Prof Derrik soon Anki Flashcards
UMN “CNS” pattern weakness presents with? (vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv IMPT!!!) - […] - […] - […] - […] LMN “PNS” pattern weakness presents with? (vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv IMPT!!!) - […] - […] - […] - […]
UMN “CNS” pattern weakness presents with? (vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv IMPT!!!) - Hyperreflexia - Hypertonia (clasp-knife) - Spasticity - Other signs like pronator drift (yes it’s an UMN sign) LMN “PNS” pattern weakness presents with? (vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv IMPT!!!) - Areflexia - Hypotonia - Muscle wasting - Fasciculations For understanding: In UMN lesions, high
If you get both signs of hyperreflexia (UMN lesion) AND fasciculation (LMN lesion) at different area of the body, where is the lesion? […]
If you get both signs of hyperreflexia (UMN lesion) AND fasciculation (LMN lesion) at different area of the body, where is the lesion? Prob CNS, at spinal cord This is because you can have lesions at the spinal segments, obliterating LMN at that segmental level and obliterating UMN at levels below that. See pic! At the level where there is lesion to LMN, LMN signs would dominate because the end co
gray matter is gray bc […] white matter is white bc […]
gray matter is gray bc it’s filled with cell bodies white matter is white bc it’s filed with myelin (fat)
Brainstem comprise of […]
Brainstem comprise of Midbrain, Pons and Medulla
Impt Cord levels …. IMPT!!! Diaphragm (Phrenic Nerve): […] Brachial Plexus: […] Lumbosacral Plexus: […] Sphincteric supply: […] At which level does the spinal cord end and what is the associated name? […]
Impt Cord levels …. IMPT!!! Diaphragm (Phrenic Nerve): C3-C5 Brachial Plexus: C5-T1 Lumbosacral Plexus: L1-S4 Sphincteric supply: S2-S4 At which level does the spinal cord end and what is the associated name? Cauda equina, L1/2.
Brain has large cross section, hence lesion likely to affect […] Cord has small cross section, hence lesion likely to affect […]
Brain has large cross section, hence lesion likely to affect only 1 side (unilateral signs) Cord has small cross section, hence lesion likely to affect both sides (bilateral signs) and sphincteric involvement (urological symptoms)
Lesion in the […] results in pure ataxia
Lesion in the cerebellum (or the tracts) results in pure ataxia Direct clue! If ataxia –> skip differentiating CNS/PNS, Brain/Cord –> directly pinpoint to cerebellum
Which CN nuclei are in: Midbrain: […] Pons: […] Medulla: […] CN that arise from the midpontine level would be CN […]. The only CN that arises from the pons proper would CN […]. CN nuclei lesons are always LMN lesions (NOT UMN!!). Motor cranial nerves are analogous to LMN.
Which CN nuclei are in: Midbrain: III, IV Pons: V, VI, VII, VIII Medulla: IX, X, XII CN that arise from the midpontine level would be CN VI, VII and VIII. The only CN that arises from the pons proper would CN V. CN nuclei lesons are always LMN lesions (NOT UMN!!). Motor cranial nerves are analogous to LMN. 2 (CN 1 & 2), 2, 4, 3, 1 (CN 11)
What are some signs of brainstem lesions? (vvvvvv IMPT!!!) Depends on which structure (see pic) Comparing strokes of the cerebrum and brainstem: […] Also remember that […] can also result from brainstem lesions due to cerebellar connections (at pons)
What are some signs of brainstem lesions? (vvvvvv IMPT!!!) Depends on which structure (see pic) Comparing strokes of the cerebrum and brainstem: Strokes of the brainstem normally cause LoC, strokes of the cerebrum do not. Also remember that cerebellar ataxia can also result from brainstem lesions due to cerebellar connections (at pons) Horner syndrome is a combination of signs and symptoms caused
Right sided LMN facial weakness, Left sided UMN arm and leg weakness. Where is the lesion? […]
PURE MOTOR WEAKNESS. lesion is at the […]
PURE MOTOR WEAKNESS. lesion is at the corona radiata Confirm again. this was quizzed. but can’t find in slides If anything, the corona radiata is something that the descending fibres have to pass through on the way down. Googled:
name some cerebral hemisphere lesions signs (vvvvvv IMPT!!!) - […] - […] - […] - […] - […] - […] - […]
“name some cerebral hemisphere lesions signs (vvvvvv IMPT!!!) - Hemiparesis - Visual field defects - Cognitive deficits - dysphasia (higher cognitive function) - dyscalculia (higher cognitive function) - agnosia (higher cognitive function) - neglect (higher cognitive function) Impt concept - Subcortical lesions (white matter) tend to give rise to pure motor/sensory syndromes - Cortical lesions (gr
Ataxia is […]lateral to the lesion at the cerebellum. Lesions of the vermis would affect the […] more.
Ataxia is ipsilateral to the lesion at the cerebellum. Lesions of the vermis would affect the eyes and trunk more. Ataxia ipsilateral to cerebellum!!! Dont forget!! Lesions to the cerebellum can cause dyssynergia, dysmetria, dysdiadochokinesia, dysarthria and ataxia of stance and gait. Ataxia is a rare neurological disease. It is progressive – affecting a person’s ability to walk, talk, and use fi
CNS lesions Unilateral signs suggest that the lesion is at the […] Bilateral signs suggests that the lesion is at the […]
CNS lesions Unilateral signs suggest that the lesion is at the Brain Bilateral signs suggests that the lesion is at the Cord Brain larger surface area so lesion likely 1 sided Spinal cord smaller surface area so lesion likely to hit both sides Cord lesions may also present with incontinence (sphinteric dysfunction) Revision card cuz impt
Hemiparesis, or unilateral paresis, is […] Normally with cord lesions they would normally affect […] side(s). It can lead to […]. Normally with brain lesions they’re more often on […], therefore it would cause […].
“Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (hemi- means ““half””) Normally with cord lesions they would normally affect both side(s). It can lead to paraparesis/ quadaparesis depending on the cord level. Normally with brain lesions they’re more often on one hemisphere, therefore it would cause hemiparesis.”
