Neurology - stroke and haemorrhage

Question 1

What are the tests for for subarachnoid haemorrhage?

Answer 1

CT - white star

12 hours - 2-4 weeks after do an LP - CSF xanthochromia

Question 2

How would you treat a subarachnoid haemorrhage?

Answer 2

surgical clipping
endovascular coiling
can help maintain cerebral perfusion with nimodipine

Question 3

What are the investigations you would do for suspected subarachnoid hameorrhage? What is +?

Answer 3

CT - star shaped white ventricles
LP - oxyhaemoglobin, xaenthechromia
Keep charting BP, pupils and GCS

Question 4

What is the treatment for ischaemic stroke?

Answer 4

Thrombolysis - 4.5 hours after symptoms appear max
- exclude haemorrhagic by CT/MRI
Thrombectomy - 6 hours after symptoms start max

Question 5

Name 3 differentials of a stroke

Answer 5

migraine
hypoglycaemia
Bell’s palsy (infection)
Todd’s paraesis (seizure)

Question 6

What investigations do you do when you suspect a stroke?

Answer 6

CT, MRI
glucose
ECG, echo

Question 7

How would you treat haemorrhage stroke?

Answer 7

BP < 140/80
GTN 
labetalol 5mg - 10mg - 20mg - blous 
check platelets and clotting - can give platelet transfusion  
if on warfarin give Vit K 
SURGERY

Question 8

How would you treat ischaemic stroke?

Answer 8

Thrombosis
Thrombectomy
do not control BP until 24 hours after

Question 9

What is the most common condition to cause an ischaemic stroke?

Answer 9

Carotid stenosis

Question 10

What are the two types of haemorrhage?

Answer 10

subarachnoid or intracerebral

Question 11

How can you cause arterial dissection and what are the two vessels most commonly affected?

Answer 11

neck trauma or hyperextension

dissection of carotid or subarachnoid artery

Question 12

Which kind of stroke could a cardiac arrest cause?

Answer 12

hypoperfusion could lead to an ischaemic stroke

Question 13

Name some risk factors for cardioembolic strokes

Answer 13

infective vegatation, AF, rheumatic valves, degenerative or congenital valve disorders

Question 14

What are 3 modifiable and 3 non-modifiable RF for strokes?

Answer 14

Modifiable: hypertension, smoking, alcohol intake, obesity, cocaine use, high cholesterol
Non-modifiable: older age, male black/African/Asian, cardiac disease, AF, sleep apnoea, hypercoagulability, neurosphyillis

Question 15

What are some primary and secondary preventions for stroke?

Answer 15

Primary - smoking cessation, weight loss, diet, exercise, alcohol reduction, aspirin
Secondary - anticoagulation, angioplasty/stenting

Question 16

What happens to vital signs during a stroke?

Answer 16

BP and temp increase

O2 sats fall

Question 17

What happens to reflexes following a stroke?

Answer 17

Initally a patient will be hyporeflexive due to spinal shock but about 6 weeks later they will be hyperreflexive due to UMN damage

Question 18

What are some risks of a major bleed?

Answer 18

HAS-BLED
hypertension, hepatic or renal failure 
age 
stroke previously 
bleeding 
labile INR 
ethanol - alcohol intake 
drugs - polypharmacy

Question 19

What are the risk factors for AF causing a stroke?

Answer 19

CHADSVasc
Congestive heart failure 
hypertension 
age 
diabetes 
sex 
vascular disease

Question 20

What is the risk score to establish if TIA will lead to stroke?

Answer 20

ABCD2 
Age 
Blood pressure 
Clinical features - unilateral weakness, speech disturbance 
Diabetes 
Duration of symptoms

Question 21

What are the positives and negatives of thrombolysis?

Answer 21

Positive - improved outcomes, no change in mortality

Negative - 5% risk of haemorrhage

Question 22

Name 3 contraindications for thrombolysis

Answer 22

Haemorrhagic stroke, head injury, previous haem, aneurysm, hypertension, low platelets, low glucose, pregnancy

Question 23

What are some effects a stroke has one a person?

Answer 23

Physical - raised ICP, disability, aspiration pneumonia
Mental - depression, cognitive impairment
Social - immobility, financial, isolation

Question 24

Name 3 blood tests in a stroke workup

Answer 24

FBC, clotting, glucose, CRP, ESR, culture, sphyillis, lipid profile, autoantibodies

Question 25

Name 3 types of imaging you would do if you suspect a stroke

Answer 25

CT, MRI, doppler, ECG

Question 26

What are some eye symptoms of subarachnoid haemorrahge?

Answer 26

vertical diplopia, ptosis, weaker or more painful movements, fixed dilated pupil

Question 27

What are some symptoms of cerebellar stroke?

Answer 27

ataxia, vertigo, vomiting

Question 28

What are some symptoms of intraventricular haemorrhage?

Answer 28

headache, neck rigidity, decreased consciousness

Question 29

How would you treat subarachnoid hameorrhage?

Answer 29

nimodipine
platinum coil in aneurysm or surgical clipping
long term blood pressure control

Question 30

What is the most common vessel involved in extradural haemorrhage?

Answer 30

middle menengeal arterty

Question 31

What does an extradural haemorrhage look like on CT?

Answer 31

biconcave disc

Question 32

What is amaurosis fugax?

Answer 32

sudden loss of vision in one eye - due to emboli in retinal arteries
- symptoms of TIA in carotid sytstem (anterior circulation)

Question 33

What does a subdural haemorrahge look like on CT?

Answer 33

crescent moon shape

midline shift due to ventricle dilation