Neurology Flashcards
What percentage of strokes are due to intracranial bleeds?
10-20%
What are some risk factors for intracranial bleeds?
Hypertension Head injury Aneurysms Ischaemic stroke --> haemorrhage Brain tumours Anti-coagulations ie Warfarin
How might a patient with an intracranial bleed present?
Sudden onset headache Seizures Reduced consciousness Weakness Vomiting Sudden onset neurological symptoms
What causes a subdural haemorrhage?
Rupture of bridging veins
How does a subdural haemorrhage appear on a CT?
Crescent shape not limited by cranial sutures
In what population groups are subdural haemorrhages most likely to occur?
Why?
Elderly
Alcoholics
Brain more atrophied –> bridging vessels more likely to rupture
A subdural haemorrhage occurs between which layers of the meninges?
Dura mater
Arachnoid mater
What usually causes an extradural haemorrhage?
Rupture of the middle meningeal artery
Often associated with fracture of the temporal bone
Between what layers of the cranium, does an extradural haemorrhage occur?
Skull and dura mater
How does an extradural haemorrhage appear on a CT?
Bi-convex shape
Limited by sutures
How does an intracerebral haemorrhage present?
Similarly to an ischaemic stroke
What are the principles of managing a patient who has an intracerebral haemorrhage?
A-E assessment
Urgent head CT
FBC and clotting (correct any clotting abnormalities)
Management in a stroke unit
? neurosurgical input
Consider intubation, ventilation and ITU if drop GCS
Correct severe hypertension
Where does a SAH occur?
Subarachnoid space between the Pia mater and the arachnoid membrane
What symptoms are associated with a SAH?
Sudden onset occipital headache “thunder clap”
Neck stiffness
Photophobia
Neurological symptoms - visual changes, speech changes, weakness, seizures, LOC
What are risk factors for SAH?
HTN Smoking Excessive alcohol consumption Cocaine FHx
in what groups of people are SAH most common in?
Black people
Females
45-70 years
What is SAH particularly associated with?
Cocaine use
Sickle cell anaemia
Connective tissue disorders (E-D, Marfans)
Neurofibromatosis
What investigations should be performed in patents with ?SAH?
Urgent Head CT (hyperattenuation in the subarachnoid space)
If CT negative, after 12 hours –> LP (raised RBC, xanthochromia)
CT/MRI angiography - located site of bleed
What ECG changes may be seen in SAH?
Inverted T waves
Elevated ST
How should a patient with SAH be managed?
Neurosurgically
- Endovascular coiling
- Neurosurgical clipping
MDT approach (SALT, physio, OT, nursing)
What drug should be prescribed to patients with SAH to prevent further complications?
Nimodipine (Ca channel blocker - prevents vasospasm)
Define a TIA
Transient neurological dysfunction secondary to ischaemia without infarction
What is a crescendo TIA?
Two or more TIAs occurring within a week - carries a high risk of progressing to a stroke
How does a stroke present?
Sudden onset of neurological symptoms which are asymmetrical Sudden weakness of limbs Sudden facial weakness Sudden dysphagia Sudden visual/sensory changes
Give some risk factors of stroke
Cardiovascular disease - angina, MI, PVD Previous stroke, TIA AF Carotid artery disease DM Vasculitis Thrombocytopenia
Modifiable:
HTN
Smoking
OCCP
What scoring tool can be used in hospital to determine the likelihood of a patient having a stroke?
ROSIER
What scoring tool can be used to assess the likelihood of a patient with a suspected TIA having a subsequent stroke?
ABCD2
Define the ABCD2
A = Age (>60 = 1 pt) B = BP (>140/90 = 1 pt) C = Clinical features (unilateral weakness = 2 pt; dysphagia without weakness = 1 pt) D = Duration (> 60 min = 2 pt; 10-60 min = 1 pt; <10 min = 0 pt) D = Diabetes = 1 pt
What is the significance of a ABCD2 score in terms of need to see a specialist?
<3 = specialist assessment within 1 week >3 = specialist assessment within 1 week
How should a stroke be managed?
A - E assessment
Exclude hyperglycaemia
Urgent Head CT (exclude haemorrhagic cause)
Aspirin 300mg (only if no haemorrhage) - continue for 2 weeks
Admit to specialist Stroke Unit
What is the timeframe for potential thrombolysis treatment in the management of ischaemic stroke?
Within 4.5 hours of symptoms
What is the timeframe for potential thrombectomy in the management of ischaemic stroke ?
Within 6 hours
How should a TIA be managed?
300mg Aspirin
Perform ABCD2 score
Secondary prevention
What are the secondary prevention methods in TIA management?
Aspirin for 2 weeks then…
Clopidogrel 75mg OD (dipyridamole + aspirin)
Atorvastatin 80mg
Assess for carotid artery disease –> stenting or carotid endartectomy
Treat modifiable risk factors
Who makes up the MDT in a stroke patient?
Nurses SALT OT Physios Social services Dieticians Optometery and ophthalmology Psychology Orthotics
