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Finals revision > Neurology > Flashcards

Neurology Flashcards

1
Q

Define stroke

A

Sudden onset focal neurological deficit lasting >24hrs due to vascular aetiology

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2
Q

Define ischaemic stroke

A

Blood supply to cerebral territory compromised due to complete occlusion ro secondary to stenosis

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3
Q

What is the ischaemic penumbra

A

Surrounding area with ischaemia but no necrosis

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4
Q

4 causes of an ischaemic stroke

A

AF

Atherosclerosis - small and large vessel
- large vessel: carotid artery stenosis

thrombophillia - Anti phospholipid syndrome

MI

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5
Q

Give 4 RF for ischaemic stroke

A

Male
Age
FHx

Smoke
Alcohol
Hyperlipidaemia
HTN
DM
AF

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6
Q

CT head findings on a stroke

A

Hypoattenuation of brain parenchyma

Loss of grey white matter differentiation

Hyperattenuation in artery - indcates clot

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7
Q

Blood requests for ischaemic stroke

A

FBC
TFT
U+E - Electrolyte disturbance
Glucose - stroke mimic
Troponin - rule out concominant MI
Vasculitis screen - ESR
Lipid profile

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8
Q

Post acute stroke investigations

A

Carotid USS - carotid artery stenosis
CT angiography
ECHO - cardiac emboli suspected

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9
Q

What is the time frame windom for thrombectomy
- what is it done following
- what is the full name of it

A

6-24hrs

Anterior circualtion stroke (PAC) - salvagable tissue on CT perfusion scan or DW MRI

CT angiography with mechanical thrombectomy

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10
Q

How is an ischaemic stroke managed if over >4.5 hours

A

Aspirin 300mg - 2 weeks
Clopidogrel 75mg lifelong

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11
Q

Secondary prevention for a stroke

A

HALTS
Anti-hypertensive
Anti-platelet
Statin - high dose
Tobacco - smoking cessation
Sugar - screen for and manage DM
Surgery - carotid artery stenosis

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12
Q

How is a patient with AF causing stroke managed

A

Manage acute stroke sx

Initiate anti-coag 2 weeks post stoke

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13
Q

Define haemorrhagic stroke

A

Weakness of cerebral vessels leading to cerebra vessel rupture - neuronal injury leads to a clinical deficit

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14
Q

RF for haemorrhagic stroke

A

Male
Age
Haemophillia
HTN
Anticoagulation
Cocaine / Amphetamines
Alcohol

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15
Q

Causes of haemorrhagic stroke

A

Repurfusion injury
ruptured cerebral artery
trauma
AV malformation

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16
Q

Bloods for haemorrhagic stroke

A

FBC - Thrombocytopenia
Glucose
U+E
Clotting screen
Serum toxicology

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17
Q

Management of hemorrhagic stroke

A

ABCDE
BP control - Betal blockers
Stop / revere anti-coag
Cryoprecipitate / FFP
Nimodipine - prevent vasospasm

Surgical - clipping / coiling

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18
Q

Give 5 sx of stroke

A

Motor weakness
Dysphasia
Swallowing issues
Visual field defects
Sensory disturbance
Balance

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19
Q

Give 3 sx of each cerebral teritory:
- Anterior
- Middle
- Posterior
- Brianstem

A

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

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20
Q

Give 3 sx of each cerebral teritory:
- Anterior
- Middle
- Posterior
- Brianstem

A

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

21
Q

Describe TAC - Bamford classifcation

A

ALL 3
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia

22
Q

Describe a PACI

A

2/3 present
unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
homonymous hemianopia
higher cognitive dysfunction e.g. dysphasia

23
Q

Describe a PCI

A

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

24
Q

2 other distinguishing features of haemorrhagic stroke from hsiotry

A

headache
N+V

25
Q

Describe a lacunar stroke

A

Pure motor
pure sensory
sensorimotor
ataxic hemiparesis

26
Q

Define a TIA

A

Sudden onset neurological deficit due to temporary cerebrla ischaemia without infarction - full resolution in 24 hours

27
Q

Investigations for TIA

A

MRI with diffusion weighting

Bloods
FBC
Glucose
clotting screen
Lipids
U+E

ECG

Carotid doppler

28
Q

causes of cerebellar syndrome

A

infarction
MS
Alcoholism
Neoplastic
BET
Cerebral plasy
Fredrichs ataxia

29
Q

What is Friedrichs ataxia assosciated with

A

HOCM

30
Q

Give 3 features of friedrichs ataxia

A

AR - Trinucleotide repeat

cerebellar ataxia
high arched palet
spinocerebllar degeneration
optic atrophy

31
Q

describe a 3rd nerve palsy

A

down and out

double vision
ptosis - complete
proptosis
fixed dilated pupil - surgical

32
Q

Give a cause of a surgical 3rd nerve palsy

A

PCA aneurysm

33
Q

Give 4 causes of non surgical 3rd nerve palsy

A

MS
DM
HTN

34
Q

Describe a 4th nerve palsy

A

UP AND OUT

vertical diplopia
torsional diplopia - tilting of objects
head tilt

35
Q

describe an argyll-robertson pupil

A

small irregualr pupil

no repsonse to light but can accommodate

36
Q

Give 3 clasifcations for TLoC

A

Neurally mediated reflex syncope

Orthostatic hypotenison

cardiogenic syncope

37
Q

outline neurally mediated reflex syncope

A

vasovagal - reflex bradycardia and peripheral vasodilatation in response to: strong emotion / fear / needles

situational - post cough / micturition / exercise

carotid sinus hypersensitivity - tight collar

38
Q

prodromal features of faint

A

dizzy
sweaty
blurred vision
pallor

39
Q

primary causes of orthostatic hypotension

A

PD
Lewy body dementia

40
Q

secondary causes of orthostatic hypotension

A

DM
Uraemia
alcohol
diuretics

41
Q

cardiogenic causes of syncope

A

Long QT
HOCM
Heart block

SVT
AF

Aortic stenosis

42
Q

Investigations fro syncope

A

Lying and standing BP
ECG
Full CVS exam
Tilt table test

43
Q

what is vasovagal syncope

A

reflex bradycardia and peripheral vasodilation in response to stress/fear/needles

44
Q

What is neurally mediated reflex syncope

A

symptomatic hypotension due to neural reflex vasodilation and bradycardia

45
Q

Sx of neurally mediated syncope

A

narrowing of vision
blurred vision
sweating
pallor
dizziness

46
Q

What is orthostatic hypotension

A

insufficeincy of baroreceptors to respond to drop in BP

47
Q

Seizure triggers

A

lack of sleep
alcohol
drugs
stroke
SOL
Low sodium
haemorrhage

48
Q

Which seizures does carbamazepeine affect

A

Absence and myoclonic

Finals revision (17 decks)

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