Neurology Flashcards
What is the difference between stroke and TIA? 2 things
Stroke
Lasts more than 24hours
Residual recovery
TIA
Lasts seconds - 24hours
Complete recovery
Give 3 main pathologies underlying Cerebral vascular accidents?
Embolism
Thrombosis
Haemorrhage
Give 5 risk factors for stroke?
HEADS Hypertension/Hyperlipidemia Elderly Atrial fibrllation Diabetes Smoking & Alcohol
How can you recognise a Total/Partial anterior circulation (TAC/PAC) stroke?
TAC:
Higher dysfunction (aphasia, visuospatial disturbance, decreased conscious levels)
Homonymous heminopia
Hemiparesis (2 of arm, face or leg)
PAC:
2/3 of above
Symptoms must be same side or else its not a stroke
How can you recognise a Posterior circulation (POCS) stroke?
VANISH'D Vertigo Ataxia Nystagmus Intention tremor Slurred speech (Also in TAC/PAC) Heel-shin test (+ve) Dysdiaodochokinesis Broad based walking gait
How can you recognise a Lacunar (LACS) stroke?
Pure motor
Pure sensory
Ataxic hemiparesis
Which investigations will you do when suspecting a stroke? 6 things
CT head (within 24 hrs) - rule out bleed US carotids - stenosis is risk factor ECG - AF is risk factor FBC - polycythamia Cholesterol - risk factor Glucose - hypoglycaemia CRP/ESR - temporal arteritis
What 3 factors need to be in place for thrombolysing a stroke patient?
Expert team in place (neuroimaging/clinicians)
Patient seen within 4.5hrs of symptom onset
No contraindications exist
Give 5 contraindications to thrombolysing a stroke patient?
Major infarct or haemorrhage on CT Mild (non disabling) deficits Recent surgery/trauma/obstetric delivery Past CNS haemorrhage Seizures at presentation
Suggest 4 primary prevention steps for stroke?
Control risk factors: hypertension, diabetes, cholesterol, cardiac disease
Exercise
Quit smoking
Suggest 3 secondary prevention steps for stroke?
Control risk factors like primary prevention
Aspirin (75mg daily)
Warfarin (if embolic or AF 2 weeks after stroke)
What does the DVLA say about stroke/TIA?
No driving for 1 month after episode
If a patient experiences a TIA, how can you assess the risk of getting a stroke?
ABCD2 score Age > 60y/o Blood pressure >140/90 Clinical features: -unilateral weakness (2) -speech disturbance Duration of symptoms: -more than 1hr (2) -less than 1hr Diabetes
Score More than 4 = specialist review within 24hrs
Otherwise within 7 days
What is the classical triad of signs in Parkinsonism?
Tremor
Rigidity
Bradkinesia/Hypokinesia
Name 4 professionals involved in the management of Parkisons disease?
Neurologist Physiotherapist Social worker GP OT
What are the risk factors for epilepsy? 4 risk factors
Congenital/developmental disorders (ie migrational disorders) Infections Febrile convulsions in early life Head injury Brain tumour
Give 4 seizure triggers?
Flashing lights
Infection/Fever
Sleep deprivation
Stress
What does the DVLA say about Epilepsy?
Need to be seizure free for >1yr to drive
What are partial seizures and describe them?
Focal onset of seizures referable to one part of the hemisphere
Simple partial seizure: Awareness unimpaired. No post-ictal symptoms
Complex partial seizure: Awareness impaired. More likely post-ictal symptoms
What are the different types of primary generalised seizures? 4 types
Absence: Brief <10secs pauses
Tonic-clonic: Loss of consciousness, limb stiffen (tonic) then jerk (clonic). Post-ictal confusion and drowsiness
Myoclonic: Sudden jerk of a limb, face or trunk
Atonic (akinetic): Sudden loss of muscle tone
Name 3 drugs which are useful for managing epilepsy?
Sodium valproate
Lamotrigine (better tolerated, less teratogenic)
Carbamezapine
What is status epilepticus?
Condition where the brain is in a constant state of seizure > 5mins
Name 4 types of drugs used in treating parkinsons disease?
