Neurology Flashcards
extradural haematoma location
btw skull and dura
causes of extradural haematoma
low-impact trauma
presentation of extradural haematoma
LOC –> lucid interval –> rapid decline in consciousness
signs of extradural haematoma
due to mass effect: - - uncal herniation| - fixed, dilated pupil (CN3 compression)
CT fts of extradural haematoma
hyperdense (bright) biconvex/lentiform collection around the surface of the brain
definitive management of extradural haematoma
craniotomy and evacuation
Definition of acute subdural haematoma
fresh collection of blood btw dura and meninges
causes of acute subdural haematoma
trauma (> common) - high speed-injuries/ acc-deceleration vascular lesions (AV malformations)
presentation of acute subdural haematoma
spectrum - from asx to comatosed
CT imaging for ACUTE subdural haematoma
hyperdense (bright) crescenteric collection surrounding the brainNot limited by suture lines
Definitive tx for acute subdural haematoma
decompressive craniotomy
Define chronic subdural haematoma
old collection of blood btw dura and meninges
common groups of pts w/ chronic subdural haematoma
- elderly- alcoholics- anticoagulated- infants
Presentation of chronic subdural haematoma
- several weeks after mild head injury| - progressive confisions, LOC, weakness or higher cortical function
CT fts of CHRONIC subdural haematoma
hypodense (dark) crscenteric collection around the surface of the brainnot limited by suture lines
Definitive tx chronic subdural haematoma
burr hole drainage
Definition intracerbral haematoma (ICM)
collection of blood w/in the substance of the brain
causes/risk factors for intracerebral haematoma
- HTN- vascular lesion (aneurysm, AV malformation)- cerebral amyloid angiopathy- brain tumour- infarct (stroke pts undergoing thrombolysis)
presentation intracerebral haematoma
! similar to ischaemic stroke
CT fts intracerebral haematoma
hyperdensity (bright) w/in the substane of the brain
Tx of intracerebral haematom
Conservative - under stroke Dr| Surgical evac for large clots in pts w/ impaired consciousness
define subarachnoid haemorrhage
bleed into the subarchnoid space (deep to subarachnoid layer of the meninges)
causes of subarachnoid haemorrhage
- trauma (> common)- ruptured aneurysm (> common spontaneous cause)- AV malformation- mycotic aneurysm- pituitary apoplexy- idiopathic
presentation of subarachnoid haemorrhage
sudden onset severe headache, meck stifness and photophobia
CT fts subarachnoid haemorrhage
hyperdensitiy (white) w/in cisterns/sulci
diagnosis of subarachnoid if CT unconclusive
LP done after 12hrs| xanthochromia
Tx of subarachnoic haemorrhae
manage cause of the bleed
Definitino of intraventricular haemorrhage
collection of blood w/in the ventricular system of the brain
causes of intraventricular haemorrhage in children
prematurity of the periventricular vascular structures
causes of intraventricular haemorrhage in adults
- extension of a subarachnoid haemorrhage- vascular lesions (aneurysms, AV malformation)- tumours
CT fts of intraventricular haemorrhage
hyperdensity (bright) in the dark CSF spaces w/in ventricles
Complication of intraventricular haemorrhage + management of this
obstructive hydrocephalus| surgical CSF diversion (external ventricular drain)
Which bleed may result in vasospasms
subarachnoid haemorrhage
Fts Duchenne musclar dystrophy
- progressive prox muscle weakness from 5yrs old
- calf pseudohypertrophy
- Gower’s sign (arms used to sit up)
- 30% have intellectual impairment
- X linked recessive
Becker muscular dystrophy fts
- after 10yrs
- unlikey intellectual impairment
- X linked recessive
Idiopathic Parkinson’s disease
a) Key/classic fts
b) other fts
a) Asymmetry of clinical signs
b) Unilateral extrapyramidal fts
Vascular Parkinsonism
a) Key/classic fts
b) other fts
a) Predominant lower body signs
b) Tremor less common; rigidity (lower>upper limbs); lack of facial expression
