42
Q

What procedure can be done after intracranial haemorrhage is excluded with stroke?

A
  • Thrombolysis with alteplase.
    Alteplase is a tissue plasminogen activator that rapidly breaks down clots and can reserve effects of stroke if given in time.
  • Thrombectomy (mechanically remove clot): not used after 24 hours since the onset of symptoms .
43
Q

What is the window frame to give thrombolysis for stroke?

A

4.5 hours from the onset of the stroke.

NOTE patients need to be monitored after for haemorrhage

44
Q

Should BP be lowered during stroke?

A

No because it would risk reducing the perfusion to the brain

45
Q

Management for TIA

A
  • aspirin 300mg daily and start secondary prevention for CVD.

refer and seen within 24 hours by stroke specialist

46
Q

What specialist imagining can be done for stroke?

A
  • CT
  • Diffusion-weighted MRI
  • Carotid ultrasound can used to assess for carotid stenosis. (if there is stenosis- endarterectomy to remove plaques or carotid stent to widen lumen is considered)
47
Q

What are the secondary prevention of stroke?

A
  • Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily)
  • Atorvastatin 80mg should be started but not immediately
  • Carotid endarterectomy or stenting in patients with carotid artery disease
  • Treat modifiable risk factors such as hypertension and diabetes
48
Q

What are the acute management for migraine?

A
  • go to dark quiet room and sleep
  • paracetamol
  • Triptans (e.g. sumatriptan 50mg as the migraine starts)
  • NSAIDs (e.g ibuprofen or naproxen)
  • Antiemetics if vomiting occurs (e.g. metoclopramide)
49
Q

What are triptans? what do they act on?

A

they are 5HT receptors agonists (serotonin receptor agonists).

Act on:
- Smooth muscle in arteries to cause vasoconstriction

  • Peripheral pain receptors to inhibit activation of pain receptors
  • Reduce neuronal activity in the central nervous system
50
Q

What medications/ treatment can be used long term to reduce the frequency and severity of migraine attacks?

A
  • Propranolol
  • Topiramate (this is teratogenic and can cause a cleft lip/palate so patients should not get pregnant)
  • Amitriptyline

ALSO

  • Acupuncture
  • Vitamin B2 (riboflavin) supplementation
  • if migraine triggered around menstruation, prophylaxis with NSAIDs (e.g. mefanamic acid) or triptans (frovatriptan or zolmitriptan) can be helpful.

Pathologies ADULTS (9 decks)

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