Neurology Brief Flashcards
what is the new definition of a TIA
ischaemia without infarction
what is as crescendo TIA
two or more TIAs within a week
carries high risk of developing into a stroke
what is alteplase
tissue plasminogen activator
management of stroke
- exclude hypoglycaemia
- immediate CT head to exclude haemorrhage
- aspirin 300mg stat and continued for 2 weeks
- alteplase if within 4.5 hrs of onset of symptoms
- monitoring for post thrombolysis complications
- repeated CT head
- monitoring for post thrombolysis complications
- admit to specialist stroke centre
- diffusion weighted MRI is gold standard imaging
- carotid ultrasound if carotid stenosis is suspected
management of TIA
300mg aspirin daily
referred and seen within 24hrs by stroke specialist
start secondary prevention for cardiovascular disease
management of carotid stenosis
endarterectomy to remove plaques
carotid stenting to widen lumen
what is the secondary prevention of stroke
clopidogrel 75mg once daily
carotid endarterectomy or stenting in patients with carotid disease
treat modifiable risk factors
what percentage of strokes are caused by intracranial bleeds
10-20%
draw out the glasgow coma scale

what causes subdural haemorrhage
rupture of bridging veins in the outermost meningeal layers between dura mater and arachnoid mater
CT scan appearance of subdural haemorrhage
crescent shape and not limited by cranial sutures
which population of patients is most likely to have a subdural haemorrhage
the elderly and alcoholics
they have atrophy and vessels are more likely to rupture
which artery in which region is most likely to cause a extradural haemorrhage
middle meningeal artery in the temporo-parietal region
this can be associated with a fracture of the parietal bone
CT appearance of an extradural haemorrhage
egg shaped and limited by cranial sutures
Typical history is a patient with a traumatic head injury and ongoing headache.
They have a period of improved neurological symptoms and consciousness followed by a rapid decline over hours.
What sort of bleed is this?
extradural haemorrhage
other features of a subarachnoid haemorrhage other than thunderclap headache
neck stiffness
photophobia
vision changes
neurological symptoms
risk factors for subarachnoid haemorrhage
- hypertension
- smoking
- excessive alcohol consumption
- cocaine use
- family history
- black ethnicity
- female sex
- age 45-70
- sickle cell anaemia
- neurofibromatosis
- autosomal dominant polycystic kidney disease
- connective tissue disorders
investigations for subarachnoid haemorrhage
CT head will show hyperattenuation in the subarachnoid space
LP will show raised red cells and xanthochromia
CT or MRI angiography to locate source of bleeding
management of subarachnoid haemorrhage
- surgery
- coiling (endovascular)
- clipping (cranial surgery)
- Nimodipine
- CCB
- to prevent vasospasm and ischaemia following SAH
- LP or Shunt for hydrocephalus
- antiepileptic meds for seizures
multiple sclerosis only affects the neurons of the _______ nervous system where the myelin is formed by ________
multiple sclerosis only affects the neurons of the central nervous system where the myelin is formed by oligodendrocytes
internuclear opthalmoplegia presents how and how is it caused
- one eye lags behind the other
- the affected eye adducts minimally
- they have diplopia
*
what is lhermitte’s sign
electric shock sensation when neck is stretched in patients with MS
what are the two types of ataxia and what are the differences
- sensory ataxia - problem with proprioceptive sense
- results in positive rombergs
- can cause pseudoathetosis
- cerebellar ataxia
- result of problems with the cerebellum coordinating movement
- suggests cerebellar lesions
what is a clinically isolated syndrome in MS
first episode of demyelination and neurological signs and symptoms
MS cannot be diagnosed at this point as the lesions are not ‘disseminated in time and space’
pts with clinically isolated syndrome may never have another episode or develop MS
if lesions seen on MRI then they are more likely to progress to MS