a) Key/classic fts
b) other fts
a)
b)
Dementia with Lewy bodies
a) Key/classic fts
b) other fts
a) Triad: dementia; parkinsonism and visual hallucinations
b) Prominent visual hallucinations; fluctuating alertness
Drug induced parkinsonism
a) Key/classic fts
b) other fts
a) Hx of dopamine blocking drugs (anti-psychotics, metoclopramide)
b) symetrical rigidity; lack of facial expression
Multi-systems atrophy (as a diff of parkinsonism)
a) Key/classic fts
b) other fts
a) Prominent early autonomic fts (hypotension, bladder instability
b) Symmetrical Parkinsonism with autonomic complications
Progressive supranuclear palsy (as a diff of parkinsonism)
a) Key/classic fts
b) other fts
a) early falls, truncal rigidity, vertical gaze palsy
b)
Normal pressure hydrochephalus (as a diff of parkinsonism)
a) Key/classic fts
b) other fts
a) Triad: dementia; gait disorder; bladder instability
b) normal pressure hydrochephalus on neuro-imaging
Extrapyramidal fts0
tremor
bradykinesia
Headache red flag sx (10)
- Thunderclap (first and worst)
- a/w accelerated/malignant HTN
- acute + papilloedema
- acute + focal neurology
- head trauma + raised ICP signs (gradual, diplopia, >morning)
- a/w photophobia + nuchal rigidity + fever +/- rash
- a/w reduced consciousness
- a/w acute red eye
- 3rd trimester pregnancy/early post-partum
- head injury + elderly/alcoholic/anticoagulated
ICP symptoms
- precipitated (not worse) by valsava
- papilloedema
- wakes from sleep
Others: - worse on waking/lying down
- pulse synchronous tinnitus
- episodes of transient visual loss when changing posture (standing)
- vomiting
fts of headaches warantign 2WW (?Ca)
- ICP fts
- a/w new onset seizures
- a/w persistent new or progressive neurological deficit
- hx of malignancy (?mets)
- unexplained vomiting
Migrain fts
- throbbing pain lasting hrs - 3 days
- sensitivity to stimuli
- nausea
- worst with physical activity
+/- aura (evolves slowly, lasts few mins-60mins)
Acute tx for migraine
- aspiring dispersable 900mg
- NSAID + metoclopramide/domperidone (with caution)
- triptan (<10 days per mo, ideally <6/mo)
NOT opiates
Tension type headache
- band-like
- mostly featureless
+/- mild photo/phonophobia
NO nausea
Cluster headache
- M>F
- most severe pain lasting 30-120mins
- unilateral, side-locked
- agistation, pacing
- unilateral cranial autonomic fts (tearing, red conjunctiva, ptosis, miosis, nasal stuffiness)
Acute tx cluster headache
- sumatriptan injection 6mf s/c (CI for IHD and stroke)
- Hi-flow oxygen NRB mask
- pred 60mg OD 1 week
treatment tiptan overuse headache
stop triptan for 2-3 mo
Migraine prophylaxis 1st line - drug, dose, course
propanolol MR 80mg OD - incr to tolerance, max 240mg OD
course: 3 months at highest tolerated target dose to assess efficacy
Migraine prophylaxis 2nd line (indication; drug, dose, course)
topimarate 25mg OD, incr by 15-25mg every fortnight, target 50mg BD
course: 3 months at highest tolerated target dose to assess efficacy
Topimarate counselling pts
- teratogenic + interacts with oral contraceptives
- paraesthesia
- weight loss
none above are causes to stop unless not tolerated - worsening depression
Tension type headache prophylaxis (medical, other)
- amitriptyline 10mg at night, incr by 10mg a week up to 100mg
- OR gabapentin 100mg TDS increasing by 100mg TDS to 900mg TDS
- acupuncture if available
investigations for 2ry headache (after excludign main 3)
Hb, Ca2+, TFTs, ESR, CRP
review lifestyle
review medications
TIA criteria
rapidly developign clinical signs of focal/global disturbance of cerebral function self-resolving in <24hrs
Risk assessment for TIA
ABCDD
Age >60 - pt
BP>140/90 at presentation - 1pt
Clinical fts (unilateral weakness - 2pts; speech disturbance w/out weakness - 1pt)
Duration sx >1hr - 2pts; 10-59mins - 1pt
Diabetes -1pt
OR AF - 4pts
High risk = 4pts - see within 4hrs
Tx ischaemic stroke
alteplase (thrombolysis)
mechanical embolectomy (8-12hrs onset)
