Stroke + Head Flashcards
Total anterior cerebral stroke features
- Homonymous hemianopia
- Contralateral hemiparesis
- Higher cortical dysfunction: i.e. aphasia, neglect
PACI= 2 of those features
Posterior cerebral infarct features
Cerebellar features (DANISH)
Bilateral motor/sensory loss
Isolated hemianopia
Bilateral visual field loss
CN palsy + contralateral motor/sensory deficit
Features of a lacunar cerebral stroke
Pure sensory or motor dysfunction ALONE
Ataxic hemiparesis
Risk factors for ischaemic stroke [7]
Hypertension
Atrial fibrillation
Hyperlipidaemia
Diabetes
Smoking
Previous TIA
Valvular heart disease
Acute treatment for ischaemic stroke (<4.5 hours)
Thrombolysis
- IV Alteplase
If suitable
- Thrombectomy
Acute treatment for ischaemic stroke (>4.5 hours)
High dose aspirin
- 300mg
- Given rectally/ enteral tube if dysphagia present
- Continue for 2 weeks or until discharge
PPI
Acute treatment of cerebral venous thrombosis
1st= heparin
Then wafarin
Antiplatelet
- first line= Clopidogrel 75mg OD
Statin
- Artovastatin 80mg OD
BP and DM control
Carotid endarterectomy for carotid disease.
Risk factors for haemorrhagic stroke
Anticoagulant use
Illicit drug use
AV malformations
Coagulopathy
Examples of higher cortical dysfunction in stroke
Expressive and receptive dysphasia
Neglect
Second line antiplatelet for stroke prevention
Dipyridamole 200mg BD
First line management for TIA
High dose aspirin= 300mg
Imaging in suspected TIA
MRI to identify ischaemia/ bleed
A carotid endarterectomy should be offered in TIA patients with…
> 50%
The hallmark features of horner syndrome are..
Miosis (constricted pupils)
Anhihydrosis
Ptosis (drooping eyelid|)
Causes of horner syndrome
Infarction
- Stroke (lateral medullary/ sympathetic tracts)
Demyelination
Trauma
- Spinal cord/ thoracic outlet, lung apex
Carotid dissection/ thrombosis
Cavernous sinus aneurysm
Post-ganglionic lesions in Horner’s syndrome present …
Without anhidrosis
Cause of post-ganglionic lesions in Horner’s syndrome
Carotid artery dissection / aneurysm
Cavernous sinus thrombosis
Cluster headache
Pre-ganglionic lesions in Horner’s syndrome present as…
Anhidrosis of the face only
Causes of pre-ganglionic lesions in Horner’s syndrome
Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib
Central lesions in Horner’s syndrome present as…
Anhidrosis of the face, trunk and arm
Causes of central lesions in Horner’s syndrome
Stroke
Multiple sclerosis
Tumour
Encephalitis
The 4 types of migraines are…
- Migraines without aura
- Migraines with aura
- Silent migraine
- Hemiplegic migraine
A chronic migraine is defined as…
Having migraine episodes at least 15 days per month
Examples of triggers for migraines [8]
Psychological
- Stress
- Abnormal sleep
Sensory
- Bright lights
- Strong smells
Physical
- Dehydration
- Menstruation
- Foods= caffeine, cheese
- Trauma
The pattern of a migraine typically occurs as _______
Aura followed by headache
Features of an aura in a migraine
Sparks in vision/ blurred vision
Loss of visual fields
Sensory symptoms: paraesthesia, numbness
Dysphasia
A headache in migraines lasts for…
4-72 hours
Describe the nature of a headache in migraines
Commonly unilateral
Pounding/throbbing
Accompanied by
- Photophobia/ Phonophobia
- nausea/ vomiting.
A hemiplegic migraine can mimic a______
Stroke
Features of a hemiplegic migraine
Hemiplegia
Ataxia
Changes in consciousness
Initial, non-pharmacological management of a migraine
Migraine diary
- Triggers, duration, treatment use
Avoiding triggers
- Stress, foods, sleep
Pharmacological management of an acute migraine attack
Simple analgesia
- Paracetamol, NSAIDs
Triptans
_________ is indicated for nausea and vomiting in mirgaines
Metoclopramide
________ is the first line triptan used for acute migraines
Sumitriptan
Medication overuse headaches occur when…
Analgesia are taken for continuous periods >3 months.
