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Phase 3a > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a stroke

A

Infarction of bleeding in the brain manifesting with sudden onsent focal CNS signs

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2
Q

What are the risk factors for a stroke?

A

CVD-: Angina, MI, PVD
TIA, Stroke
AD, carotid artery disease
HTN, diabetes, smoking , vasculitis , thrombophilia, OCP

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3
Q

What is the aetiology of a stroke?

A

Cerberal microangiopathic and thrombosis
Cardiac emboli - AF, endocarditis, atherosclerosis
Shock - sudden BP - vasculitis
Carotid artery dysplasia/ dissection
Venous sinus thrombosis
Antiphosphilipid
Aneurysm rupture
Anticoagulation
Thrombolysis
SAH
MI
Respiratory arrest

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4
Q

What’s the pathophysiology of an ischaemic

A

Ischaemic tissue leads to inflammatory responses and oedema and lack of perfusion to the brain

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5
Q

What is the pathophysiology of the haemorrhagic stroke?

A

SAH - blood causing vasospasm - increasing ICP - vasoconstriction - lack og oxygen
Then ICP is greater than MAP so decrease of cerebral perfusion pressure - brain Ischaemia - lack of cerebral perfusion pressure - brain ishcaemia - increase sympathetic s - increase blood pressure , decrease HR - brainstem dysfunction

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6
Q

What are the signs and symptoms of a stroke?

A

Sudden limb weakness
Facial Weakness
Wernickes dysphagia - cant understand or communicate
Broca’s aphasia - cant formulate words
Visual/ sensory loss
Facial drooping
Arm weakness
Speech difficulties

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7
Q

What are the signs one symptoms of a lacunar stroke

A

Ataxic hemiparesis
Pure motor, sensory
Sensorimotor
Dysarthia
Cognition and sensory intact

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8
Q

How do you manage a stroke

A

Exclude hypoglycaemia
Immediate CT to exclude haemorrhage - negative do diffusion weighted MRI
Aspirin 300mg for 2 weeks
Thrombolysis with alteplase IV within 4.5 hours
Mechanical thrombectomy up to 48 hours
Long term clopidogrel/ warfarin
IV manitol for brain oedema

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9
Q

What is an ACA stroke presentation

A

Contralateral weakness and sensory loss of the lower limb
Incontinence
Drowsiness
Thinking and personality
Truncated ataxia

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10
Q

What is MCA stroke presentation

A

Contralateral motor and sensory weakness
Hemiparesis
Speech impairment
Facial droop

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11
Q

What are the features of a PCA stroke

A

Perception changes
Homonymous hemianopia

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12
Q

What is a vertebrobasilar artery stroke features?

A

Coordination and balance affected

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13
Q

What is lateral medullary syndrome

A

Sudden onset vomiting and vertigo
Ipsilateral horners syndrome - reduced sweating, facial numbness , dysarthria , limb ataxia and dysphagia

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14
Q

What are symptoms of a brainstem infarction

A

Quadraiplegia
Facial paralysis
Numbness
Gaze
Vision
Coma
Locked in syndrome
Altered consciousness
Vertigo
Vomiting

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15
Q

What is a SAH

A

Bleeding between the arachnoid and pia mater into the SA space where the CSF is located

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16
Q

How does a SAH present?

A

Sudden onset occipital headache - thunderclap
Collapse, seizures, vomiting, coma
Neck stiffness
Headache
Fever
Photophobia
Kernings
Focal neurological signs

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17
Q

What causes a SAH?

