Neurology Flashcards
What is morton’s neuroma?
A benign neuroma affecting the intermetatarsal plantar nerve, most commonly the third inter-metatarsophalangeal space
Features of morton’s neuroma?
Forefoot pain, worse on walking (like a pebble in their shoe) or a burning paiin
Mulder’s click - hold the neuroma between finger and thumb. Other hand squeezes the metatarsals together. Click may be heard
Distal loss of sensation
How to treat morton’s neuroma?
Avoid high-heels
Metatarsal pad
Corticosteroid injection
Proportion of ischaemic to haemorrhagic stroke
85% ischaemic
15% haemorrhagic
Risk factors of ischaemic stroke
Age HTN Smoking Hyperlipidaemia DM AF
Risk factors for haemorrhagic stroke
Age
HTN
AVM
Anticoagulation therapy
What classification system do we use for strokes?
Oxford Stroke Classification
Bamford classification
Total anterior circulation stroke
A large stroke affecting areas supplied by middle and anterior arteries
Needs all 3 of:
Unilateral weakness (and/or sensory deficit) of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Partial anterior circulation stroke
Just the anterior circulation is compromised
2/3 of:
Unilateral weakness (sensory deficit) of face, arm, leg
Homonymous hemianopia
Higher cerebral dysfunction (visuospatial disorder, dysphagia)
Posterior circulation syndrome
Damage to the area of the brain supplied by the posterior circulation
One of the following required:
Cranial nerve palsy + contralateral deficit
Bilateral motor/sensory deficit
Horizontal gaze palsy
Cerebellar dysfunction (vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
Lacunar syndrome
Subcorticol stroke secondary to small vessel disease
No loss of higher cerebral functions
One of the following: Pure sensory stroke Pure motor stroke Sensori-motor stroke Ataxic hemiparesis
What is the ROSIER score?
A scoring system for stroke. If score is >0, stroke is the likely diagnosis
Aspirin and stroke
Aspirin 300mg orally/rectally as soon as haemorrhagic stroke has been excluded
Thrombolysis
Thrombolysis with alteplase should be given if:
Within 4.5 hours of onset of stroke symptoms
Haemorrhage definitely excluded
Thrombolysis contraindications
Previous intracranial haemorrhage Seizure with stroke Stroke/traumatic brain injury past 3 months Active bleeding GI bleeding type problems
Thrombectomy
Within 6 hours of symptom onset
If ischaemic stroke in the proximal anterior circulation confirmed by CTA/MRA
Statins and anticoagulants
Statins shouldn’t be started till 48 hours after stroke
Anticoagulants shouldn’t be started for 2 weeks after stroke
Secondary prevention of stroke
Clopidogrel 75mg daily
Aspirin plus dipyramidole if clopidogrel is contraindicated
Transient ischaemic attack
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemic, without acute infarction
Treatment of TIA
Give aspirin, 300mg immediately
If patient has had multiple TIAs, discuss the need for admission or observation with stroke specialist
Clopidogrel long term
When should carotid artery endarterectomy be considered
Stroke/TIA in carotid territory
Carotid stenosis >70%
What is the first-line investigation in stroke
Non-contrast CT head scan
Extradural haematoma
Collection of blood between the skull and the dura
Extradural haematoma CT scan
Biconvex collection around the edge of the brain (oval coming from the edge)