Oxford Clinicals II Flashcards
What is the danger of giving preventives of migraine such as Topiramate in women on pills?
Preventives such as Topiramate can cause embryopathy and interfere with the pill.
Migraine, stroke, and the PILL (combined contraceptive)
What are the causes of stroke? List 4.
- Small vessel occlusion/cerebral microangiopathy or thrombosis insitu
- Cardiac emboli (AF, endocarditis, MI)
- Atherothromboembolism
- CNS bleeds (increased BP, trauma, aneurysm rupture, anticoagulation, thrombolysis)
What are the pointers that could indicate the stroke is due to ischaemia?
AF, Carotid bruit, past TIA, and IHD
What are the signs of cerebral infarcts?
Depending on the site, there may be contralateral sensory loss or hemiplagia - initially flaccid and then becoming spastic (UMN).
Homonymous hemianopia
visuo-spatial deficit
What are the signs of brainstem infarcts?
Quadriplegia
Disturbance of gaze and vision
Locked-in syndrome
What are the signs of lacunar infarcts?
Ataxic hemiparesis, pure motor, pure sensory, sensorimotor, dysarthria/clumsy hand
Consciousness and cognition is intact except in thalamic stroke.
What is “locked-in syndrome”?
Patient with locked-in syndrome are aware of surroundings, but are unable to respond due to complete paralysis of all voluntary muscles apart from vertical eye movement and blinking.
When is thrombolysis contraindicated?
Thrombolysis is contraindicated in:
- Haemorrhagic stroke, or if there is any form of haemorrhage
- Uncontrolled Blood Pressure
- Massive stroke
- High bleeding risk
What must be excluded before Aspirin can be administered for stroke?
Once haemorrhagic stroke is excluded, aspirin can be given at 300MG.
What is Todd’s palsy?
Todd’s palsy is focal weakness in a part of the body after a seizure. It is postictal paralysis or paresis.
What are the stages a patient with a seizure experiences?
Prodromal, aura, ictus (the seizure itself), postictal
Describe prodrome and aura.
A prodrome can occur days or hours preceding the seizure. It is not part of the seizure itself. Patients will experience a change in mood or behaviour.
An aura is part of the seizure of which the patient is aware. (a warning sign of a seizure going to happen)
This is common in focal seizures, not generalised seizures. Patients may have a strange feeling in the gut, or an experience such as a deja vu or strange smells, or flashing lights.
Gives examples of non-epileptic causes of seizures
Trauma, stroke, haemorrhage, increased intra-cranial pressure, alcohol or benzodiazepine withdrawal, metabolic disturbances such as decreased calcium and uraemia, infection such as syphilis and meningitis, increased temperature, and drugs such as TCA, cocaine, tramadol.
What is the first line treatment for generalised tonic-clonic seizures?
Sodium valproate
Lamotrigine
This is followed with carbamazepine, or topiramate
What is the first line treatment for absence seizures?
Sodium valproate
Lamotrigine
Ethosuximide