A

Berry Aneurysm rupture either at the posterior/anterior communicating bifurcations
Encephalitis
Vasculitis
Tumours
AV malformations

More at risk if bleeding disorders or blood thinners

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18
Q

How do you investigate a suspected SAH

A

CT Head
Lumbar Puncture - high red cells, xanthochromia, angiography

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19
Q

What is the management of SAH

A

Neurosurgery
Ventilation
Hydrated
Nimodipine - prevents vasospasm
Antiepileptic

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20
Q

How do you investigate a TIA

A

Diffusion weighted CT and MRI
Carotid Doppler US
Carotid Doppler angiography

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21
Q

How long can a TIA last

A

Less than 24 hours

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22
Q

How do you manage somone post TIA

A

Calculate a ABCD^2
Control CVD risk factors - BP, lipids , smoking
Antiplatlets - 2 weeks aspirin for hen clopidogrel ( Aspirin and SR dipyramidole)
Carotid endcardectomy - 2 weeks
No driving for a month
If AF warfarin

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23
Q

What is an extradural haemorrhage

A

Bleeding between the skull and dura mater usually due to a skull fracture affecting the middle meningeal artery

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24
Q

What is the aetiology of an extradural haemorrhage?

A

Traumatic skull fracture usually between temporal and parietal bone

Damage to MMA and extradural blood accumulation that’s limited to suture lines that leads to tissue compression

Frontal : Anterior Ethmoïdal
TP: MMA
Occipital: transverse and sigmoid sinuses
Vertex : SSS

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25
Q

What are the risk factors for an extradural haemorrhage

A

Pregnancy , SLE , vasculitis, under 60

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26
Q

How does an extradural haemorrhage present

A

Initial loss of consciousness - lucid state as blood slowly pools then GCS suddenly drops and ICP rises - brain stem compression

Severe Headache, vomiting , confusion, seizures and haemiparesis with brisk reflexes and up going planters + dilated ipsilateral pupil, deep coma , bilateral weakness, deep breathing , shallow , high BP loss HR and resp failure

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27
Q

What are the differential for an extradural?

A

Epilepsy, carotid dissection , CO poisoning

28
Q

How do you investigate an extradural

A

CT - biconvex shaped lemon and lime limited by dural attachements
X Ray skull to find fracture

29
Q

How do you manage an extradural

A

Clot Evacuation, bleeding ligation, craniectomy, ventilation, intubation and mannitol
Stop Aspirin and antiplatlets

30
Q

What are complications of an extradural?

A

High ICP
supratentorial herniation
Arterial compression - stroke
Brain stem compression - heart and resp arrest
Paralysis and sensory loss
Seizures

31
Q

What is a subdural haemorrhage

A

Bleeding between the dura and arachnoid mater due to tearing of the bridging veins between cortex and venous sinuses - deceleration

32
Q

What are the risk factors for subdural

A

Brain atrophy , epileptics , alcohol, anti coagulation
Acute changes are white chronic are grey

33
Q

What is the etiology of a subdural hemorrhage

A

Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations

34
Q

What is the etiology of a subdural hemorrhage?

A

Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations

35
Q

What is the pathophysiology of subdural?

A

Head trauma leads to the tearing of the bridging veins, and small cortical arteries and blood accumulate leading to compression

36
Q

What are the symptoms of subdural haemorrhage?

A

Fluctuating consciousness (GCS) , headache, sleepiness,, unsteadiness, personality change

37
Q

What are the signs of a subdural hemorrhage?

A

Raised ICP, seizures, unequal pupils, hemiparesis

37
Q

What are the signs of a subdural hemorrhage?

A

Raised ICP, seizures, unequal pupils, hemiparesis

38
Q

What is the differentials for subdural hemorrhage

A

Stroke, dementia, SOL, absence seizures

39
Q

Are subdural hemorrhages chronic or acute?

A

Chronic - 14 days , sub-acute 2-14 acute 48-72 hours

40
Q

How do you investigate a subdural hemorrhage?

A

CT/MRI - midline shift and clot, crescent shape, and blood collection in keeping with sickle cell shape
Chronic is grey acute is white and hyperdense
Manage by reversing clotting abnormalities

Ligation via burr hole craniostomy
Craniotomy
Diuretics
Frozen Plasma
Vitamin K and Frozen VIII bypass inhibitor
High ICP shifts midline - tentorial herniation
Investigate cause e.g. Abuse

41
Q

What are neonatal causes of meningitis?

