Neurology Flashcards
Define stroke
Sudden onset focal neurological deficit lasting >24hrs due to vascular aetiology
Define ischaemic stroke
Blood supply to cerebral territory compromised due to complete occlusion ro secondary to stenosis
What is the ischaemic penumbra
Surrounding area with ischaemia but no necrosis
4 causes of an ischaemic stroke
AF
Atherosclerosis - small and large vessel
- large vessel: carotid artery stenosis
thrombophillia - Anti phospholipid syndrome
MI
Give 4 RF for ischaemic stroke
Male
Age
FHx
Smoke
Alcohol
Hyperlipidaemia
HTN
DM
AF
CT head findings on a stroke
Hypoattenuation of brain parenchyma
Loss of grey white matter differentiation
Hyperattenuation in artery - indcates clot
Blood requests for ischaemic stroke
FBC
TFT
U+E - Electrolyte disturbance
Glucose - stroke mimic
Troponin - rule out concominant MI
Vasculitis screen - ESR
Lipid profile
Post acute stroke investigations
Carotid USS - carotid artery stenosis
CT angiography
ECHO - cardiac emboli suspected
What is the time frame windom for thrombectomy
- what is it done following
- what is the full name of it
6-24hrs
Anterior circualtion stroke (PAC) - salvagable tissue on CT perfusion scan or DW MRI
CT angiography with mechanical thrombectomy
How is an ischaemic stroke managed if over >4.5 hours
Aspirin 300mg - 2 weeks
Clopidogrel 75mg lifelong
Secondary prevention for a stroke
HALTS
Anti-hypertensive
Anti-platelet
Statin - high dose
Tobacco - smoking cessation
Sugar - screen for and manage DM
Surgery - carotid artery stenosis
How is a patient with AF causing stroke managed
Manage acute stroke sx
Initiate anti-coag 2 weeks post stoke
Define haemorrhagic stroke
Weakness of cerebral vessels leading to cerebra vessel rupture - neuronal injury leads to a clinical deficit
RF for haemorrhagic stroke
Male
Age
Haemophillia
HTN
Anticoagulation
Cocaine / Amphetamines
Alcohol
Causes of haemorrhagic stroke
Repurfusion injury
ruptured cerebral artery
trauma
AV malformation
Bloods for haemorrhagic stroke
FBC - Thrombocytopenia
Glucose
U+E
Clotting screen
Serum toxicology
Management of hemorrhagic stroke
ABCDE
BP control - Betal blockers
Stop / revere anti-coag
Cryoprecipitate / FFP
Nimodipine - prevent vasospasm
Surgical - clipping / coiling
Give 5 sx of stroke
Motor weakness
Dysphasia
Swallowing issues
Visual field defects
Sensory disturbance
Balance
Give 3 sx of each cerebral teritory:
- Anterior
- Middle
- Posterior
- Brianstem
Contralateral weakness and sensory deficit of lower limb
Apraxia
Dysphasia
Dysarthia
Homonymous heminaopia
Contralateral motor weakness and seosnry loss - upper limb
Facial droop
Dysphasia
Aphasia
contralateral homonymous heminaopia
Give 3 sx of each cerebral teritory:
- Anterior
- Middle
- Posterior
- Brianstem
Contralateral weakness and sensory deficit of lower limb
Apraxia
Dysphasia
Dysarthia
Homonymous heminaopia
Contralateral motor weakness and seosnry loss - upper limb
Facial droop
Dysphasia
Aphasia
contralateral homonymous heminaopia
Contralateral homnymous heminaopia - macualr sparing
vertigo
memory defictis
visual agnosia
quadraplegia
facial paralysis
coma
locked in
decreased GCS
Describe TAC - Bamford classifcation
ALL 3
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia
Describe a PACI
2/3 present
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia
Describe a PCI
1 present
Cranial nerve palsy + contralateral motor / sensory deficit
bilateral motor sensory deficit
conjugate eye movement disorder
cerebellar dysfucntion - vertigo / nystagmus / ataxia
Isolated homonymous heminaopia
2 other distinguishing features of haemorrhagic stroke from hsiotry
headache
N+V
Describe a lacunar stroke
Pure motor
pure sensory
sensorimotor
ataxic hemiparesis
Define a TIA
Sudden onset neurological deficit due to temporary cerebrla ischaemia without infarction - full resolution in 24 hours
Investigations for TIA
MRI with diffusion weighting
Bloods
FBC
Glucose
clotting screen
Lipids
U+E
ECG
Carotid doppler
causes of cerebellar syndrome
infarction
MS
Alcoholism
Neoplastic
BET
Cerebral plasy
Fredrichs ataxia
What is Friedrichs ataxia assosciated with
HOCM
Give 3 features of friedrichs ataxia
AR - Trinucleotide repeat
cerebellar ataxia
high arched palet
spinocerebllar degeneration
optic atrophy
describe a 3rd nerve palsy
down and out
double vision
ptosis - complete
proptosis
fixed dilated pupil - surgical
Give a cause of a surgical 3rd nerve palsy
PCA aneurysm
Give 4 causes of non surgical 3rd nerve palsy
MS
DM
HTN
Describe a 4th nerve palsy
UP AND OUT
vertical diplopia
torsional diplopia - tilting of objects
head tilt
describe an argyll-robertson pupil
small irregualr pupil
no repsonse to light but can accommodate
Give 3 clasifcations for TLoC
Neurally mediated reflex syncope
Orthostatic hypotenison
cardiogenic syncope
outline neurally mediated reflex syncope
vasovagal - reflex bradycardia and peripheral vasodilatation in response to: strong emotion / fear / needles
situational - post cough / micturition / exercise
carotid sinus hypersensitivity - tight collar
prodromal features of faint
dizzy
sweaty
blurred vision
pallor
primary causes of orthostatic hypotension
PD
Lewy body dementia
secondary causes of orthostatic hypotension
DM
Uraemia
alcohol
diuretics
cardiogenic causes of syncope
Long QT
HOCM
Heart block
SVT
AF
Aortic stenosis
Investigations fro syncope
Lying and standing BP
ECG
Full CVS exam
Tilt table test
what is vasovagal syncope
reflex bradycardia and peripheral vasodilation in response to stress/fear/needles
What is neurally mediated reflex syncope
symptomatic hypotension due to neural reflex vasodilation and bradycardia
Sx of neurally mediated syncope
narrowing of vision
blurred vision
sweating
pallor
dizziness
What is orthostatic hypotension
insufficeincy of baroreceptors to respond to drop in BP
Seizure triggers
lack of sleep
alcohol
drugs
stroke
SOL
Low sodium
haemorrhage
Which seizures does carbamazepeine affect
Absence and myoclonic