Weakness and loss of senses at…. Whole body except head: […] Legs: […]
Weakness and loss of senses at…. Whole body except head: Cervical Legs: Thoracic and Lumbosacral
Dorsal Column Medial Lemniscus (DCML) and corticospinal (lateral tract) fibres decussate at […] Spinothalamic Fibres decussate at […]
Dorsal Column Medial Lemniscus (DCML) and corticospinal (lateral tract) fibres decussate at lower brainstem Spinothalamic Fibres decussate at level of entry This one if dk then really honggan!! MEMORIZE!! Spinothalamic is pain and temperature (lateral) + crude touch and pressure (anterior), decussate at spinal level DCML is proprioception and vibration + fine touch, decussate at medulla cortical s
Corticospinal (Lateral Tracts) decussates at […]
Corticospinal (Lateral Tracts) decussates at lower brainstem
Anterior cord syndrome results in - […] - […] - […] Causes: […] Posterior cord syndrome results in - Loss of proprioception and vibration - Loss of fine touch - UMN weakness Causes: Tabes Dorsalis (syphilis), B12 (folate) deficiency Cord Hemisection (Brown Sequard Syndrome) results in - Contralateral loss of pain and temp + crude touch and pressure (spinothalamic alr decussate at point of
Anterior cord syndrome results in - Loss of pain & temperature - Loss of crude touch & pressure - UMN weakness Causes: Cord Infarcts. Propensity for infarct because anterior spinal artery is the ONLY supply to anterior spinal cord Posterior cord syndrome results in - Loss of proprioception and vibration - Loss of fine touch - UMN weakness Causes: Tabes Dorsalis (syphilis), B12 (folate) deficiency
Anterior cord syndrome results in - Loss of pain & temperature - Loss of crude touch & pressure - UMN weakness Causes: Cord Infarcts. Propensity for infarct because anterior spinal artery is the ONLY supply to anterior spinal cord Posterior cord syndrome results in - […] - […] - […] Causes: […] Cord Hemisection (Brown Sequard Syndrome) results in - Contralateral loss of pain and temp + cru
Anterior cord syndrome results in - Loss of pain & temperature - Loss of crude touch & pressure - UMN weakness Causes: Cord Infarcts. Propensity for infarct because anterior spinal artery is the ONLY supply to anterior spinal cord Posterior cord syndrome results in - Loss of proprioception and vibration - Loss of fine touch - UMN weakness Causes: Tabes Dorsalis (syphilis), B12 (folate) deficiency
What is consciousness? Awake person who is fully responsive to a thought or perception and indicates by his speech or behaviour the awareness of self and ones surroundings (external environment and stimuli) How to test for (and confirm) consciousness? 1. […] 2. […]
What is consciousness? Awake person who is fully responsive to a thought or perception and indicates by his speech or behaviour the awareness of self and ones surroundings (external environment and stimuli) How to test for (and confirm) consciousness? 1. response to external stimuli (visual response, verbal/non verbal response, social response) (appropriate to context) 2. memory and recall, higher
which are the 4 most impt systems in maintaining consciousness? (IMPT!!!) 1. […] 2. […] 3. […] 4. […]
which are the 4 most impt systems in maintaining consciousness? (IMPT!!!) 1. Cardiovascular system 2. Respiratory system 3. Brain(CNS) function 4. Energy substrates and electrolytes TLDR, good bp, enough oxygen, enough glucose, suitable environment whack any of these = temporarily depressed cortical activity = pengsan/faint/syncope
Components of CVS that maintains consciousness? - […] - […] - […]
Components of CVS that maintains consciousness? - Heart (rate, rhythm, stroke volume) - Blood Vessels (BP) - Cerebral circulation (carotid arteries, cerebral arteries, cerebral venous system)
How does the respiratory system maintain consciousness? - […] - […]
How does the respiratory system maintain consciousness? - Lungs - air exchange (maintain paO2 and paCO2) - Chest wall and resp muscles (effective breathing)
How does CNS function to keep consciousness? - […] - […]
How does CNS function to keep consciousness? - Reticular activating system of brainstem - Adequate cerebral hemispheric function (in acute interference of hemispheric function, decreased level of consciousness is more likely to occur if left side is involved)
Which substrates and electrolytes are esp impt for maintaining consciousness? - […] - […]
Which substrates and electrolytes are esp impt for maintaining consciousness? - Glucose (and ketones) - Electrolytes (Na, K, Ca)
What is the difference between sleep and impaired consciousness? […]
What is the difference between sleep and impaired consciousness? whether the person can be woken up :/
What medical terms are used to define the different states of impaired consciousness? 1. […] 2. […] 3. […] 4. […]
“What medical terms are used to define the different states of impaired consciousness? 1. Lethargy - difficulty in maintaining awake state 2. Obtundation - responds to non-pain stimuli 3. Stupor - responds to pain 4. Coma - no response ““Mn - Let Out Stupid Comments”” Differentiating sleep and impaired consciousness: Sleeping people can illicit some sort of response.”
Evaluation of a person with impaired consciousness: 1. […] 2. […] 3. […] 4. […]
Evaluation of a person with impaired consciousness: 1. Orientation and Memory (time,space,person,digit span, recall of items after 5 mins) 2. Conscious level 3. Brainstem reflex function 4. Motor and sensory function, and coordination
[…] is used to assess level of consciousness and it is comprised of 3 parts (E,V,M) 1. […] 2. […] 3. […] Outline some limitations of using the GCS (IMPT!!) - Evaluating eye opening if there is severe orbito-facial injury - Assessment of verbal function if intubated - Inability to score differences between right- and left-sided motor function - Lack of neuro-ophthalmic evaluation: pupillary
Glasgow Coma Scale (GCS) is used to assess level of consciousness and it is comprised of 3 parts (E,V,M) 1. Eye-opening response 2. Best verbal response 3. Best motor response Outline some limitations of using the GCS (IMPT!!) - Evaluating eye opening if there is severe orbito-facial injury - Assessment of verbal function if intubated - Inability to score differences between right- and left-sided
Glasgow Coma Scale (GCS) is used to assess level of consciousness and it is comprised of 3 parts (E,V,M) 1. Eye-opening response 2. Best verbal response 3. Best motor response Outline some limitations of using the GCS (IMPT!!) - […] - […] - […] - […] - […]
Glasgow Coma Scale (GCS) is used to assess level of consciousness and it is comprised of 3 parts (E,V,M) 1. Eye-opening response 2. Best verbal response 3. Best motor response Outline some limitations of using the GCS (IMPT!!) - Evaluating eye opening if there is severe orbito-facial injury - Assessment of verbal function if intubated - Inability to score differences between right- and left-sided
What are the common causes for impairment of consciousness? - […] - […] - […] - […] - […] - […] - […] - […] - […] - […] - […] - […]
What are the common causes for impairment of consciousness? - Traumatic brain injury - Cerebrovascular event (hemorrhage, thrombosis, embolism, vasculitis) - Seizures or status epilepticus (post-ictal state) - Syncope (transient cerebral hypoperfusion) - CNS Infection (meningitis, encephalitis, brain abscess) - Post-infectious/inflammatory reaction/disorder (ADEM, MS) - Medications (overdose of me
Prolonged impairment of consciousness (comatose state) occurs if […]. Injury/insult to the brain persist depending on the cause Name some causes of comatose state - […] - […] - […] - […]
Prolonged impairment of consciousness (comatose state) occurs if large areas of the brain is affected. Injury/insult to the brain persist depending on the cause Name some causes of comatose state - Traumatic brain injury - Cerebrovascular accident (Hemorrhage, Thrombosis, Embolism, Vasculitis) - CNS Infection (viral/autoimmune encephalitis) - Refractory status epilepticus and drugs. think about th
Syncope definition (IMPT!!!) […] What are the causes of Syncope? - […] - […]
Syncope definition (IMPT!!!) A paroxysmal event with loss of consciousness and postural tone due to cerebral hypoperfusion, with spontaneous recovery. What are the causes of Syncope? - Decreased Cerebral perfusion - Decreased Oxygenation in the blood Syncope usually caused by abrupt reduction/cessation of energy substrates to the cerebral cortex through sudden decrease in well oxygenated blood sup
What are the classical clinical features of syncope? - […] - […] - […] - […] - […] - […] - […] What about prodromal symptoms (pre-syncope)? - Light headedness/dizziness/nausea - Feeling of warmth - Sweating - Vision greying or blackening (blurring of vision normally occurs first) - Hearing muffled and feeling distant What are common triggers for syncope? Peripheral vasodilation!! (ho
What are the classical clinical features of syncope? - Loss of consciousness & postural tone (in definition) - Pallor, sweating - Whole episode usually last less than 30 seconds, spontaneous recovery) - Convulsions, a few irregular myoclonic jerks, tonic flexion/extension, complex movements, autmatisms (licking, chewing, fumbling) - Visual and auditory hallucinations - Sudden onset, urinary incont
What are the classical clinical features of syncope? - Loss of consciousness & postural tone (in definition) - Pallor, sweating - Whole episode usually last less than 30 seconds, spontaneous recovery) - Convulsions, a few irregular myoclonic jerks, tonic flexion/extension, complex movements, autmatisms (licking, chewing, fumbling) - Visual and auditory hallucinations - Sudden onset, urinary incont
What are the classical clinical features of syncope? - Loss of consciousness & postural tone (in definition) - Pallor, sweating - Whole episode usually last less than 30 seconds, spontaneous recovery) - Convulsions, a few irregular myoclonic jerks, tonic flexion/extension, complex movements, autmatisms (licking, chewing, fumbling) - Visual and auditory hallucinations - Sudden onset, urinary incont
What are the classical clinical features of syncope? - Loss of consciousness & postural tone (in definition) - Pallor, sweating - Whole episode usually last less than 30 seconds, spontaneous recovery) - Convulsions, a few irregular myoclonic jerks, tonic flexion/extension, complex movements, autmatisms (licking, chewing, fumbling) - Visual and auditory hallucinations - Sudden onset, urinary incont
What are the classical clinical features of syncope? - Loss of consciousness & postural tone (in definition) - Pallor, sweating - Whole episode usually last less than 30 seconds, spontaneous recovery) - Convulsions, a few irregular myoclonic jerks, tonic flexion/extension, complex movements, autmatisms (licking, chewing, fumbling) - Visual and auditory hallucinations - Sudden onset, urinary incont
What are the 2 categories of syncope? - […] - […]
What are the 2 categories of syncope? - neurally-mediated (neurocardiogenic or reflexmediated) - cardiogenic (cardiac rhythm or structural cardiacdisorders) Read below
Definition of seizure […]
Definition of seizure Sudden and unusual / erratic electrical changes in the cortical neurons that we cannot control. Causes brief alteration in a person’s consciousness, sensation, movements or actions Like derek said, seizures are basically power surges.
