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Neurology > Stroke and Palsy > Flashcards

Stroke and Palsy Flashcards

1
Q

What is Bell’s palsy?

A

Isolated dysfunction and inflammation of the facial nerve (CN7)

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2
Q

What is a possible cause of Bell’s palsy?

A

HSV-1 re-activation

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3
Q

What are some symptoms of Bell’s palsy?

A

Unilateral facial weakness of lower motor neurons
Postauricular otalgia
Hyperacusis
Altered taste to front 2/3rds of the tongue
Dry mouth and eyes

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4
Q

What is the treatment for Bell’s palsy?

A

Prednisolone if within 72 hours of symptom onset

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5
Q

What is Ramsay Hunt syndrome?

A

Re-activation of VZV in the facial nerve

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6
Q

What is the presentation of Ramsay Hunt syndrome?

A

Severe ear pain
Tender and painful vesicular rash in and around ear, face, mouth
Vertigo
Deafness

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7
Q

What is the treatment for Ramsay Hunt syndrome?

A

Prednisolone and Acyclovir within 72 hours

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8
Q

What is bulbar palsy?

A

Lower motor neuron lesion affecting cranial nerves 9, 10 and 12

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9
Q

Which cranial nerves are affected in bulbar palsy?

A

Glossopharyngeal
Hypoglossal
Vagus

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10
Q

What are the main causes of bulbar palsy?

A

MND
MG
GBS
Brainstem stroke

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11
Q

What is the presentation of bulbar palsy?

A

Absent jaw jerk and gag reflex
Flaccid fasciculation of the tongue
Quiet nasal speech

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12
Q

What are some causes of cerebral palsy?

A

HIE
Infection
Meningitis
Trauma
Haemorrhage

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13
Q

What is spastic cerebral palsy?

A

The most common
Damage to pyramidal pathways and UMN
Hypertonia and hyperreflexia
Scissor gait
Clasp knife spasticity

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14
Q

What is dyskinetic cerebral palsy?

A

Damage to basal ganglia pathways presenting with choreiform movements

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15
Q

What is ataxic cerebral palsy?

A

Damage to cerebellar pathways and cerebellum
Presents with uncoordinated movements

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16
Q

What are some early signs and symptoms of cerebral palsy?

A

Hand preference before 18 months
Increased or decreased tone
Failure to meet milestones

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17
Q

What does broad based ataxic gait suggest?

A

Cerebellar lesions

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18
Q

What is normal pressure hydrocephalus?

A

Excess CSF accumulates in the ventricles, increasing the pressure and causing symptoms?

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19
Q

What is the triad of NPH?

A

Dementia
Magnetic gait
Incontinence
Wet, wacky and wobbly
Hakim-Adams triad

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20
Q

What does MRI show for NPH?

A

corpus callosum bowing

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21
Q

What can be used to manage NPH?

A

Therapeutic LP
Ventriculoperitoneal shunt - shunt CSF from brain to abdomen

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22
Q

What is GCA?

A

Inflammatory granulomatous arteritis of large cerebral arteries and other large vessels

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23
Q

What artery is affected in GCA?

A

Temporal artery - in segments

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24
Q

What is the presentation of GCA?

A

Severe headache
Scalp or temple tenderness
Jaw claudication
Amaurosis fugax

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25
Q

What is the diagnostic criteria for GCA?

A

3 or more of -
Over 50
New headache
Temporal artery tenderness
Raised ESR
Abnormal artery biopsy

26
Q

What is the 1st line diagnosis for GCA?

A

Raised ESR or CRP

27
Q

What is gold standard for GCA diagnosis?

A

Temporal artery biopsy - sample 3-5cm

28
Q

What is the treatment for GCA?

A

Prednisolone - oral without vision changes
IV methylprednisolone - with visual changes

29
Q

What is a brain abscess?

A

Pus filled swelling in the brain

30
Q

What is the management of brain abscess?

A

Craniotomy
Simple aspiration

31
Q

What is an ischaemic stroke?

A

Reduction in cerebral blood flow due to artery occlusion or stenosis

32
Q

What are some risk factors for stroke?

A

Smoking
Obesity
HTN
Diabetes
Previous TIA

33
Q

What is the presentation of an anterior circulation stroke?