A

E.coli
Group B streptococcus - S. agalactiae
Listeria Monocytogenes

42
Q

What are young adult causes?

A

Neisseria Meningitidis
Streptococcus Pneumoniae

43
Q

What are elderly causes?

A

Streptococcus Pneumoniae
Neisseria Meningitidis
Listeria Monocytogenes

44
Q

What is aseptic meningitis

A

Autoimmune, medications, malignancy,

45
Q

What are the common viral causes of meningitis?

A

Enterovirus, HSV, VZV, CMV, cryptococcus candidia, TB, syphilis

46
Q

Meningitis differentials?

A

Malaria, encephalitis, septicemia, SAH, dengue, tetanus

47
Q

Meningitis Risk Factors?

A

Students, travel, immunocompromised, pregnancy

48
Q

What are the complications of meningitis

A

Cerebral Oedema, herniation, deafness, epilepsy, hydrocephalus, cognitive defects

49
Q

What are the signs and symptoms of meningitis?

A

Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness, seizures

Decreased GCS, coma, Seizures

Nonblanching Peticheak rash ( meningococcal septicemia) - DIC and subcutaneous hemorrhage

Kernings+ve: Spinal Pain, resistance to leg extension when the hip is flexed
Brudinzkis: Lift head and neck of bed 0- flexion of hips and kness

50
Q

How do you investigate meningitis?

A

Blood cultures
Lumbar punctures

51
Q

How to do you treat meningitis

A

Ceftriaxone/ Cefotaxime
BenPen if community rash
Chloramphenicol if allergy
Cover with amoxicillin for listeria
Dexamethasone can be used

52
Q

What do you do if someone is septic with meningitis

A

Blood cultures
IV antibiotics
Intubation
Fluid results - inotropes, vasopressors
Urine output
Delay LP

53
Q

What are viral CSF changes?

A

Clear, normal pressure , 10-100 lymphocytes, normal glucose, high protien

54
Q

What are viral CSF changes?

A

Clear, normal pressure, 10-100 lymphocytes, normal glucose, high protein

55
Q

What is Fungal CSF?

A

Clear/Cloudy with normal pressure and mononuclear with high protein and India ink positive

56
Q

What are bacterial CSF changes?

A

Cloydt, high pressure, neutrophils, low glucose, greater than 150 protien and gram stain and culture

57
Q

What are TB CSF changes?

A

Fibrin web, opaque, mononucleosis, low glucose. 1-5 protein, acid-fast bacilli

58
Q

What is encephalitis

A

Acute inflammatory brain disease due to pathogens

59
Q

What is Aetiology

A

Viral: HSV-1, Arbovirus, VZV, measles, mumpsCMV, EBV

Bacterial: listeria cytogenesis, mycobacteria, spirochetes - syphilis, legionella

Parasites: Toxoplasma, Malaria
Fungi: Aspergillus, cryptococcus, leptospirosis

Autoimmune: NMDA, Acute dissimenated lymphoma

60
Q

Risks for encephalitis?

A

Immunosuppression, travel, exposure

61
Q

What are encephalitis complications

A

Seizures, SIADH, High ICP

62
Q

What is S+S of encephalitis

A

Bizzare, confusion, low GCS, coma, fever, headache, focal neurological signs, seizures, nuchal rigidity, hallucinations

63
Q

What are investigations for encephalitis?

A

Blood cultures
Viral PCR
Throat swab
MSU
toxoplasma IGM
Malaria film
Contrast CT
LP and CSF culture and PCR

64
Q

What is the definition of Guillan barre?

A

Acute paralytic polyneuropathy that affects the PNS causing ascending and sensory weakness
Demyelinating

Phase 3a (3 decks)

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