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General med > Neurology > Flashcards

Neurology Flashcards

1
Q

extradural haematoma location

A

btw skull and dura

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2
Q

causes of extradural haematoma

A

low-impact trauma

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3
Q

presentation of extradural haematoma

A

LOC –> lucid interval –> rapid decline in consciousness

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4
Q

signs of extradural haematoma

A

due to mass effect: - - uncal herniation| - fixed, dilated pupil (CN3 compression)

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5
Q

CT fts of extradural haematoma

A

hyperdense (bright) biconvex/lentiform collection around the surface of the brain

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6
Q

definitive management of extradural haematoma

A

craniotomy and evacuation

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7
Q

Definition of acute subdural haematoma

A

fresh collection of blood btw dura and meninges

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8
Q

causes of acute subdural haematoma

A 
trauma (> common) - high speed-injuries/ acc-deceleration vascular lesions (AV malformations)
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9
Q

presentation of acute subdural haematoma

A

spectrum - from asx to comatosed

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10
Q

CT imaging for ACUTE subdural haematoma

A

hyperdense (bright) crescenteric collection surrounding the brainNot limited by suture lines

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11
Q

Definitive tx for acute subdural haematoma

A

decompressive craniotomy

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12
Q

Define chronic subdural haematoma

A

old collection of blood btw dura and meninges

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13
Q

common groups of pts w/ chronic subdural haematoma

A
  • elderly- alcoholics- anticoagulated- infants
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14
Q

Presentation of chronic subdural haematoma

A
  • several weeks after mild head injury| - progressive confisions, LOC, weakness or higher cortical function
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15
Q

CT fts of CHRONIC subdural haematoma

A

hypodense (dark) crscenteric collection around the surface of the brainnot limited by suture lines

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16
Q

Definitive tx chronic subdural haematoma

A

burr hole drainage

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17
Q

Definition intracerbral haematoma (ICM)

A

collection of blood w/in the substance of the brain

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18
Q

causes/risk factors for intracerebral haematoma

A
  • HTN- vascular lesion (aneurysm, AV malformation)- cerebral amyloid angiopathy- brain tumour- infarct (stroke pts undergoing thrombolysis)
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19
Q

presentation intracerebral haematoma

A

! similar to ischaemic stroke

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20
Q

CT fts intracerebral haematoma

A

hyperdensity (bright) w/in the substane of the brain

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21
Q

Tx of intracerebral haematom

A

Conservative - under stroke Dr| Surgical evac for large clots in pts w/ impaired consciousness

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22
Q

define subarachnoid haemorrhage

A

bleed into the subarchnoid space (deep to subarachnoid layer of the meninges)

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23
Q

causes of subarachnoid haemorrhage

A
  • trauma (> common)- ruptured aneurysm (> common spontaneous cause)- AV malformation- mycotic aneurysm- pituitary apoplexy- idiopathic
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24
Q

presentation of subarachnoid haemorrhage

A

sudden onset severe headache, meck stifness and photophobia

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25
Q

CT fts subarachnoid haemorrhage

A

hyperdensitiy (white) w/in cisterns/sulci

26
Q

diagnosis of subarachnoid if CT unconclusive

A

LP done after 12hrs| xanthochromia

27
Q

Tx of subarachnoic haemorrhae

A

manage cause of the bleed

28
Q

Definitino of intraventricular haemorrhage

A

collection of blood w/in the ventricular system of the brain

29
Q

causes of intraventricular haemorrhage in children

A

prematurity of the periventricular vascular structures

30
Q

causes of intraventricular haemorrhage in adults

A
  • extension of a subarachnoid haemorrhage- vascular lesions (aneurysms, AV malformation)- tumours
31
Q

CT fts of intraventricular haemorrhage

A

hyperdensity (bright) in the dark CSF spaces w/in ventricles

32
Q

Complication of intraventricular haemorrhage + management of this

A

obstructive hydrocephalus| surgical CSF diversion (external ventricular drain)

33
Q

Which bleed may result in vasospasms

A

subarachnoid haemorrhage

34
Q

Fts Duchenne musclar dystrophy

A
  • progressive prox muscle weakness from 5yrs old
  • calf pseudohypertrophy
  • Gower’s sign (arms used to sit up)
  • 30% have intellectual impairment
  • X linked recessive
35
Q