A

Hemiplegia
Weakness
Hemisensory loss
Speech problems

34
Q

What is the presentation of a posterior circulation stroke?

A

DANISH

35
Q

What is the presentation of a brainstem stroke?

A

Quadriplegia - locked in

36
Q

Where causes a pure sensory stroke?

A

Lacunar infarcts in the basal ganglia/ pons/ thalamus

37
Q

What is the diagnosis for ischaemic stroke?

A

non contrast head CT to rule out haemorrhagic

38
Q

What is the management for ischaemic stroke?

A

300mg aspirin
Thrombolysis with alteplase within 4.5 hours of symptom onset
Thrombectomy

39
Q

What is given after ischaemic stroke for prevention?

A

Clopidogrel daily life-long
Aspirin 75mg for first 2 weeks
High dose statin

40
Q

What is a SAH?

A

Bleeding between arachnoid and pia mater often due to spontaneous rupture of a berry aneurysm in the circle of willis

41
Q

What is the presentation of SAH?

A

Thunderclap headache
Meningism
N+V
Speech changes
Weakness
Confusion
Coma

42
Q

What is the diagnosis of SAH?

A

Urgent non-contrast head CT shows a star shape
If negative, LP after 12 hours shows yellow CSF from bilirubin breakdown

43
Q

What is the treatment for SAH?

A

Nimodipine
Endovascular coiling
Surgical clipping

44
Q

What sort of drug is nimodipine?

A

Ca2+ antagonist to reduce vasospasm

45
Q

What is an epidural/ extradural haemorrhage?

A

Bleeding between the skull and dura due to rupture of the middle meningeal artery commonly due to trauma

46
Q

In what age group and why is an extradural haemorrhage more likely?

A

Younger adults because the middle meningeal artery is more exposed

47
Q

Where is the most common site of an extradural haemorrhage?

A

Pterion - where the parietal, temporal, sphenoid and frontal bones meet

48
Q

What is the presentation of an epidural haemorrhage?

A

Reduced GCS with latent period
Headache
Vomiting
Nausea
Seizures
Confusion

49
Q

What is the diagnosis of an epidural haemorrhage?

A

Non contrast head CT shows a lemon shape (ePIEdural = lemon)

50
Q

What is the management of an epidural haemorrhage?

A

Mannitol to reduce ICP
Clot evacuation - craniotomy then ligate MMA

51
Q

What is a subdural stroke?

A

Bleeding between the dura and arachnoid from rupture of bridging veins under low pressure

52
Q

What is the cause of a subdural stroke?

A

Brain atrophy in the elderly and alcohol abuse makes vein walls thin
Bridging veins are under low pressure and bleed slowly
It can increase ICP and cause a midline shift
Beyond suture lines

53
Q

What is the diagnosis of subdural haemorrhage?

A

Head CT - crescent banana shape

54
Q

What is the treatment of a subdural haemorrhage?

A

Mannitol to reduce ICP
Burr hole washout or craniotomy for drainage

55
Q

What is an intracerebral stroke?

A

Bleeding within the cerebellum

56
Q

What is the treatment for intracerebral stroke?

A

craniotomy to drain accumulated blood
mannitol for raised ICP

57
Q

What is a TIA?

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia
Lasts minutes to 24 hours
Resolves spontaneously usually within 1 hour

58
Q

What is the presentation of TIA?

A

Contralateral sensory or motor deficits
Facial and limb weakness
Ataxia
Vertigo
Dysphasia
Diplopia

59
Q

What is the diagnosis of a TIA?

A

1st line - diffusion weighted CT/ MRI
Then carotid imaging with doppler USS

60
Q

What is the management of a TIA?

A

300mg aspirin
Carotid endocardectomy within 2 weeks

61
Q

What is the ABCD2 score?

A

Risk of stroke after TIA
A - age over 60 = 1
B - blood pressure over 140/90 = 1
C - unilateral weakness = 2
Speech disturbance without weakness = 1
Diabetes = 1
Duration over 60 mins = 2
10-59 minutes = 1

Score under 4 = 7 day referral
4-6 = 24 hours
Over 6 = immediate

62
Q

What cannot you do after TIA?

A

Drive for 1 month

Neurology (12 decks)

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