Peer-Teaching Flashcards
75yr old male Sudden onset weakness in left arm, slurred speech and L sided facial droop Resolved in 15 minutes Smokes 10/day for 30 years Most likely diagnosis
Transient Ischaemic Attack
Define Transient Ischaemic Attack
focal, sudden onset, neurological deficit lasting <24hrs, with complete clinical recovery
Causes of TIA
Thromboembolism from carotids
Cardioembolism
Hyperviscosity e.g. polycythaemia
What is amaurosis fugax
Emboli passes into retinal artery
A curtain descending over my field of vision’
Investigations of TIA
ABCD2- Risk score of a stroke
Carotid Doppler- stenosis
CT angiography- stenosis
Treatment of TIA
Modifiable Risk Factors- stop smoking/alcohol, exercise, diet Aspirin immediately Clopidogrel Statin- simvastatin Treat BP- Beta Blocker or ARB
80yr old female Sudden onset R arm weakness, sensory loss in R arm, difficulty speaking and swallowing Present for >5hrs with no improvement PMH: AF, Hypertension, Diabetes Diagnosis?
Stroke
Define stroke
Rapid onset of neurological deficit caused by focal, cerebral, spinal or retinal INFARCTION
Rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24HRS or leading to death
Signs and symptoms of MCA stroke
Motor Weakness, Hemiplegia
Sensory disturbances
Receptive and Affective Aphasia
Signs and symptoms of ACA stroke
Frontal Lobe
Drowsiness
Logical thinking
Personality
Signs and symptoms of PCA stroke
Contralateral Hemianopia
Initial investigation of stroke
CT scan
Medical Treatment of ischaemic stroke
Throbolysis- IV Altepase
Aspirin for 2 wks then clopidogerol
Medical treatment of haemorrhagic stroke
Control BP- Beta Blocker/ ARB
Beriplex if warfarin related
Surgery- Clot evation
Conservative treatment of stroke
Rehabilitation- Physio, OT
Modifiable Risk Factors- Stop smoking/alcohol, exercise
50 Year old male Local shopping Sudden sharp pain- ‘Feels like he has been kicked in the back of the head’ Neck stiffness Feels systemically fine Diagnosis
Subarachnoid Haemorrhage
Give example of BV in extradural layer
Middle Meningeal Artery
Give example of BV in subdural layer
Bridging veins
Give example if BVs in subarachnoid layer
Circle of Willis
Main cause of subarachnoid haemorrhage
Berry aneurysm
What is a subarachnoid haemorrhage
Spontaneous bleed in subarachnoid space
Rupture of artery so raised ICP
What is result of raised ICP
Lower consciousness
Signs of subarachnoid haemorrhage
Kernigs and Bradzini sign
Ix of SAH
CT scan
Tx of SAH
Neurosurgeon
Causes of subdural haemorrhage
RTA
Metastasis cause rupture
Pathophysiology of subdural haemorrhage
Rupture of bridging veins
Few weeks/months later
Haematoma formation -> Hyperosmotic so draws water from the brain
Raised ICP and midline shift
Clinical presentation of SDH
Fluctuating consciousness
Headache
Ix of SDH
CT scan - Sickle shaped, crescent shaped collection of blood
Tx of SDH
Neurosurgeon - Irrigation
IV Mannitol
True or False:
Extradural haemorrhage is a medical emergency
True
Cause and pathology of extra dural haemorrhage
Head injury -> Fracture in temporal/parietal bone -> Rupture of the middle meningeal artery
Rapid collection of blood in extradural space
Signs of extradural haemorrhage
Decrease consciousness, Signs of raised ICP
Complication of EDH
Tentornial herniation - death of respiratory arrest
Ix of EDH
CT scan- biconvex hypodense haematoma
Tx of EDH
Neurosurgery- irrigation, IV Mannitol
Clinical diagnosis of epilepsy
2 or more unprovoked seizures with >24hrs apart
Define seizure
The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain due caused by excessive, hypersynchronous neuronal discharges
Type of epilepsy seizures
Generalised
Partial/focal
What is Generalised seizure
Affects whole cortex with no localising features to one hemisphere
What is partial seizure
Focal onset with features referred to a lobe
Types of generalised seizures
Tonic-clonic Absence seizure Myoclonic Tonic Atonic
Describe generalised tonic-clonic seizure
No prodrome or aura.
Tonic Phase- Rigidity ->
Clonic Phase- Rhythmic muscle jerking (seconds to minutes).
Post-ictal- Drowsiness, confusion and coma
Describe generalised absence seizure
Typically childhood, stops talking mid-sentence- carry on where left off
Describe generalised myoclonic seizure
Sudden isolated jerk of limb, face or trunk. May be thrown to the ground
Describe generalised tonic seizure
Sudden sustained stiffening of the body.
Not followed by jerking
Describe generalised atonic seizure
Sudden loss of muscle tone and cessation. Fall
Types of partial seizures
Depends on lobe affected
Purpose of temporal lobe
Memory, Emotion and Receptive speech
Describe partial seizure of temporal lobe
Aura- Deja-vu, auditory hallucinations, funny smells
Out of body experience, automatisms e.g. lip smacking, chewing, fiddling
Purpose of frontal lobe
Motor and Thought Processing
Describe partial seizure of frontal lobe
Jacksonian march - seizure “marches” up or down the motor homunculus starting in face or thumb
Post-ictal Todd’s palsy - paralysis of limbs involved in seizure for several hour
Purpose of parietal lobe
Sensory disturbances
Describe partial seizure of parietal lobe
Tingling/numbness
What is Todd’s palsy
Paralysis of limbs involved in seizure for several hour
Due to focal seizure of temporal lobe
Investigations of Epilepsy
EEG (electroencephalogram)
Tx of epilepsy:
Emergency
Generalised
Partial
Emergency (Status Epilepticus)- IV Lorazepam
Generalised- Sodium Valporate, Lamotrigine
Partial/Focal- Carbamezapine
List the differences between dementia or delirium
Dementia: Onset - Insidious (months to years) Course - Progressive Duration - months to years Consciousness - Normal unless severe Causes - Disorder
Delirium: Onset - Acute (hours to days) Course - Fluctuating Duration - hours to weeks Consciousness - Altered Causes - Stroke, Metabolic, Infective etc
What is dementia
A syndrome that causes memory loss, difficulties with thinking, problem-solving, language and ADL’s
Diagnosis of dementia
Clinical diagnosis
MMSE- <17/30 serious cognitive impairment
Treatment of dementia
Healthier Lifestyle
Social Support
Acetylcholinesterase Inhibitor (e.g Rivastigmine)
Control CV Risk Factors