Causes of seizure? […] - […] - […] - […] - […] - […]
Causes of seizure? acute systemic metabolic disturbance/disturbance of brain structure or metabolism, causing irritation of the cortex - Hypoglycemia or electrolyte disturbance - Head trauma - Stroke - Alcohol & alcohol withdrawal - Drugs & drug withdrawal The label “epilepsy” is not used because the seizures are closely related to the underlying temporary disturbance of brain function Seizures ar
What is epilepsy? […]
What is epilepsy? A chronic condition characterized by a predisposition to recurrent, usually spontaneous (not reflex) seizures multiple seizures (not in same day) = epilepsy
”"”Fit vs Faint”” How to diagnose? (IMPT!!!) - […] - […] (gold standard lol) - (if not) […] - (if not) […]”
”"”Fit vs Faint”” How to diagnose? (IMPT!!!) - Clinical history is key. Based on detailed description of events experienced by the patient and/or eye-witness before, during and after a event/seizure (blow by blow) - Video-recording of event/Home recording (gold standard lol) - (if not) Witness should attend consultation/be telephoned - (if not) Written account ““HH ah, how to diagnose Fit vs Faint
Name 2 differential diagnosis of epilepsy? - […] - […]
“Name 2 differential diagnosis of epilepsy? - Breath Holding Spell (cyanotic) - Breath Holding Spell (pallid) What? I don’t understand this slide.. ““Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to pass out (lose consciousness). Breath-holding spells usually occur when a young child is angry, frustrated, in pain, or
what are signs of epileptic seizures? - […] - […] - […] - […] - […] - […] - […]
what are signs of epileptic seizures? - Sudden stiffening followed by repetitive shakes or jerks - Auras, coloured orbs, automatisms, psychic auras, terror - Pre-ictal cry - Disrupted breathing - Incontinence - Prolonged duration - Prolonged disorientation after event with sleepiness and aching Just follow Derek’s.
in neuro nomenclature, Myelo- refers to […] but can also refer to myeloid lineages eg myelosuppression. Radiculo - refers to […]
in neuro nomenclature, Myelo- refers to spinal cord but can also refer to myeloid lineages eg myelosuppression. Radiculo - refers to roots
Examples of disease at levels of nerves. […]
Examples of disease at levels of nerves. Mononeuropathy, Mononeuritis multiplex, Peripheral neuropathy Roots –> Plexus –> Nerve –> NMJ –> Muscle Roots, Plexus, Nerves considered LMN NMJ, muscles considered neuromuscular complex Peripheral neuropathies can affect neurons of any length, but normally target neurons of a specific length.
NMJ and Muscle lesions What are signs of proximal myopathy (muscle lesions)? - […] - […] - +/- […] What are signs of NMJ lesions? - […] - […] - […] Why does NMJ and muscle lesions both present with proximal weakness? Why not distal? Proximal muscles exert much more force than distal muscles. So when muscles become weak all over the body, its the proximal movements that are affected the
NMJ and Muscle lesions What are signs of proximal myopathy (muscle lesions)? - Proximal weakness - Wasting without fasciculations - +/- Pseudohypertrophy What are signs of NMJ lesions? - Proximal weakness - Ocular weakness (think myasthenia gravis) - Fatiguability (think myasthenia gravis) Why does NMJ and muscle lesions both present with proximal weakness? Why not distal? Proximal muscles exert m
Duchenne muscular dystrophy (DMD) is […] Which gene is mutated in DMD? […] What does DMD patients present with? - Proximal weakness - Affect heart and respiratory muscles (death from cardiac complications and respiratory failure) There are other variations of muscular dystrophy. Which one has similar signs and symptoms to those of DMD but tend to be milder and progress more slowly? Becker Musc
Duchenne muscular dystrophy (DMD) is a X-linked genetic disorder characterized by progressive muscle degeneration and weakness. Which gene is mutated in DMD? Dystrophin gene on X chromosome. Dystrophin is a component of the membrane cytoskeleton in normal muscle, contributes to membrane stability. What does DMD patients present with? - Proximal weakness - Affect heart and respiratory muscles (deat
What in the world is myasthenia gravis? […] Cause? […] Why increasing fatique with repetitive muscle use? […]
What in the world is myasthenia gravis? weakness and increasing fatigue after repetitive use of any of the muscles under your voluntary control Cause? Ab mediated autoimmune reaction!! AchRAbs (Acetylcholine Receptor AntiBodies) that competes with Ach for AchRs. Why increasing fatique with repetitive muscle use? At first got more Ach than AchRAb. But with sustained contraction, the exhaustion of A
General observations about LMN (roots, plexus and nerve) […] General observation about nerves […] What are important and common causes of peripheral neuropathies? - Diabetic neuropathy - B12 (folate) deficiency - GBS/CIDP/Iatrogenic Proximal weakness GOT reflex Peripheral neuropathies NO reflex
General observations about LMN (roots, plexus and nerve) Are part of LMN, so will have areflexia, hypotonia, wasting, fasciculations, weakness, sensory abnormalities General observation about nerves Long nerves more vulnerable to systemic insults than short nerves. Henceit affects the extremities of limbs first (glove and stocking distribution weakness and numbness) (all 4 limbs, but usually feet
median nerve kena whack = […] Radial nerve kena whack = […] Ulnar nerve kena whack = […]
median nerve kena whack = Carpel Tunnel Syndrome Radial nerve kena whack = Saturday Night Palsy Ulnar nerve kena whack = Cubital tunnel syndrome Just read the slides.
