Neurology Flashcards
Name 5 causes of cerebellar lesions
VITAMIN C Vascular Inflammatory - MS Trauma Alcohol Metabolic Iatrogenic - Phenytoin and carbamazepine Neoplastic Congenital - Friedrichs ataxia
What is Fredrich’s ataxia
AR trinucleotide repeat disorder
GAA - chromosome 9
Name 3 presentations of Fredrich’s ataxia
kyphoscoliosis Spinocerebellar tract degeneration HOCM DM Cerebellar ataxia optic atrophy High arched palette
How does a lesion of the cerebellar vermis present
Truncal ataxia
gait instability
How does a lesion of cerebellar hemisphere present
Ipsilateral limb signs
Name 5 risk factors for an ischaemic stroke
Male FHx of stroke - < 60 Old age smoking AF Hypercholesterolaemia DM Alcohol
Name 4 causes of ischaemic stroke
Cardiac emboli - AF / IE
Atherothromboembolism - Carotid artery
Systemic hypoperfusion - cardiac arrest
Describe the investigations in an acute suspected stroke
1st line - CT scan
Others
- MRI with DWI
- Carotid artery USS
- Echo
- ECG +/- 72 hr tape
- Bloods
Describe the management of acute stroke <4.5 hours
< 4.5 hours
IV Alteplase
repeat CT 24 hrs after
300 mg Aspirin
Describe the management of acute stroke > 4.5 hrs
> 4.5 hrs 300mg Aspirin (2 weeks) 75 mg Clopidogrel (lifelong)
When is mechanical thrombectomy offered
Patient with Anterior circulation stroke within 6hrs
Name 4 CI to IV alteplase in stroke
Haemorrhagic stroke Unstable BP INR - High Recent head trauma GI bleed Recent surgery Platelet count
Describe secondary prevention for strokes
HALTSS
HTN - Anti-hypertensives
Antiplatelet - Clopidogrel 75mg
Lipids - Atorvastatin
Tobacco - smoking cessation
Sugar - DM screen
Surgery - >50% Ipsilateral carotid artery stenosis –> carotid endarterectomy
How should a patient diagnosed with AF following a stroke be treated differently in secondary prevention
HALTSS - A is different
Initiate Warfarin or DOAC 2 weeks post stroke
STROKE PRESENTATION
TACI
ACA + MCA
ALL 3 REQUIRED
contralateral weakness +/- sensory deficits of face / arm / legs \+ contralateral homonymous hemianopia \+ Higher cerebral dysfunction - aphasia - neglect
STROKE PRESENTATION
PACI
ACA OR MCA
2 REQUIRED
contralateral weakness +/- sensory deficits of face / arm / legs
+
contralateral homonymous hemianopia
OR - This alone
Higher cerebral dysfunction alone
STROKE PRESENTATION
Lacunar stroke
Pure: - motor - sensory - sensorimotor OR Ataxic hemiparesis
STROKE PRESENTATION
Posterior circulation infarct
Cerebellar dysfunction OR Conjugate eye movement disorder OR Bilateral motor/sensory deficit OR Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit OR Cortical blindness/isolated hemianopia.
What are the rules following a stroke and driving
No driving for 1 month
Don’t have to inform DVLA
HAEMORRHAGIC STROKE
Name 4 risk factors
older age FHx Malignancy Anti-coagulants cocaine Haemophilia vasculitis
HAEMORRHAGIC STROKE
Name 3 causes of a haemorrhagic stroke
ruptured cerebral artery
trauma
AV malformation
reperfusion injury - ischaemic stroke
HAEMORRHAGIC STROKE
Describe the management
conservative
- BP
- lifestyle advice
Medical
- Stop anti-coag and anti-platelet
- Factor 7 concentrate
- Antihypertensive (Beta blocker / CCB)
- Nimodipine (vasospasm)
Surgical
- Clipping
- Coiling
HAEMORRHAGIC STROKE
Name the reversal agents for
- warfarin
- heparin
- LMWH
- Apixaban
warfarin
- Beri plex
- vitamin K
Heparin
- protamine
LMWH
- Protamine
Apixaban
- Beri plex
Describe the ABCD2 risk score
A > 60
B - BP >140/80
Clinical features
Unilateral weakness(2)
speech impairment without weakness (1)
Duration
> 60 mins (2)
<59 mins (1)
D - Diabetes (1)
Describe how raised ICP presents
Headache - worse on lying down/bending/coughing papilledema seizures reduced consciousness - GCS N+V - relieves headache Cushigs triad
What is Cushing’s triad and what presentation is it commonly found in
Raised ICP
Raised BP
Reduced HR
Irregular breathing
Name 2 causes of raised ICP
Meningitis
haemorrhages
SOL
Hydrocephalus
What is the management of raised ICP
Bed rest and head elevation
IV mannitol
Name 4 risk factors for SAH
Family hx previous aneurysmal SAH Smoking alcohol PCKD Increased BP
Name 4 causes of a SAH
Aneurysmal
- ADPCK
- Rupture of berry aneurysm
- atherosclerosis
- HTN
Non aneurysmal
- Trauma
- AVM
- Coagulopathies
How does a SAH present
Thunderclap headache N+V Reduced GCS Double vision Meningism - photophobia / neck stiffness / pain on flexion Seizure Kernig's sign 3rd CN palsy - PCA aneurysm
Describe the investigations for a SAH
Non contrast CT head
Serial LP - If CT -ve but clinical signs present
- 12 hrs post sx onset
- Xanthochromia
Name 4 SAH complications
re-bleeding hydrocephalus Vasospasm Hyponatraemia seizures
What is the management of a SAH
ABCDE
Analgesia and anti-emetics
Nimodipine
Clipping / coiling
Describe the flow of CSF
Lateral ventricles Foramen of monro 3rd ventricle cerebral aqueduct 4th ventricle - central spinal canal - SA cisterns
GCS
Describe the scoring system for eye opening
Spontaneous - 4
To sound - 3
To pain - 2
No response - 1
Not testable
GCS
Describe the scoring system for verbal response
Can you tell me your name
Do you know where you are
Do you know the date today
Orientated response - 5
confused conversation- 4
Inappropriate / random words - 3
Incomprehensible - 2
No response - 1
GCS
Describe the scoring system for motor response
Obeys commands- 6
- 2 part command
Localises to pain - 5
- trapezius squeeze
- supraorbital notch
Withdraws to pain - 4
- flexion response
Abnormal flexion response to pain - 3
- decorticate posturing
Abnormal extension response - 2
- Decerebrate posturing
No response - 1