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3A > Neurology - Bleeding > Flashcards

Neurology - Bleeding Flashcards

1
Q

SAH causes

A

ANEURYSM
- RF - HTN, PKD, AVM

Common places for aneurysm

  • ACA and anterior communicating
  • MCA bifurcation
  • Posterior communicating and internal carotid
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2
Q

SAH presentation

A 
Thunderclap headache 
Worst headache ever
Sudden onset
Meningism
FND 
Vomiting 
CN3 palsy 
LOC 
Seizure 
Reduced GCS
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3
Q

SAH investigations

A

CT - STAR SHAPED LESION IN BASAL CISTERN

LP - Xanthochromia, protein

ECG - Long QT, ST elevation

Ophthalmoscopy

  • Loss of light reflex
  • Intraocular haemorrhage
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4
Q

SAH management

A

Endovascular coiling
Nimodipine - Reduces spasm
Ventriculoperitoneal shunt to reduce ICP

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5
Q

SAH complications

A 
Re-bleed - 20%
Vasospasm - Stroke
Hyponatraemia 
Hydrocephalus 
Loss of sympathetic reflex - HTN
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6
Q

SDH causes

A

Tear in bridging veins
Alcoholics
Elderly - Anticoags
Shaken babies

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7
Q

SDH presentation

A 
Previous head trauma - Up to 9 months 
LOC 
FND 
Headache 
Personality changes 
Change in GCS
^ ICP
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8
Q

SDH investigations

A

CT - Concave lesion
Midline shift - Not limited by suture lines

Bright on CT - New
Dark on CT - Old

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9
Q

SDH management

A

Burr holes
Craniotomy

Old - Conservative management unless symptoms

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10
Q

EDH causes

A

Head trauma - Pterion
Tearing of middle meningeal artery - 90%
Dural venous sinus - 10%

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11
Q

EDH presentation

A 
Trauma - Lucid interval (hours) - Change in GCS
Headache 
^ ICP
Brisk reflexes 
Upward plantars

Skull fracture

  • Asymmetrical face
  • CSF rhinorrhoea
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12
Q

EDH investigations

A

CT - Convex lesion - Does not cross suture lines
XR - Skull fracture
LP contraindicated

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13
Q

EDH management

A

Burr holes

^ ICP - Mannitol

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14
Q

Total anterior stroke

A

ACA
MCA

Presentation

  • Unilateral weakness
  • Homonymous hemianopia
  • Higher cognitive disorder - Dysphasia?
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15
Q

Partial anterior stroke

A

Part of ACA or MCA

2 of…

  • Unilateral weakness
  • Homonymous hemianopia
  • Higher cognitive disorder - Dysphasia?
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16
Q

Posterior stroke

A

Vertebrobasilar

Presentation

  • LOC
  • Isolated homonymous hemianopia
  • Cerebellar disorder
  • CN palsy
  • Contralateral motor/sensory deficit
17
Q

Lacunar stroke

A

Perforating arteries

Presentation

  • Pure motor
  • Pure sensory
  • Ataxic hemiparesis
  • Mixed sensory motor
18
Q

ACA stroke

A

Hemiparesis

Sensory loss in LOWER

19
Q

MCA stroke

A

Hemiparesis

Sensory loss in UPPER

20
Q

Weber stroke

A

PCA

CN3
Contralateral hemiparesis

21
Q

Wallenberg

A

PICA

Ipsilateral

  • Sensory loss of pain
  • Loss of gag reflex
  • Hoarse voice
  • Cerebellar signs
  • Horner’s syndrome

Contralateral
- Sensory loss of pain

22
Q

Lateral pontine syndrome

A

AICA

Ipsilateral

  • Sensory loss of pain
  • Loss of gag reflex
  • Hoarse voice
  • Cerebellar signs
  • Horner’s syndrome
  • FACIAL PARALYSIS
  • DEAFNESS

Contralateral
- Sensory loss of pain

23
Q

Locked in syndrome

A

Basilar

Unable to move except eyes and extra-ocular muscles

24
Q

Wernicke’s aphasia

A

Receptive

Superior temporal gyrus
MCA

Sentences do not make sense
Speech fluent
Comprehension impaired

25
Q

Broca’s aphasia

A

Expressive

Inferior frontal gyrus
MCA

Non-fluent speech
Comprehension normal

26
Q

Conduction aphasia

A

Arcuate fasciculus - Connects Broca to Wernicke

Fluent speech
Poor repetition
Aware of errors
Comprehension normal

27
Q

Global aphasia

A

Affects all 3 areas

Carnage

28
Q

Stroke investigations

A

Bloods

  • Glucose
  • LFT
  • Clotting
  • INR
  • Prothrombin

URGENT CT!!!

29
Q

Ischaemic stroke management

A 
ABC 
Monitor BP - DO NOT CORRECT
Monitor BM 
300mg Aspirin - After excluding haemorrhage
< 4.5 hours - Thrombolysis - Alteplase

Surgery - Thrombectomy - WITHIN 6 HOURS

30
Q

Thrombolysis contraindications

A

> 4.5 hours / unknown time of onset
3 hours if > 80

Seizure at onset

Aneurysm
Tumour
Previous head injury

Anticoags
Clotting disorder
Liver disease

31
Q

Stroke secondary prevention

A

Aspirin 300mg for 2 weeks

THEN

Clopidogrel 75mg for life

Statin if > 3.5mmol after 48 hours

AF - Anticoags after 14 days

32
Q

Haemorrhagic stroke management

A

Factor 7A

Vit K to reverse warfarin
Protamine to reverse heparin

Seizures - Lamotrigine
ICP - Mannitol
BP - BB

Surgical evacuation

33
Q

TIA definition

A

Stroke with symptoms lasting < 24 hours

34
Q

TIA investigations

A

24 hour ECG
MRI
Carotid doppler

35
Q

TIA management

A

300mg Aspirin

< 7 days ago - Review in 24 hours
> 7 days ago - Review in 7 days

Statin
Lifestyle changes

Carotid endarterectomy within 2 weeks if occlusion > 70%

3A (31 decks)

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