Can someone with saturday night palsy extend his elbows? […]
Can someone with saturday night palsy extend his elbows? Yes! because damage comes AFTER nerve to triceps
Signs of damage to sciatic nerve: 1. […] 2. […] 3. […] More often the common peroneal/ fibular nerve is squished 1. […] 2. […] 3. […] 4. […]
Signs of damage to sciatic nerve: 1. Foot drop (weak dorsiflexion) 2. Weak plantarflexion 3. Weak hip adduction More often the common peroneal/ fibular nerve is squished 1. Foot drop (weak dorsiflexion) 2. Strong plantarflexion (tibial nerve intact) 3. Strong hip adduction 4. Strong inversion (tibialis posterior- tibial n) Sciatic does hip adduction Sciatic splits into common peroneal and tibial n
Lumbosacral plexus injury tends to be at level of […]
Lumbosacral plexus injury tends to be at level of L4-S1 Can mimic sciatic nerve injuries (same roots) Eh slides say this is impt eh:
“right cerebellum lesion presentation ““mn - DDDANISH”” D[…] D[…] D[…] A[…] N[…] I[…] S[…] H[…]”
“right cerebellum lesion presentation ““mn - DDDANISH”” Dysdiadochokinesia - Inability to perform rapid alternating movements Dysmetria - inability to judge distance Dyssynergy - loss of coordination of motor movement Ataxia - incoordination of movements Nysagmus - eyes make repetitive, uncontrolled movements Intention tremor - movement tremors Scanning speech/stacatto - ataxic dysarthria in which
Weakness to whole body down the neck. Which level of damage? […]
Weakness to whole body down the neck. Which level of damage? Cervical C5
There are a heck load of nociceptors in our head. examples of where they can they be found? […] Does the parenchyma hurt? […] Strokes could hurt due to: Process: Dissections or bleeds Consequence: Raised-ICP Special: Thalamic strokes
There are a heck load of nociceptors in our head. examples of where they can they be found? scalp bone (esp periosteum) blood vessels mucosal linings meninges cranial nerves ears eyes teeth Does the parenchyma hurt? NO!!!! Because there are no nociceptors there. That’s why neurosurgery is done while conscious Strokes could hurt due to: Process: Dissections or bleeds Consequence: Raised-ICP Special
What are the 2 most important Red flags of sinister headaches? (IMPT!!!) - […] - […] Other redflags? (but not seen in all sinister headaches) - tempo (sudden onset or evolving) - constitutional (weight loss/ fever/ confusion and seizures) - elderly (think tumours and temporal arteritis) - meningitic features (fever, headache, photophobia, neck ache etc)
What are the 2 most important Red flags of sinister headaches? (IMPT!!!) - Raised ICP - Neurological deficit Other redflags? (but not seen in all sinister headaches) - tempo (sudden onset or evolving) - constitutional (weight loss/ fever/ confusion and seizures) - elderly (think tumours and temporal arteritis) - meningitic features (fever, headache, photophobia, neck ache etc) In the elderly tempo
Features of raised ICP? What makes it worse? (IMPT!!!!) - […] - […] - […] - […]
Features of raised ICP? What makes it worse? (IMPT!!!!) - Clear postural/pressure features (worse on cough/sneezing/bending over/visual obscurations on bending over) - Worse in night than day - Wake up with headache + vomitting - Pulsatile tinnitus Pt 1, anything that strains the body would cause pain. Visual obstructions when bending over is a serious sign because it means that ICP is high enough
What is the diff between raised ICP and glaucoma? Raised ICP […] Glaucoma […] which 3 cranial nerves are vulnerable to raised ICP? Why? […]
What is the diff between raised ICP and glaucoma? Raised ICP impedes venous flow from back of eye –> optic disc swelling and oedema (blurred margins), which is collectively called papilloedema Glaucoma pressure is inside the eye –> no disc swelling, only enhanced disc cupping which 3 cranial nerves are vulnerable to raised ICP? Why? CN VI (most vulnerable) as it emerges from the lip of foramen m
“Other features of sinister headaches A thunderclap headache, also referred to as a lone acute severe headache, is a headache that is severe and sudden-onset. Which causes of thunderclap headaches are sinister and must be excluded? (““VSD””) (IMPT!!!!) - […] - […] - […] Which causes of thunderclap headaches are non-sinister (primary headaches) and its ok to relac? […] What are symptoms of
“Other features of sinister headaches A thunderclap headache, also referred to as a lone acute severe headache, is a headache that is severe and sudden-onset. Which causes of thunderclap headaches are sinister and must be excluded? (““VSD””) (IMPT!!!!) - Subarachnoid haemorrhage!!!! - Venous sinus thrombus - Dissection Which causes of thunderclap headaches are non-sinister (primary headaches) and Migraine, cluster
When we do lumbar puncture to check for bleeding in CSF, how do we know if it’s not bleeding from the needle injury? […]
When we do lumbar puncture to check for bleeding in CSF, how do we know if it’s not bleeding from the needle injury? Instead of immediately, wait for 8 hours. look for breakdown of blood products (bilirubin - xanthochromia) We dont look for RBCs cuz if the infiltrating needle passes through a vessel before the CSF (traumatic tap), then we’ll get a false positive result from the test. 8/24 is also
What causes of headaches with neck stiffness are sinister? […] What causes of headaches with neck stiffness are NOT sinister? […] Neck stiffness is a sign of meningitis because? […]
What causes of headaches with neck stiffness are sinister? Meningism! So either infective meningitis (irritation from bacteria) or SAH (irritation from blood) What causes of headaches with neck stiffness are NOT sinister? Cervicogenic headache (tight neck muscles) Neck stiffness is a sign of meningitis because? you stretch meninges when you bend your neck.
Temporal tenderness/Jaw claudication (headache pain on chewing) is a sign of […] Why is it important to diagnose immediately? […] Definitive test for temporal arteritis? Temporal artery biopsy (but beware of skip lesions) If headache in elderly patient, suspect temporal arteritis and just prescribe what drug?
“Temporal tenderness/Jaw claudication (headache pain on chewing) is a sign of temporal arteritis, a sinister headache Why is it important to diagnose immediately? If missed, causes bilateral blindness in 50% of untreated patients!!! Definitive test for temporal arteritis? Temporal artery biopsy (but beware of skip lesions) If headache in elderly patient, suspect temporal arteritis and just prescribe High dose steroids (temporal arteritis is a form of vasculitis). This is a sinister headache.
True or False? 1. CT scans can diagnose meningitis […] 2. CT scans can predict those who will cone […] 3. A normal CT scan means safe to do LP […] 4. Lumbar puncture causes coning […]
True or False? 1. CT scans can diagnose meningitis Untrue; The best diagnostical method is a lumbar puncture with CSF examination 2. CT scans can predict those who will cone Untrue 3. A normal CT scan means safe to do LP Whether or not a patient presents with edema on CT scan does not affect the safety of an LP 4. Lumbar puncture causes coning Untrue, no evidence to say so For pt 4. it’s not entir
List the conditions that are confined to CNS (IMPT!!!) - […] - […] - […] - […] - […] - […] - […] List the conditions that are confined to PNS (IMPT!!!) - Brachial neuritis - Peripheral neuropathies inc GBS (Guillain Barre) - Mononeuritis Multiplex - Myasthenia Gravis - Myositis List the conditions that affect both CNS/ PNS (IMPT!!!) - B12 (folate) deficiency - Vasculitides inc Sjogre
“List the conditions that are confined to CNS (IMPT!!!) - Stroke - Epilepsy - Multiple sclerosis - Dementias - Parkinson Disease - Encephalitis - Meningitis (can affect anywhere with meninges) List the conditions that are confined to PNS (IMPT!!!) - Brachial neuritis - Peripheral neuropathies inc GBS (Guillain Barre) - Mononeuritis Multiplex - Myasthenia Gravis - Myositis List the conditions that
List the conditions that are confined to CNS (IMPT!!!) - Stroke - Epilepsy - Multiple sclerosis - Dementias - Parkinson Disease - Encephalitis - Meningitis (can affect anywhere with meninges) List the conditions that are confined to PNS (IMPT!!!) - […] - […] - […] - […] - […] List the conditions that affect both CNS/ PNS (IMPT!!!) - B12 (folate) deficiency - Vasculitides inc Sjogrens - S
“List the conditions that are confined to CNS (IMPT!!!) - Stroke - Epilepsy - Multiple sclerosis - Dementias - Parkinson Disease - Encephalitis - Meningitis (can affect anywhere with meninges) List the conditions that are confined to PNS (IMPT!!!) - Brachial neuritis - Peripheral neuropathies inc GBS (Guillain Barre) - Mononeuritis Multiplex - Myasthenia Gravis - Myositis List the conditions that
What presentations would suggest CNS lesion? (vvvvv IMPT!!!) - […] - […] - […] - […] What presentations would suggest PNS lesion? (vvvvv IMPT!!!) - Exclusively LMN issues - Muscle/ NMJ issues (eg Myasthenia Gravis, peripheral neuropathies)
What presentations would suggest CNS lesion? (vvvvv IMPT!!!) - UMN lesions - Cerebellar/ Basal gangia (nuclei symptoms) eg ataxia - Cognitive signs - Visual field defects (all visual field defects are CNS problems eg hemianopia) What presentations would suggest PNS lesion? (vvvvv IMPT!!!) - Exclusively LMN issues - Muscle/ NMJ issues (eg Myasthenia Gravis, peripheral neuropathies) LMN mostly PNS e
What presentations would suggest CNS lesion? (vvvvv IMPT!!!) - UMN lesions - Cerebellar/ Basal gangia (nuclei symptoms) eg ataxia - Cognitive signs - Visual field defects (all visual field defects are CNS problems eg hemianopia) What presentations would suggest PNS lesion? (vvvvv IMPT!!!) - […] - […]
What presentations would suggest CNS lesion? (vvvvv IMPT!!!) - UMN lesions - Cerebellar/ Basal gangia (nuclei symptoms) eg ataxia - Cognitive signs - Visual field defects (all visual field defects are CNS problems eg hemianopia) What presentations would suggest PNS lesion? (vvvvv IMPT!!!) - Exclusively LMN issues - Muscle/ NMJ issues (eg Myasthenia Gravis, peripheral neuropathies) LMN mostly PNS e
What is a reflex arc made of? […] What are the physiological functions of the reflex arc? - Prevents overstretching of muscle - protective - Helps maintain posture - Generates tone UMN input modulates and regulates reflex.