- At least 15+ a month for simple analgesia
In medication-overuse headaches, treatment involvements…
Stopping medication for at least 1 month
_______ is first line indicated for prophylaxis in migraines
Propranolol
__________ is second-line indicated for prophylaxis in migraines
Topiramate
__________ is a non-pharmacological treatment recommended for migraine prophylaxis
Acupuncture
Tension headache lasts for….
30 mins to 7 days
The distribution of tension headaches is…
Pain across head in “band-line” pattern
Negative features of tension headaches:
Nausea + vomiting
Aggravated by physical activity
List 8 red flags for headaches
Sudden onset= thunderclap headache, new in >50.
Headache worse on laying or standing
Headache that wakes from sleep
Headache associated with vomiting
Papilloedema
Focal neurological deficit
Meningitic features: fever, photophobia, rash
Change in personality/ cognition
A headache worse on standing could indicate….
A CSF leak
A headache worse on laying down could indicate…
Space occupying lesion
Cerebral venous sinus thrombosis
Non-pharmacological treatment of a tension headache
Identifying and avoiding triggers
Relaxation techniques
Hot towels
Cluster headaches are associated with…
Heavy smoking and drinking
A family history
Trauma
The pathophysiology of cluster headaches involve the abnormal activation of…
The trigeminal autonomic reflex
Cluster headaches typically occur, how frequently?
A least 3-4 a day for weeks.
Cluster headaches commonly radiates to….
The temporal and maxillary region
Associated features of a cluster headache
Lacrimation
Rhinorrhea
Non-anhidrosis horner syndrome
The duration of a cluster headache typically lasts for…
15mins- 3 hours.
Cluster headaches can be exacerbated by…
Light (photophobia)
Sound (hyperacusis/ phonophobia)
What inflammatory marker is elevated in cluster headaches?
ESR
Non-pharmacological advice for cluster headaches
Avoid heavy alcohol
What is the first-line management of an acute cluster headache
Subcutaneous sumatriptan + high flow 100% oxygen
What is the second-line management of an acute cluster headache
Intranasal zolmitriptan
What medication is used as prophylaxis for cluster headaches
Verapamil
Short-term prednisolone
Lithium can be used as prophylaxis for _______
cluster headaches (2nd line)
Indications for a CT head in trauma for <16 [5]
NAHI suspicion
Seizure (no epilepsy hx)
GCS <14 or 15 (in <1 year)
GCS <15 after 2 hours
Focal neurological deficit
Indications for a CT head in trauma for adults
GCS <13 or <15 after 2 hours
Open/ depressed skull fracture
Seizure
Focal neurological deficit
> 1 vomiting episode
Motor, sensory and autonomic innervation of the facial nerve (CN7)
Motor
- Muscle of facial expression
Sensory
- Anterior 2/3 of tongue
- External auditory canal
- Pinna
Autonomic
- Salivary glands (sympathetic)
Motor, sensory and autonomic innervation of the facial nerve (CN7)
Motor
- Muscle of facial expression
Sensory
- Anterior 2/3 of tongue
- External auditory canal
- Pinna
Autonomic
- Salivary glands (sympathetic)
Symptoms of Bell’s palsy usually peaks…
Within 3 weeks
Features of Bell’s palsy
Unilateral, complete facial weakness (involves forehead)
Reduced lacrimation
Hyperacusis
Loss of taste in anterior 2/3 tongue
Bell’s palsy is associated with a history of recent….
Viral illness (HSV especially)
Most people make a full recovery for Bell’s palsy within…
3-4 months
Refferal to a neurologist should be made in Bell’s palsy if treatment does not improve symptoms in…
3 weeks.
General advise given for Bell’s palsy
Eye care:
- Lubricating drops
- Taping eyes closed when sleeping
- Avoiding irritation like dust/ swimming
- Wearing sunglasses when outdoors
___________ is the first line pharmacological treatment indicated in Bell’s palsy
Oral prednisolone
Triad for normal pressure hydrocephalus
Abnormal gait
Dementia
Urinary incontinence
Management of normal pressure hydrocephalus
ventriculoperitoneal shunting
