Neurology Flashcards
What is a stroke
Infarction of bleeding in the brain manifesting with sudden onsent focal CNS signs
What are the risk factors for a stroke?
CVD-: Angina, MI, PVD
TIA, Stroke
AD, carotid artery disease
HTN, diabetes, smoking , vasculitis , thrombophilia, OCP
What is the aetiology of a stroke?
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
What’s the pathophysiology of an ischaemic
Ischaemic tissue leads to inflammatory responses and oedema and lack of perfusion to the brain
What is the pathophysiology of the haemorrhagic stroke?
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
What are the signs and symptoms of a stroke?
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
What are the signs one symptoms of a lacunar stroke
Ataxic hemiparesis
Pure motor, sensory
Sensorimotor
Dysarthia
Cognition and sensory intact
How do you manage a stroke
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
What is an ACA stroke presentation
Contralateral weakness and sensory loss of the lower limb
Incontinence
Drowsiness
Thinking and personality
Truncated ataxia
What is MCA stroke presentation
Contralateral motor and sensory weakness
Hemiparesis
Speech impairment
Facial droop
What are the features of a PCA stroke
Perception changes
Homonymous hemianopia
What is a vertebrobasilar artery stroke features?
Coordination and balance affected
What is lateral medullary syndrome
Sudden onset vomiting and vertigo
Ipsilateral horners syndrome - reduced sweating, facial numbness , dysarthria , limb ataxia and dysphagia
What are symptoms of a brainstem infarction
Quadraiplegia
Facial paralysis
Numbness
Gaze
Vision
Coma
Locked in syndrome
Altered consciousness
Vertigo
Vomiting
What is a SAH
Bleeding between the arachnoid and pia mater into the SA space where the CSF is located
How does a SAH present?
Sudden onset occipital headache - thunderclap
Collapse, seizures, vomiting, coma
Neck stiffness
Headache
Fever
Photophobia
Kernings
Focal neurological signs
What causes a SAH?
Berry Aneurysm rupture either at the posterior/anterior communicating bifurcations
Encephalitis
Vasculitis
Tumours
AV malformations
More at risk if bleeding disorders or blood thinners
How do you investigate a suspected SAH
CT Head
Lumbar Puncture - high red cells, xanthochromia, angiography
What is the management of SAH
Neurosurgery
Ventilation
Hydrated
Nimodipine - prevents vasospasm
Antiepileptic
How do you investigate a TIA
Diffusion weighted CT and MRI
Carotid Doppler US
Carotid Doppler angiography
How long can a TIA last
Less than 24 hours
How do you manage somone post TIA
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
What is an extradural haemorrhage
Bleeding between the skull and dura mater usually due to a skull fracture affecting the middle meningeal artery
What is the aetiology of an extradural haemorrhage?
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
What are the risk factors for an extradural haemorrhage
Pregnancy , SLE , vasculitis, under 60
How does an extradural haemorrhage present
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
What are the differential for an extradural?
Epilepsy, carotid dissection , CO poisoning
How do you investigate an extradural
CT - biconvex shaped lemon and lime limited by dural attachements
X Ray skull to find fracture
How do you manage an extradural
Clot Evacuation, bleeding ligation, craniectomy, ventilation, intubation and mannitol
Stop Aspirin and antiplatlets
What are complications of an extradural?
High ICP
supratentorial herniation
Arterial compression - stroke
Brain stem compression - heart and resp arrest
Paralysis and sensory loss
Seizures
What is a subdural haemorrhage
Bleeding between the dura and arachnoid mater due to tearing of the bridging veins between cortex and venous sinuses - deceleration
What are the risk factors for subdural
Brain atrophy , epileptics , alcohol, anti coagulation
Acute changes are white chronic are grey
What is the etiology of a subdural hemorrhage
Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations
What is the etiology of a subdural hemorrhage?
Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations
What is the pathophysiology of subdural?
Head trauma leads to the tearing of the bridging veins, and small cortical arteries and blood accumulate leading to compression
What are the symptoms of subdural haemorrhage?
Fluctuating consciousness (GCS) , headache, sleepiness,, unsteadiness, personality change
What are the signs of a subdural hemorrhage?
Raised ICP, seizures, unequal pupils, hemiparesis
What are the signs of a subdural hemorrhage?
Raised ICP, seizures, unequal pupils, hemiparesis
What is the differentials for subdural hemorrhage
Stroke, dementia, SOL, absence seizures
Are subdural hemorrhages chronic or acute?
Chronic - 14 days , sub-acute 2-14 acute 48-72 hours
How do you investigate a subdural hemorrhage?
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
What are neonatal causes of meningitis?
E.coli
Group B streptococcus - S. agalactiae
Listeria Monocytogenes
What are young adult causes?
Neisseria Meningitidis
Streptococcus Pneumoniae
What are elderly causes?
Streptococcus Pneumoniae
Neisseria Meningitidis
Listeria Monocytogenes
What is aseptic meningitis
Autoimmune, medications, malignancy,
What are the common viral causes of meningitis?
Enterovirus, HSV, VZV, CMV, cryptococcus candidia, TB, syphilis
Meningitis differentials?
Malaria, encephalitis, septicemia, SAH, dengue, tetanus
Meningitis Risk Factors?
Students, travel, immunocompromised, pregnancy
What are the complications of meningitis
Cerebral Oedema, herniation, deafness, epilepsy, hydrocephalus, cognitive defects
What are the signs and symptoms of meningitis?
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
How do you investigate meningitis?
Blood cultures
Lumbar punctures
How to do you treat meningitis
Ceftriaxone/ Cefotaxime
BenPen if community rash
Chloramphenicol if allergy
Cover with amoxicillin for listeria
Dexamethasone can be used
What do you do if someone is septic with meningitis
Blood cultures
IV antibiotics
Intubation
Fluid results - inotropes, vasopressors
Urine output
Delay LP
What are viral CSF changes?
Clear, normal pressure , 10-100 lymphocytes, normal glucose, high protien
What are viral CSF changes?
Clear, normal pressure, 10-100 lymphocytes, normal glucose, high protein
What is Fungal CSF?
Clear/Cloudy with normal pressure and mononuclear with high protein and India ink positive
What are bacterial CSF changes?
Cloydt, high pressure, neutrophils, low glucose, greater than 150 protien and gram stain and culture
What are TB CSF changes?
Fibrin web, opaque, mononucleosis, low glucose. 1-5 protein, acid-fast bacilli
What is encephalitis
Acute inflammatory brain disease due to pathogens
What is Aetiology
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
Risks for encephalitis?
Immunosuppression, travel, exposure
What are encephalitis complications
Seizures, SIADH, High ICP
What is S+S of encephalitis
Bizzare, confusion, low GCS, coma, fever, headache, focal neurological signs, seizures, nuchal rigidity, hallucinations
What are investigations for encephalitis?
Blood cultures
Viral PCR
Throat swab
MSU
toxoplasma IGM
Malaria film
Contrast CT
LP and CSF culture and PCR
What is the definition of Guillan barre?
Acute paralytic polyneuropathy that affects the PNS causing ascending and sensory weakness
Demyelinating
