Neurology Flashcards
CVA
Acute onset
Pt with risk fx: 65yr DM / Hpt with acute onset hemiparesis
Secondary risk factors – DM, Hpt
atherosclerosis (macro-vascular disease) = Angina, Claudication, Erectile dysfunction
Previous vascular events
Systemic (secondary cause) =Fever, Arthritis, Constitutional symptoms etc.
Young stroke
Def: <50 / 55 yrs
Mimics / Intra-cranial lesions
Infective causes (RPR, HIV, meningitis)
Cardio-embolic
Hyper-coagubility state
CVA Mx
-Thrombolysis: TIME, CONTRA-INDICATIONS, SIZE
-Protect the Penumbra (FIRST 24HR): Aspirin, BP, Glucose, Aspirate, Oxygen
-Secondary prevention: BP / DM / Cholesterol
-Rehabilitation
Localization
Hemispheric (1/2 of body)
Brainstem (1/2 head + 1/2 opposite side of body)
Spinal cord (waist down)
Polyneuropathy ( both forearms + hands & below knee lower leg + feet)
Myopathy (Shoulders + waist-thigh (upper lower-limb)
Hypertonia (Spastcity)
Babinski sign
Clonus
Hyperreflexia
Regional weakness
Hypotonia
Atrophy
Fasciculations
Hyporeflexia
Focal weakness
symptoms and signs of raised intracranial pressure
Nausea and vomiting
Headache worse on cough or Valsalva, or bending forward
Headache worse at night / in morning, improve during the day (gravity’s effect when lying down)
Papilledema
Dilated pupil / NIII paralysis / NVI paralysis – due to imminent herniation over tentorium
Kussmaul’s reflex (bradycardia with hypertension)
Depressed level of consciousness
RED FLAGS to look for regarding headaches
Sudden onset (thunder clap) / Recent onset of new headache / Progressive headache
Onset after age 50 years
Onset after recent trauma
Associated systemic disease like HIV OR Neoplasm history
Systemic symptoms including fever
Neurologic deficit (including decreased consciousness)
Papilledema
Contra-indications to LP
Papilledema on fundoscopy
Lateralising signs
Unilateral weakness
Unilateral headache
etc
Complications of meningitis:
Strokes – inflammation around the cerebral arteries as they run through the meninges trip coagulation.
Cranial nerve paralysis – most commonly gaze paralysis because 3,4,6 is affected. Bacterial also commonly cause permanent deafness, especially in children (8 affected).
Brain abscess – consider this in patient who is not responding to treatment and are developing localising signs
Raised intracranial pressure, herniation and death.
Treatment of TBM, bacterial, CCM, Viral Meningitis
TBM = standard TB Tx + steroids (adults)
Bacterial = Steroids (children), Ceftriaxone/Cefotaxime/Meropenem
CCM = Amphotericin B + flucytosine induction then fluconazole (CD4 >200)
Viral = symptomatic management
Delirium vs Dementia
Acute onset (hrs-days) vs Chronic onset (months)
Attention defcit/confusion vs Higher functions
Fluctuates during day vs Chronic stable cause
Hallucinations vs none
Acute med condition (sepsis) vs Degenerative cerebral damage (multi-infarcts)
Reversible vs Permanent
Main symptoms of delirium
Disorientation
Fluctuating
Difficulty maintaining or shifting attention
Illusions and Hallucinations
Delirium
Def: a transient, usually reversible, cause of altered mental function due to an underlying medical condition.
occur at any age, occurs more commonly in patients who are elderly and have a previously compromised mental reserves.
DSM-5 diagnostic criteria:
Disturbance in attention (reduced ability to focus) and awareness.
Change in cognition (eg, memory deficit, disorientation, language disturbance, perceptual disturbance) that is not better accounted for by another condition.
Develops over a short period (usually hours to days) and tends to fluctuate.
Caused by a general medical condition, an intoxicating substance, medication use, etc.
Delirium causes
-Dehydration
-Hyper- and Hypo’s = Hypoglycaemia, Hypoxia, Hypercapnia, Hyponatremia, Hypercalcemia
-Infective causes ( Pneumonia, UTI’S etc.), Meningitis and other intracranial infections
-Metabolic causes = Renal failure, Liver failure
-Nutritional (Vitamin deficiencies) = Especially Thiamine
-Drugs (and Polypharmacy in the elderly) = ETOH, anticholinergics, benzo’s etc.
-Post-ictal state
-Intracranial lesions = CVA’s, metastasis, etc