What is a reflex arc made of? Afferent limb (sensory neuron) + efferent limb (LMN) What are the physiological functions of the reflex arc? - Prevents overstretching of muscle - protective - Helps maintain posture - Generates tone UMN input modulates and regulates reflex.
What is a reflex arc made of? Afferent limb (sensory neuron) + efferent limb (LMN) What are the physiological functions of the reflex arc? - […] - […] - […] UMN input modulates and regulates reflex.
What is a reflex arc made of? Afferent limb (sensory neuron) + efferent limb (LMN) What are the physiological functions of the reflex arc? - Prevents overstretching of muscle - protective - Helps maintain posture - Generates tone UMN input modulates and regulates reflex.
Movement has several elements: - […] - […] - […]
Movement has several elements: - Power - Coordination - Quantity
Do motor neurons pass through the cerebellum? […] Therefore in cerebellar dysfunction there would be […] Other signs would include: Arms: Rebound, Finger nose dysmetria, Dysdiadochokinesis Legs: Heel shin Ataxia, Broad Based Gait Eyes: Nystagmus, Dysmetric Saccades, Broken Pursuit Mouth: Cerebellar dysarthria Trunk: Truncal Ataxia
Do motor neurons pass through the cerebellum? No Therefore in cerebellar dysfunction there would be pure ataxia and cerebellar signs. Other signs would include: Arms: Rebound, Finger nose dysmetria, Dysdiadochokinesis Legs: Heel shin Ataxia, Broad Based Gait Eyes: Nystagmus, Dysmetric Saccades, Broken Pursuit Mouth: Cerebellar dysarthria Trunk: Truncal Ataxia Dysmetria - terminal tremors Basically
Which CN nuclei are in: Midbrain: III, IV Pons: V, VI, VII, VIII Medulla: IX, X, XII CN that arise from the midpontine level would be CN VI, VII and VIII. The only CN that arises from the pons proper would CN V. CN nuclei lesons are always […]
Which CN nuclei are in: Midbrain: III, IV Pons: V, VI, VII, VIII Medulla: IX, X, XII CN that arise from the midpontine level would be CN VI, VII and VIII. The only CN that arises from the pons proper would CN V. CN nuclei lesons are always LMN lesions (NOT UMN!!). Motor cranial nerves are analogous to LMN. 2 (CN 1 & 2), 2, 4, 3, 1 (CN 11)
Subcortical lesions (white matter) tend to give rise to […]. Cortical lesions (grey matter) tend to give rise to […]. Deficits would include: Language: […] Spelling: Dysgraphia Arithmetic: […] Visuospatial orientation: […] Awareness: […]
“Subcortical lesions (white matter) tend to give rise to pure motor or sensory syndromes. Cortical lesions (grey matter) tend to give rise to motor and/ or sensory syndromes PLUS cortical features. Deficits would include: Language: Dysphasia Spelling: Dysgraphia Arithmetic: Dyscalculia Visuospatial orientation: Agnosias Awareness: Neglect Epilepsy starts in the cortex, and can begin with 1 neuron.
Do motor neurons pass through the cerebellum? No Therefore in cerebellar dysfunction there would be pure ataxia and cerebellar signs. Other signs would include: Arms: […] Legs: […] Eyes: […] Mouth: […] Trunk: […]
Do motor neurons pass through the cerebellum? No Therefore in cerebellar dysfunction there would be pure ataxia and cerebellar signs. Other signs would include: Arms: Rebound, Finger nose dysmetria, Dysdiadochokinesis Legs: Heel shin Ataxia, Broad Based Gait Eyes: Nystagmus, Dysmetric Saccades, Broken Pursuit Mouth: Cerebellar dysarthria Trunk: Truncal Ataxia Dysmetria - terminal tremors Basically
Summary of lesions (IMPT!!!) Brain: Cerebrum: […] Brainstem: […] Cerebellum: […] Cord: Cervical: UMN, sphincteric involvement, sensory level, LMN Thoracic: UMN, sphincteric involvement, sensory level, LMN LS: UMN, sphincteric involvement, sensory level, LMN
Summary of lesions (IMPT!!!) Brain: Cerebrum: UMN, Contralateral Brainstem: UMN, Contralateral (+/- ipsilateral face because of CN VII double innervation) Cerebellum: Pure ataxia, Ipsilateral Cord: Cervical: UMN, sphincteric involvement, sensory level, LMN Thoracic: UMN, sphincteric involvement, sensory level, LMN LS: UMN, sphincteric involvement, sensory level, LMN
Summary of lesions (IMPT!!!) Brain: Cerebrum: UMN, Contralateral Brainstem: UMN, Contralateral (+/- ipsilateral face because of CN VII double innervation) Cerebellum: Pure ataxia, Ipsilateral Cord: Cervical: […] Thoracic: […] LS: […]
Summary of lesions (IMPT!!!) Brain: Cerebrum: UMN, Contralateral Brainstem: UMN, Contralateral (+/- ipsilateral face because of CN VII double innervation) Cerebellum: Pure ataxia, Ipsilateral Cord: Cervical: UMN, sphincteric involvement, sensory level, LMN Thoracic: UMN, sphincteric involvement, sensory level, LMN LS: UMN, sphincteric involvement, sensory level, LMN
Anterior cord syndrome affects the […] tracts Posteior cord syndrome affects the […] tracts Brown-Sequard Syndrome affects the […] tracts.
Anterior cord syndrome affects the spinothalamic +/- lateral tracts Posteior cord syndrome affects the DCML and corticospinal tracts Brown-Sequard Syndrome affects the ALL 3 tracts.
Why are reflexes still present in muscle or NMJ lesions? […]
Why are reflexes still present in muscle or NMJ lesions? Lesions here tend to be partial and cause partial weakness. Therefore there will still be a reflex until the weakness is super profound. While a lesion in LMN is at a neuron so lesion tends to be complete –> areflexia So in diseases such as polymyositis and Guillain-Barre, reflexes would still remain. Repeat card. IMPT!
Common radiculopathies: - […] - […] General presentations: […]
Common radiculopathies: - C5-7 - L4-S1 General presentations: Sensory and motor distributions confined to single nerve roots
Summary of presentations of PNS lesions. Think root, plexus, nerve, NMJ, Muscle. Then think pattern, distribution and comments. […]
Summary of presentations of PNS lesions. Think root, plexus, nerve, NMJ, Muscle. Then think pattern, distribution and comments.
