Neurology

Question 1

What is ICH?

Answer 1

Bleeding into brain parenchyma from small arterioles often weakened by blood pressure

Question 2

What are risk factors of ICH?

Answer 2

HTN, smoking, alcohol abuse,amyloidosis,wafarin

Question 3

What will you find on the CT on ICH?

Answer 3

Fresh blood (hyperintense/bright white) on CT in a known vascular distribution

Question 4

What are risk factors for a TIA?

Answer 4

Hypertension
AF
Diabetes
>55
Male
Smoker
family history
Prior TIA/stroke
Vasculitis

Question 5

Name the typical sign of a TIA

Answer 5

sudden onset,
short duration (< 10 minutes)
weakness
numbness/tingling
speech problems
vision changes
dizziness
headache

Question 6

What is the cause of a TIA?

Answer 6

temporary non-functioning brain because of a disruption causing lack of blood flow usually caused by an embolus: reversible and blood is restored in a short time

Question 7

What investigations can be done to confirm a stroke?

Answer 7

Bloods: glucose, FBC, lipid , coagulation screen, ESR
CT brain
MRI brain
CT angiography and MR angiography
Carotid ultrasound
Echocardiography:

Question 8

What is the acute management of a TIA?

Answer 8

1) 300mg aspirin
2) Referral for assessment within 24 hours by a stroke specialist clinician
Screen for atrial fibrillation and carotid stenosis*
3) confirmed TIA and not at high risk for haemorrhage
3A) dual antiplatelets for 21 days: i.e., continue aspirin at 75mg daily
3B) load additionally with clopidogrel 300mg stat, then 75mg daily

Initiate secondary prevention: lifestyle advice, statin, smoking cessation, hypertension and diabetes management

Question 9

What are some red flags for headaches?

Answer 9

Headache that is new or unexpected in an individual patient
* Thunderclap headache (intense headache with abrupt or “explosive” onset)
* Headache with atypical aura (duration >1 hour, or including motor
weakness)
* Aura occurring for the first time in a patient during use of combined oral
contraceptives
* New onset headache in a patient older than 50 years
* New onset headache in a patient younger than 10 years
* Persistent morning headache with nausea
* Progressive headache, worsening over weeks or longer
* Headache associated with postural change
* New onset headache in a patient with a history of cancer
* New onset headache in a patient with a history of HIV infection.

Question 10

what is cerebral venous thrombosis?

Answer 10

Thrombosis in the cerebral veins or ductal sinuses and causes obstruction to the drainage of the BBB and causes pressure.
Occlusion of dural sinus causes decreased cerebrospinal
fluid (CSF) absorption and elevated intracranial
pressure

Question 11

What is are sign that are related to headaches caused by neoplasm?

Answer 11

Headache secondary to neoplasm characteristics:
* Progressive
* Worse in the morning and/or when lying
down
* Aggravated by Valsalva-like manœuvres
* Accompanied by nausea and/or vomiting