questions Flashcards
neurobiology of fear what does the amygdala do
integrates sensory and cognitive info
types of ischaemic strokes
intracranial small vessel atherosclerosis
large vessel atherosclerosis (eg carotid artery stenosis)
cardio-embolic (AF)
rare causes: vasculitis, arterial dissection, prothrombotic states
what is a haemorrhagic stroke
rupture of a cerebrospinal artery
either primary or subarachnoid
oligoclonal bands in CSF
MS
definition of TIA
episode of neurological dysfunction due to temporary focal cerebral or retinal ischaemia without infarction
usually lasting seconds to minutes with complete recovery
presentation of a stroke
asymmetrical
- sudden weakness of limbs
- sudden facial weakness
- sudden onset dysphasia
- sudden onset visual or sensory loss
what is TACS
Involves the anterior AND middle cerebral arteries on the affected side
Defined by:
- Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
- Homonymous hemianopia
- Cortical signs (dysphasia, neglect)
Most severe type of stroke
what is PACS
Involves the anterior OR middle cerebral artery on the affected side
Defined by:
- 2 out of the 3 features present in a TACS OR
- Higher cerebral dysfunction alone e.g. dysphagia
what is LACS
Lacunar infarcts are small infarcts in the deeper part of the brain (basal ganglia, thalamus, white matter) and in the brain stem
Caused by occlusion of a single deep penetrating artery, affect 2 of face arm and leg
should be NO: visual field defect, higher cerebral dysfunction, or brainstem dysfunction
posterior circulation syndrome
cranial nerve palsy
involves the vertebrobasilar arteries and associated branches (supplying the cerebellum, brainstem and occipital lobe)
defined by:
- bilateral motor and/or sensory deficits
- conjugate eye movement disorders
- isolated homonymous hemianopia
- cortical blindness
- cerebellar deficits without ipsilateral motor/sensory signs
acute stroke management
urgent imaging
thrombolysis/thrombectomy
blood pressure lowering- IV labetalol, IV GTN
stroke unit carre
swallow assessment, nutrition and hydration
antiplatelets
DVT prevention
contraindication to thrombolysis
on anticoagulant
previous ICH
recent stroke
pregnancy/post partum
recent head injury
recent surgery
seizure
timing for thrombolysis
up to 4.5 hours
guidance on thrombectomy
as soon as possible and within 6 hours, with IV thrombolysis if not contraindicated
anticoagulant reversal
Vitamin K/Prothrombin complex for warfarin
Specific antidotes to direct thrombin (idarucizumab) and factor Xa inhibitors (andexanet alpha)
If unavailable, prothrombin complex advised
Other options of tranexamic acid and rFVIIa have been tried and are recommended by some guidelines
Malignant MCA syndrome
rare syndrome usually seen in very large anterior territory stroke
tends to occur 2-5 days post stroke,
generally problematic in younger patients
treatment- hemicraniotomy
Amaurosis fugax
temporary loss of vision in one or both eyes due to a lack of blood flow to the retina
what is amaurosis fugax a clinical sign of
if it is caused by a TIA then it is evidence of internal carotid artery stenosis
- a warning sign of incipient ICA territory stroke
investigations for a TIA
history- TIA is often based on its description
carotid duplex US
ECG
blood tests
management of TIA
immediate antiplatelet therapy
secondary prevention interventions- antihypertensive therapy, statins
surgery and stenting for carotid stenosis
Wernicke’s dysphasia
speech fluent, comprehension abnormal, repetition impaired
first line management for trigeminal neuralgia
Carbamazepine
epileptic drugs that are suitable during pregnancy
lamotrigine
Levetiracetam
carbamazepine
which antihypertensives should be stopped during pregnancy
ace inhibitors
ARBs
thiazide diuretics