Common injuries of the plexi: Brachial: […]% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? […] Features? Shoulder rotated forward Affected arm diminished in length and girth Muscle atrophy of the affected arm Waiter’s tip deformity of the affected wrist Cer
Common injuries of the plexi: Brachial: 75% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? (C5-C6) Features? Shoulder rotated forward Affected arm diminished in length and girth Muscle atrophy of the affected arm Waiter’s tip deformity of the affected wrist Cerv
Common injuries of the plexi: Brachial: 75% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? (C5-C6) Features? […] Klumpke’s palsy level? (C8-T1) Features? […] Lumbosacral plexus level? (L4-S1) Injuries tend to be intrapelvic, L4-S1 Thus can mimic sciatic nerv
Common injuries of the plexi: Brachial: 75% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? (C5-C6) Features? Shoulder rotated forward Affected arm diminished in length and girth Muscle atrophy of the affected arm Waiter’s tip deformity of the affected wrist Cerv
Common injuries of the plexi: Brachial: 75% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? (C5-C6) Features? Shoulder rotated forward Affected arm diminished in length and girth Muscle atrophy of the affected arm Waiter’s tip deformity of the affected wrist Cerv
Common injuries of the plexi: Brachial: 75% of the brachial plexus injuries occur at the roots/ trunks. In anatomical terms it would mean that they occur above the clavicle. The parts below are well protected. Erb’s palsy level? (C5-C6) Features? Shoulder rotated forward Affected arm diminished in length and girth Muscle atrophy of the affected arm Waiter’s tip deformity of the affected wrist Cerv
Approaching seizures: […]
Approaching seizures: Just read below
There are a heck load of nociceptors in our head. examples of where they can they be found? scalp bone (esp periosteum) blood vessels mucosal linings meninges cranial nerves ears eyes teeth Does the parenchyma hurt? NO!!!! Because there are no nociceptors there. That’s why neurosurgery is done while conscious Strokes could hurt due to: Process: […] Consequence: […] Special: […]
There are a heck load of nociceptors in our head. examples of where they can they be found? scalp bone (esp periosteum) blood vessels mucosal linings meninges cranial nerves ears eyes teeth Does the parenchyma hurt? NO!!!! Because there are no nociceptors there. That’s why neurosurgery is done while conscious Strokes could hurt due to: Process: Dissections or bleeds Consequence: Raised-ICP Special
What are the 2 most important Red flags of sinister headaches? (IMPT!!!) - Raised ICP - Neurological deficit Other redflags? (but not seen in all sinister headaches) - […] - […] - […] - […]
What are the 2 most important Red flags of sinister headaches? (IMPT!!!) - Raised ICP - Neurological deficit Other redflags? (but not seen in all sinister headaches) - tempo (sudden onset or evolving) - constitutional (weight loss/ fever/ confusion and seizures) - elderly (think tumours and temporal arteritis) - meningitic features (fever, headache, photophobia, neck ache etc) In the elderly tempo
Revision: raised ICP occurs when: Excess in the skull: […] Extra stuff that’s not meant to be there: […] Blockage of drainage systems: - […] - […]
Revision: raised ICP occurs when: Excess in the skull: Malignant/Idiopathic intracranial HTN Extra stuff that’s not meant to be there: Tumours, absesses, brain swelling Blockage of drainage systems: - Venous (sinus) thrombosis - Obstructive/ non-communicating Hydrocephalus
Normal vs raised-ICP fundus: Normal: - […] - […] Raised-ICP: - […] - […]
Normal vs raised-ICP fundus: Normal: - Crisp margins - Normal vasculature Raised-ICP: - Blurred margins –> papilloedema - Disrupted vasculature, microhaemorrhages Think margin and vasculature!! Blurred margins due to disc swelling and oedema from obstruction of venous drainage from back of eye
Management of haemorrhagic bleeds in the brain? - […] - […] - […] - […]
Management of haemorrhagic bleeds in the brain? - Manage BP - Monitor glucose levels - Ventilate if required - Ensure that temperature is fine BP, blood sugar, ventilation, temperature. Basic parameters.
What are clinical features of venous sinus thrombosis? - […] - […] - […] Venous sinus thrombosis occurs in patients with? - […] - […] How to investigate? How to treat? Investigate with venography (CT or MR), treat via anti-coagulation What sign is elicited in venous sinus thrombosis? Empty Delta Sign
What are clinical features of venous sinus thrombosis? - Headache +/- focal signs - Seizures - Raised ICP (cuz its sinister) Venous sinus thrombosis occurs in patients with? - Coagulation disorders and dehydration ((pregnant women are susceptible) - Post COVID How to investigate? How to treat? Investigate with venography (CT or MR), treat via anti-coagulation What sign is elicited in venous sinus
What are clinical features of venous sinus thrombosis? - Headache +/- focal signs - Seizures - Raised ICP (cuz its sinister) Venous sinus thrombosis occurs in patients with? - Coagulation disorders and dehydration ((pregnant women are susceptible) - Post COVID How to investigate? How to treat? […] What sign is elicited in venous sinus thrombosis? […]
What are clinical features of venous sinus thrombosis? - Headache +/- focal signs - Seizures - Raised ICP (cuz its sinister) Venous sinus thrombosis occurs in patients with? - Coagulation disorders and dehydration ((pregnant women are susceptible) - Post COVID How to investigate? How to treat? Investigate with venography (CT or MR), treat via anti-coagulation What sign is elicited in venous sinus
Why are photophobia and phonophobia not considered sinister symptoms? […]
Why are photophobia and phonophobia not considered sinister symptoms? They’re both present in common migraine headaches.
Carotid artery dissection features? - […] - […] - […] Carotid artery dissection - […] - […]
Carotid artery dissection features? - Tearing neck pain (classic, cannot forget) - Neurological deficit (Stroke, CN XII palsy, Horner’s) - +/- history of head manipulation (dont anyhow go for neck massage) Carotid artery dissection - Anticoagulation - Angioplasty - not entirely proven yet General concept (very deep concepts, need to refine!!) Anticoagulation for conditions that predispose to clott
Meningism is a clinical syndrome denoting irritation of the meninges. Meningism is said to be a triad of: - […] - […] - […] What are the 2 signs that can be elicited from meningitis? […]
Meningism is a clinical syndrome denoting irritation of the meninges. Meningism is said to be a triad of: - Headache - Neck stiffness - Photophobia (not always) What are the 2 signs that can be elicited from meningitis? Kernig’s and Brudzinski’s Fever might not be part of the triad, in case meningism isn’t caused by an actual infection.
Possible causes and effects of CNS infection: Abscess: Rare, normally in immune compromised Clinically: […] Meningitis: Bacterial- Meningococcus, Pneumococus Viral Clinically: […] Encephalitis: Tends to be viral (HSV) Or bacterial spread from meninges (in that case would be meningo-encephalitis) Clinically: […]
Possible causes and effects of CNS infection: Abscess: Rare, normally in immune compromised Clinically: Fever, headache, focal neurology Meningitis: Bacterial- Meningococcus, Pneumococus Viral Clinically: Fever, Meningism, Altered sensorium Encephalitis: Tends to be viral (HSV) Or bacterial spread from meninges (in that case would be meningo-encephalitis) Clinically: Altered sensorium, seizures, f
Possible causes and effects of CNS infection: Abscess: Rare, normally in […] Clinically: Fever, headache, focal neurology Meningitis: Bacterial- […] Viral Clinically: Fever, Meningism, Altered sensorium Encephalitis: Tends to be […] Or […] spread from meninges (in that case would be meningo-encephalitis) Clinically: Altered sensorium, seizures, fever
Possible causes and effects of CNS infection: Abscess: Rare, normally in immune compromised Clinically: Fever, headache, focal neurology Meningitis: Bacterial- Meningococcus, Pneumococus Viral Clinically: Fever, Meningism, Altered sensorium Encephalitis: Tends to be viral (HSV) Or bacterial spread from meninges (in that case would be meningo-encephalitis) Clinically: Altered sensorium, seizures, f
We suspect meningitis when the patient has: - […] - May or may not be […] What are the complications of meningitis? - […] - […] - […] - […] - […] What does meningitis with rashes points towards? […]
We suspect meningitis when the patient has: - Fever and meningism (headache, neckstiffness +/- photophobia) - May or may not be confused What are the complications of meningitis? - Neurological deficit, CN deficit, Seizures - Brain infarction - Meningeal fibrosis and hydrocephalus - Raised ICP - Mental retardation (children) What does meningitis with rashes points towards? Neisseria meningitidis!!
Now what about brain tumours? How do they present classically? - […] - […] - […] - […]
Now what about brain tumours? How do they present classically? - Raised ICP headache which has been evolving for months (not acute/sudden. If acute then likely SAH) - Neurological deficit - Associated constitutional features (weight loss which is classical of cancer) - Seizures Therefore, every patient who presents with a headache needs a full neurological examination (huh wtf seriously??? No need
Summary of the lecture: […]
Summary of the lecture: Uncle with tender head refers to temporal arteritis.
