Neurology Flashcards
What is a transient ischaemic attack?
transient episode of neurological dysfunction
caused by focal brain, spinal cord, or retinal ischaemia
without acute infarction
What are the risk factors fro a TIA?
Older age
Male
Previous TIA
Smoking
Physical inactivity
Hypertension
AF
Carotid artery disease
Hyperlipidaemia
Diabetes
How does a TIA present?
Sudden onset of+ resolves within an hour:
Unilateral weakness or sensory loss
Aphasia or dysarthria
Ataxia, vertigo or loss of balance
Visual problems
How are TIAs investigated?
MRI head
Carotid Doppler
What medication given in a TIA?
Aspirin 300mg
What is given to prevent TIAs?
Clopidogrel (if can’t tolerate - aspirin + dipyridamole)
Statin (atorvastatin)
Carotid endarectomy (>70% carotid stenosis)
What is a stroke?
Sudden onset neurological deficit
Due to ishaemic or haemorrhagic compromise in the blood supply to the brain
Lasts more than 24 hours/evidence of infarction
What is an ischaemic stroke?
Vascular occlusion or stenosis causing inadequate blood flow to parts of the brain
What is a haemorrhagic stroke?
Vascular rupture of a vessel in the brain causing haemorrhage
What are the identification tools used to identify ischaemic strokes?
FAST (community)
ROSIER score (hospital)
How is an ischaemic stroke investigated?
Blood glucose (hypoglycaemia?)
Non-contrast CT head (haemorrhage?)
MRI (shows vascular territory effected)
How is an ischaemic stroke managed?
Thrombolysis with ateplase
Mechanical thrombectomy
Aspirin 300mg daily for 2 weeks
No driving for 1 month
What are the contraindications for thrombolysis with ateplase?
Active internal bleeding
Recent haemorrhage
Recent surgery
Recent head injury
Bleeding disorder/coagulation
Stroke < 3 months
Sever hypertension
How are strokes classified?
Bamford/oxford stroke classification
What is the criteria for a total anterior circulation stroke (TACS)?
All 3 of:
- unilateral weakness (+/- sensory deficit) of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
What is the criteria for a partial anterior circulation stroke (PACS)?
Any 2 of:
- unilateral weakness (+/- sensory deficit) of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
What is the criteria for lacunar syndrome (LACS)?
1 of:
- pure sensory stroke
- pure motor stroke
-sensory-motor stroke
- ataxic hemiparesis
What is the criteria for posterior circulation syndrome (POCS)?
1 of:
- cranial nerve palsy + a contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder (e.g., gaze palsy)
- cerebellar dysfunction (e.g., ataxia, nystagmus, vertigo)
- isolated homonymous hemianopia or cortical blindness
What does a lesion in the anterior cerebral artery cause?
Contralateral hemiparesis + sensory loss in lower extremity > upper
What does a lesion in the middle cerebral artery cause?
Contralateral hemiparesis + sensory loss in lower extremity > upper
Contralateral homonymous hemianopia
Aphasia
What does a lesion in the posterior cerebral artery cause?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
What does weber’s syndrome cause?
Weber’s - branches of the posterior cerebral artery that supply the midbrain
Ipsilateral CN 3 palsy
Contralateral weakness of upper and lower extremity
What does a lesion in the posterior inferior cerebellar artery cause?
(Lateral medullary syndrome/Wallenberg syndrome)
Ipsilateral: facial pain + temperature loss
Contralateral: limb/torso pain + temperature loss
Ataxia, nystagmus
What does a lesion in the anterior inferior cerebellar artery cause?
(Lateral pontine syndrome)
Similar to Wallenberg’s but:
Ipsilateral: facial paralysis + deafness
What does a lesion in the retinal/opthalmic artery cause?
Amaurosis fugax (temporary vision loss in 1 or both eyes due to lack of blood flow to the retina)
What does a lesion in the basilar artery cause?
‘Locked- in’ syndrome
What is Cushing’s triad?
Bradycardia
Irregular respirations
Hypertension
How can a raised intercranial pressure be treated in a haemorrhagic stroke?
Mannitol
How can a raised intercranial pressure be treated in a haemorrhagic stroke?
Mannitol
Where does a intracerebral haemorrhage most commonly occur?
Basal ganglia
Where does a intracerebral haemorrhage most commonly occur?
Basal ganglia