Becker muscular dystrophy fts

A
  • after 10yrs
  • unlikey intellectual impairment
  • X linked recessive
36
Q

Idiopathic Parkinson’s disease
a) Key/classic fts
b) other fts

A

a) Asymmetry of clinical signs

b) Unilateral extrapyramidal fts

37
Q

Vascular Parkinsonism
a) Key/classic fts
b) other fts

A

a) Predominant lower body signs

b) Tremor less common; rigidity (lower>upper limbs); lack of facial expression

38
Q

a) Key/classic fts
b) other fts

A

a)

b)

39
Q

Dementia with Lewy bodies
a) Key/classic fts
b) other fts

A

a) Triad: dementia; parkinsonism and visual hallucinations

b) Prominent visual hallucinations; fluctuating alertness

40
Q

Drug induced parkinsonism
a) Key/classic fts
b) other fts

A

a) Hx of dopamine blocking drugs (anti-psychotics, metoclopramide)

b) symetrical rigidity; lack of facial expression

41
Q

Multi-systems atrophy (as a diff of parkinsonism)
a) Key/classic fts
b) other fts

A

a) Prominent early autonomic fts (hypotension, bladder instability

b) Symmetrical Parkinsonism with autonomic complications

42
Q

Progressive supranuclear palsy (as a diff of parkinsonism)
a) Key/classic fts
b) other fts

A

a) early falls, truncal rigidity, vertical gaze palsy
b)

43
Q

Normal pressure hydrochephalus (as a diff of parkinsonism)
a) Key/classic fts
b) other fts

A

a) Triad: dementia; gait disorder; bladder instability

b) normal pressure hydrochephalus on neuro-imaging

44
Q

Extrapyramidal fts0

A

tremor
bradykinesia

45
Q

Headache red flag sx (10)

A
  • 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
46
Q

ICP symptoms

A
  • 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
47
Q

fts of headaches warantign 2WW (?Ca)

A
  • ICP fts
  • a/w new onset seizures
  • a/w persistent new or progressive neurological deficit
  • hx of malignancy (?mets)
  • unexplained vomiting
48
Q

Migrain fts

A
  • throbbing pain lasting hrs - 3 days
  • sensitivity to stimuli
  • nausea
  • worst with physical activity
    +/- aura (evolves slowly, lasts few mins-60mins)
49
Q

Acute tx for migraine

A
  • aspiring dispersable 900mg
  • NSAID + metoclopramide/domperidone (with caution)
  • triptan (<10 days per mo, ideally <6/mo)
    NOT opiates
50
Q

Tension type headache

A
  • band-like
  • mostly featureless
    +/- mild photo/phonophobia
    NO nausea
51
Q

Cluster headache

A
  • M>F
  • most severe pain lasting 30-120mins
  • unilateral, side-locked
  • agistation, pacing
  • unilateral cranial autonomic fts (tearing, red conjunctiva, ptosis, miosis, nasal stuffiness)
52
Q

Acute tx cluster headache

A
  • sumatriptan injection 6mf s/c (CI for IHD and stroke)
  • Hi-flow oxygen NRB mask
  • pred 60mg OD 1 week
53
Q

treatment tiptan overuse headache

A

stop triptan for 2-3 mo

54
Q

Migraine prophylaxis 1st line - drug, dose, course

A

propanolol MR 80mg OD - incr to tolerance, max 240mg OD
course: 3 months at highest tolerated target dose to assess efficacy

55
Q

Migraine prophylaxis 2nd line (indication; drug, dose, course)

A

topimarate 25mg OD, incr by 15-25mg every fortnight, target 50mg BD
course: 3 months at highest tolerated target dose to assess efficacy

56
Q

Topimarate counselling pts

A
  • teratogenic + interacts with oral contraceptives
  • paraesthesia
  • weight loss
    none above are causes to stop unless not tolerated
  • worsening depression
57
Q

Tension type headache prophylaxis (medical, other)

A
  • 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
58
Q

investigations for 2ry headache (after excludign main 3)

A

Hb, Ca2+, TFTs, ESR, CRP
review lifestyle
review medications

59
Q

TIA criteria

A

rapidly developign clinical signs of focal/global disturbance of cerebral function self-resolving in <24hrs

60
Q

Risk assessment for TIA

A

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

61
Q

Tx ischaemic stroke

A

alteplase (thrombolysis)
mechanical embolectomy (8-12hrs onset)

General med (14 decks)

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