What is the most common cause of acute stroke? (IMPT!!!) […] (85%), normally seen in […] Which is the most dangerous type of stroke? […] (25% die before reach ED), normally seen in […] Are parenchymal strokes more serious or SAH? […] What are the signs of acute stroke? - Sudden numbness in face, arm and leg - Sudden occluded vision (mono/ bi) - Sudden confusion/ slurred speech and unders
What is the most common cause of acute stroke? (IMPT!!!) Ischaemic stroke (85%), normally seen in older patients (atherosclerosis, HTN etc) Which is the most dangerous type of stroke? SAH (always this guy) (25% die before reach ED), normally seen in younger patients (berry aneurysms/arteriovenous malformations) Are parenchymal strokes more serious or SAH? SAH What are the signs of acute stroke? -
What is the most common cause of acute stroke? (IMPT!!!) Ischaemic stroke (85%), normally seen in older patients (atherosclerosis, HTN etc) Which is the most dangerous type of stroke? SAH (always this guy) (25% die before reach ED), normally seen in younger patients (berry aneurysms/arteriovenous malformations) Are parenchymal strokes more serious or SAH? SAH What are the signs of acute stroke? -
What is the most common cause of acute stroke? (IMPT!!!) Ischaemic stroke (85%), normally seen in older patients (atherosclerosis, HTN etc) Which is the most dangerous type of stroke? SAH (always this guy) (25% die before reach ED), normally seen in younger patients (berry aneurysms/arteriovenous malformations) Are parenchymal strokes more serious or SAH? SAH What are the signs of acute stroke? -
What are the main supplies of blood to the brain? 1. […] 2. […] What does these arteries interconnect to form? What is its significance? […] Which vessel from the Circle of Willis contributes the most to cerebral circulation? […]
What are the main supplies of blood to the brain? 1. Carotid arteries (80%) 2. Vertebral arteries (20%) What does these arteries interconnect to form? What is its significance? Circle of Willis at base of brain. Provides collateral bloodflow. Which vessel from the Circle of Willis contributes the most to cerebral circulation? MCA!! So most strokes have to do with MCA
How do we gauge severity of stroke? 1. […] 2. […]
How do we gauge severity of stroke? 1. GCS (max score 15, get worried at 13)(limited use in stroke. Dont use) 2. NIHSS (max score 42, >10 would suggest 80% chance of severe damage or death in hospital Recall that GCS max score is 15, min score is 3 and below 13 is worrying. NIHSS = National Institutes of Health Stroke Scale When using the NIHSS you must remember to take 2 measurements; one when th
Outline the risk factor for strokes. Which one is the strongest modifiable risk factor? (vvvvvvv IMPT!!!) 1. […] 2. […] 3. […] 4. […] 5. […]
Outline the risk factor for strokes. Which one is the strongest modifiable risk factor? (vvvvvvv IMPT!!!) 1. HTN (strongest modifiable risk factor for all strokes) 2. DM 3. High lipids 4. Smoking 5. AF rather standard answers but need to know because these are what we target in secondary prevention Just reducing BP by 9mmHg can reduce stroke risk by 44%!! Treatment for stroke from DM is harder tha
FAST assessment for strokes? (IMPT!!!) 1. […] 2. […] 3. […] 4. […] What is used for post stroke functional assessment? What does it measure? […]
FAST assessment for strokes? (IMPT!!!) 1. Facial droop (weakness/numbness) 2. Arm drift (balance, coordination) 3. Slurred speech (language) 4. Time (CALL FOR HALP!! 995.) What is used for post stroke functional assessment? What does it measure? Modified Rankin Score (MRS), used to measure dependance 1 min of stroke kills 1.9 neurons in the brain
Why are stroke units important? […]
Why are stroke units important? improves outcomes!! Not a trivial card.
Acute stroke patient management? 1. […] 2. […] 3. […] 4. […]
Acute stroke patient management? 1. Blood pressure 2. BGL 3. Body temperature 4. Neurological observation It’s about the same as seizure management. Body temperature, BP and glucose are all parts of this. Can add respiratory support etc for either. General medical measures include - hydration - feeding - positioning - rehab TLDR to manage stroke - IV tPA - Urgent imaging to exclude bleeding - Cont
Should we treat HTN in patients with early ischemic stroke? […] Reasons for not treating HTN? 1. Blood pressure returns to baseline in a few days 2. BP lowering can cause infarct extension because of presence of an ischaemic penumbra and loss of autoregulation Reasons for treating HTN? 1. May decrease cerebral oedema, and if hypertensive encephalopathy, myocardial ischemia, CHF, aortic dissectio
Should we treat HTN in patients with early ischemic stroke? No, unless hypertensive encephalopathy, myocardial ischemia, CHF, aortic dissection. Mild and moderately elevated BP not routinely lowered!! Reasons for not treating HTN? 1. Blood pressure returns to baseline in a few days 2. BP lowering can cause infarct extension because of presence of an ischaemic penumbra and loss of autoregulation Re
Should we treat HTN in patients with early ischemic stroke? No, unless hypertensive encephalopathy, myocardial ischemia, CHF, aortic dissection. Mild and moderately elevated BP not routinely lowered!! Reasons for not treating HTN? 1. […] 2. […] Reasons for treating HTN? 1. […]
Should we treat HTN in patients with early ischemic stroke? No, unless hypertensive encephalopathy, myocardial ischemia, CHF, aortic dissection. Mild and moderately elevated BP not routinely lowered!! Reasons for not treating HTN? 1. Blood pressure returns to baseline in a few days 2. BP lowering can cause infarct extension because of presence of an ischaemic penumbra and loss of autoregulation Re
First line drug for stroke? […] Why should reasonable glycemic control be maintained in all acute stroke patients.? […] Why should measure be taken to combat fever in acute stroke patients? Fever is associated with worse outcome in ischaemic stroke (which is like most strokes) as well. Moderate hypothermia (28-34) also shown to confers powerful neuroprotective effects in animal stroke models (
First line drug for stroke? IV t-PA (thrombolytic, only 1 med lol!! time to specialize in stroke??) Why should reasonable glycemic control be maintained in all acute stroke patients.? Hyperglycaemia associated with worse outcomes and increased risk of ICH in patients treated with t-PA (fibrinolytic) Why should measure be taken to combat fever in acute stroke patients? Fever is associated with wors
First line drug for stroke? IV t-PA (thrombolytic, only 1 med lol!! time to specialize in stroke??) Why should reasonable glycemic control be maintained in all acute stroke patients.? Hyperglycaemia associated with worse outcomes and increased risk of ICH in patients treated with t-PA (fibrinolytic) Why should measure be taken to combat fever in acute stroke patients? […] Why are anticoagulants
First line drug for stroke? IV t-PA (thrombolytic, only 1 med lol!! time to specialize in stroke??) Why should reasonable glycemic control be maintained in all acute stroke patients.? Hyperglycaemia associated with worse outcomes and increased risk of ICH in patients treated with t-PA (fibrinolytic) Why should measure be taken to combat fever in acute stroke patients? Fever is associated with wors
When we use IV t-PA, what are we trying to save? […] Outline the t-PA protocol in stroke. - […] - […] - […] What are the Inclusion criteria for t-PA treatment? - Plain CT DOES NOT show haemorrhage (if haemorrhage then cannot tPA mah…) - Intravenous TPA 0.9 mg/kg, max. 90 mg - 10% of total dose as initial bolus and rest infused over 60 minutes What are the exclusion criteria for t-PA trea
When we use IV t-PA, what are we trying to save? The ischaemic penumbra, which is an area of reduced perfusion (<40% blood flow). Ischaemic core abit 没救 liao Outline the t-PA protocol in stroke. - No anticoagulants and antiplatelets for 24hrs - Maintain BP in recommended range (<180/105mmHg) - Repeat CT in 24hrs and stat if ICH is suspected What are the Inclusion criteria for t-PA treatment? - Pla
When we use IV t-PA, what are we trying to save? The ischaemic penumbra, which is an area of reduced perfusion (<40% blood flow). Ischaemic core abit 没救 liao Outline the t-PA protocol in stroke. - No anticoagulants and antiplatelets for 24hrs - Maintain BP in recommended range (<180/105mmHg) - Repeat CT in 24hrs and stat if ICH is suspected What are the Inclusion criteria for t-PA treatment? - [..