Dopamine - Levodopa with decarboxylase inhibitor
Dopamine agonist
Anticholinergics
MAO-B inhibitors
Give 6 possible triggers of migraine?
CHOCOLATE CHeese Oral contraceptives Caffeine alcohOL Travel Exercise
How can manage migraines in the acute phase and long term? 5 things
Acute:
Simple analgesics
Anti-emetics
Long term:
Avoid triggers
Triptans (sumatriptan)
Prophylaxis if > 2 attacks/month (B-blockers, Seratonin antagonists, Amytriptylline)
Give 5 professionals that might be involved in the management of a stroke patients?
Occupational Therapists Physiotherapists Speech and Language therapist Dietician Counsellors Social workers
State 6 possible complications of a stroke?
Infection (aspiration pneumonia, UTI, septicaemia) Thromboembolism (PE, DVT) Hydration and nutritional difficulties Seizures Pressure sores Seizures Depression
Suggest 4 implications of a diagnosis of epilepsy might have on a patient?
Driving (only after 1yr of seizure free)
Cannot operate heavy machinery or drive HGVs
Unable to work in armed forces, pilot or train driver
Have showers instead of baths incase of seizure
Give 4 presentation symptoms of multiple sclerosis?
Usually mono symptomatic:
Unilateral optic neuritis
Numbness/Tingling in limbs
Leg weakness
Brainstem/Cerebellar symptoms - DANISH (Dysdiadochokinesis, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia)
Give 3 possible causes of a subarachnoid haemorrhage?
Rupture of berry aneurysm
Congenital AV malformations
Trauma
State 2 diagnostic investigations for a subarachnoid and what you will see?
CT head -Obvious bleed
Lumbar puncture - CSF will be bloody or xanthachromic due to blood breakdown (billirubin)
Give the definitive treatment for subarachnoid haemorrhage?
Obliteration of aneurysm by surgical clipping OR
insertion of fine wire coil
State 4 possible complications of subarachnoid haemorrhage?
Rebleeding Cerebral ischaemia Hydrocephalus Stroke Death
How might a sub dural haemorrhage present?
Fluctuating levels of consciousness +/- intellectual slowing, sleepiness, headache, personality change
What is the management of a sub dural haemorrhage?
Irrigation/evacuation via:
1st - Burr hole craniostomy
2nd - Craniotomy
Give 4 causative organisms of meningitis?
Neisseria Meningitides
Streptococcus pneumoniae
Enteroviruses
Mycobacterium tuberculosis
Apart from blood tests, which investigations can you do in meningitis and what order?
CT head to rule out high ICP then lumbar puncture as there is risk of coning
Describe 3 differences seen on analysis of the CSF between viral and bacterial meningitis?
Appearence: Viral clear vs Bacterial cloudy
Glucose levels: Viral normal vs Bacterial low
Protein levels: Viral low vs Bacterial high
Organisms on stain/culture: Viral non seen vs Bacterial seen
Give 4 steps in the immediate management of meningitis?
ABC - O2, fluids
Abx - Benzyl penicillin, Cefotaxime, ?Aciclovir
Dexamethasone
Investigations (CT/LP)
State 3 possible complications of meningitis?
Hydrocephalus
Brain abscess
Epilepsy
Focal neurological deficits
State 4 features of myopathic facies?
Snarl Poor smile Looks sad Unable to whistle Drooping mouth
Give 3 ways in which you can manage mysthania gravis?
Anticholinesterase medication (neostigmine)
Corticosteroids
Immunosuppressors (azothioprine)
Plasmaphoresis
Give 5 possible causes of falls in the elderly?
Postural hypotension Joint problems/instability (OA) Muscular weakness (proximal myopathy, hemiparesis, diabetic neuropathy) Visual problems (macular degeneration) Balance problems (inner ear disease Epilepsy
In bacterial meningitis what will you have to do for public health measures?
Prevention household and other close contacts have to be given abx prophylaxis (rifampicin for 2 days). Also Vaccination against serogroups A and C
State 4 possible sideeffects seen in long term L-DOPA treatment of parkinsons disease?
End-of-dose deterioration of function
On/off oscillations
Freezing during movement
Dose failure (drug resistance)
Where would you perform a lumbar puncture?
Plane of iliac crests through the level L3/4