When we use IV t-PA, what are we trying to save? The ischaemic penumbra, which is an area of reduced perfusion (<40% blood flow). Ischaemic core abit 没救 liao Outline the t-PA protocol in stroke. - No anticoagulants and antiplatelets for 24hrs - Maintain BP in recommended range (<180/105mmHg) - Repeat CT in 24hrs and stat if ICH is suspected What are the Inclusion criteria for t-PA treatment? - Pla
When we use IV t-PA, what are we trying to save? The ischaemic penumbra, which is an area of reduced perfusion (<40% blood flow). Ischaemic core abit 没救 liao Outline the t-PA protocol in stroke. - No anticoagulants and antiplatelets for 24hrs - Maintain BP in recommended range (<180/105mmHg) - Repeat CT in 24hrs and stat if ICH is suspected What are the Inclusion criteria for t-PA treatment? - Pla
When we use IV t-PA, what are we trying to save? The ischaemic penumbra, which is an area of reduced perfusion (<40% blood flow). Ischaemic core abit 没救 liao Outline the t-PA protocol in stroke. - No anticoagulants and antiplatelets for 24hrs - Maintain BP in recommended range (<180/105mmHg) - Repeat CT in 24hrs and stat if ICH is suspected What are the Inclusion criteria for t-PA treatment? - Pla
Future of stroke treatment Endovascular treatment of acute ischaemic stroke? - […] - […] Treatment of malignant hemispheric infarction? - […]
Future of stroke treatment Endovascular treatment of acute ischaemic stroke? - Merci Retriever - Stentrievers Treatment of malignant hemispheric infarction? - Decompressive surgery (release pressure through the skull). Early decompression yields better results TLDR, we spam tPA now but next time maybe can use stentrievers and decompressive surgery.
Read below for […]. In case 1 there is almost 100% recovery in the taxi driver after t-PA treatment.
Read below for cases. In case 1 there is almost 100% recovery in the taxi driver after t-PA treatment.
Imaging: Where are the watershed infarctions in the brain? […] […] […]
Imaging: Where are the watershed infarctions in the brain? Cortical Border Zone: ACA MCA Internal Border Zone: LCA MCA Cortical Border Zone MCA PCA Watershed regions basically are tissues between borders of arterial supply, which are furthest away from the artery hence vulnerable to ischemia and infarction. LCA stands for penetrating arteries
Imaging: Anterior circulation stroke Anterior circulation would involve the […]. What are the early signs of acute MCA infarct that can be seen on CT? (IMPT!!!) - […] - […] - […] - […] - […] On CT, 60% of acute infarcts are seen within […] hrs. Almost all will be seen by 24hours Refer below for pictures etc.
“Imaging: Anterior circulation stroke Anterior circulation would involve the MCA and ACA. What are the early signs of acute MCA infarct that can be seen on CT? (IMPT!!!) - Dense MCA sign - Hypodensity in brain tissue - Obscuration of lentiform nucleus (cuz its the earliest area to be affected) - ““Insular ribbon”” sign - Sulcal effacement/mass effect On CT, 60% of acute infarcts are seen within 3-
Imaging: Posterior circulation stroke The posterior circulation would involve the […], […], […] or […].
Imaging: Posterior circulation stroke The posterior circulation would involve the PCA, SCA, AICA or PICA. The names here are a bit more confusing, so refer to this. Right anterior cerebellar artery stroke. Look at the hypodense area in the right cerebellum. Right posterior inferior cerebellar artery. When imaging the brain you can use the axial-coronal-sagittal planes to localise lesions. This is
Imaging: Other imaging of infarction Refer below. These could involve […].
“Imaging: Other imaging of infarction Refer below. These could involve any or all of the main vessel supplies to the brain. Note the hyperdense area on DWI (left) would (should) overlap/ correspond with the hypodense area on ADC (right). This one is harder to take note of, but clinical Hx would be helpful. Early infarctions/ small infarctions are easier to see on MRI than CT This is where you see
Imaging: Mimickers of stroke What are the conditions that mimics strokes on imaging? - […] - […] - […] - […] - […] Why would these mimic strokes? They can create hypodensities/ hyperdensities on CT/ MRI, therefore you must correlate with clinical Hx.
Imaging: Mimickers of stroke What are the conditions that mimics strokes on imaging? - cerebral venous thrombosis (venous sinus thrombosis?) - SDH/EDH/SAH (extra-axial) - Parenchymal bleeds (intra-axial) - Vascular malformations - Tumours Why would these mimic strokes? They can create hypodensities/ hyperdensities on CT/ MRI, therefore you must correlate with clinical Hx. Basically: SAH/EDH/SDH, T
Imaging: Mimickers of stroke What are the conditions that mimics strokes on imaging? - cerebral venous thrombosis (venous sinus thrombosis?) - SDH/EDH/SAH (extra-axial) - Parenchymal bleeds (intra-axial) - Vascular malformations - Tumours Why would these mimic strokes? […]
Imaging: Mimickers of stroke What are the conditions that mimics strokes on imaging? - cerebral venous thrombosis (venous sinus thrombosis?) - SDH/EDH/SAH (extra-axial) - Parenchymal bleeds (intra-axial) - Vascular malformations - Tumours Why would these mimic strokes? They can create hypodensities/ hyperdensities on CT/ MRI, therefore you must correlate with clinical Hx. Basically: SAH/EDH/SDH, T
Imaging: What are the routine MRI Brain sequences? […] with […]
Imaging: What are the routine MRI Brain sequences? DWI with ADC Diffusion-weighted imaging (DWI) Apparent Diffusion Coefficient (ADC)
In basal ganglia lesions, we can have either too much (eg - […]) or too little (eg - […]) movement.
In basal ganglia lesions, we can have either too much (eg - dyskinesia) or too little (eg - Parkinsonism) movement.
Parkinsonism is a clinical syndrome that is normally associated with? (IMPT!!!!!) 1. […] 2. […] 3. […] What are some causes of Parkinsonism? - Idiopathic Parkinson’s disease - Neuroleptic medication (EPSE - typical psychotics etc) - Wilson disease - Infective encephalitis - Vascular Parkinsonism - Parkinson Plus Syndromes
Parkinsonism is a clinical syndrome that is normally associated with? (IMPT!!!!!) 1. Lead pipe rigidity (lack of voluntary movement) 2. Bradykinesia (immobility) 3. Resting tremors What are some causes of Parkinsonism? - Idiopathic Parkinson’s disease - Neuroleptic medication (EPSE - typical psychotics etc) - Wilson disease - Infective encephalitis - Vascular Parkinsonism - Parkinson Plus Syndrome
Parkinsonism is a clinical syndrome that is normally associated with? (IMPT!!!!!) 1. Lead pipe rigidity (lack of voluntary movement) 2. Bradykinesia (immobility) 3. Resting tremors What are some causes of Parkinsonism? - […] - […] - […] - Infective encephalitis - Vascular Parkinsonism - Parkinson Plus Syndromes
Parkinsonism is a clinical syndrome that is normally associated with? (IMPT!!!!!) 1. Lead pipe rigidity (lack of voluntary movement) 2. Bradykinesia (immobility) 3. Resting tremors What are some causes of Parkinsonism? - Idiopathic Parkinson’s disease - Neuroleptic medication (EPSE - typical psychotics etc) - Wilson disease - Infective encephalitis - Vascular Parkinsonism - Parkinson Plus Syndrome
Lead-pipe rigidity is a feature of Parkinsonism. What is rigidity? […] How does extrapyramidal rigidity present vs UMN rigidity (hypertonia)? […] In UMN rigidity (clasp knife), why is it resistance found in only some ranges of motion? - Certain sets of muscles are stronger than antagonistic counterparts - Tone is therefore determined by the stronger set of muscles (flexors normally stronger th
Lead-pipe rigidity is a feature of Parkinsonism. What is rigidity? Rigidity is the resistance to passive movement. How does extrapyramidal rigidity present vs UMN rigidity (hypertonia)? Lead-pipe (hard all the time) vs Clasp knife (easy in some planes of movement) In UMN rigidity (clasp knife), why is it resistance found in only some ranges of motion? - Certain sets of muscles are stronger than an
