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402: Neurology and neurosurgery > Stroke + Head > Flashcards

Stroke + Head Flashcards

1
Q

Total anterior cerebral stroke features

A
  • Homonymous hemianopia
  • Contralateral hemiparesis
  • Higher cortical dysfunction: i.e. aphasia, neglect

PACI= 2 of those features

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2
Q

Posterior cerebral infarct features

A

Cerebellar features (DANISH)

Bilateral motor/sensory loss

Isolated hemianopia

Bilateral visual field loss

CN palsy + contralateral motor/sensory deficit

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3
Q

Features of a lacunar cerebral stroke

A

Pure sensory or motor dysfunction ALONE

Ataxic hemiparesis

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4
Q

Risk factors for ischaemic stroke [7]

A

Hypertension

Atrial fibrillation

Hyperlipidaemia

Diabetes

Smoking

Previous TIA

Valvular heart disease

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5
Q

Acute treatment for ischaemic stroke (<4.5 hours)

A

Thrombolysis
- IV Alteplase

If suitable
- Thrombectomy

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6
Q

Acute treatment for ischaemic stroke (>4.5 hours)

A

High dose aspirin
- 300mg
- Given rectally/ enteral tube if dysphagia present
- Continue for 2 weeks or until discharge

PPI

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7
Q

Acute treatment of cerebral venous thrombosis

A

1st= heparin

Then wafarin

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8
Q
A

Antiplatelet
- first line= Clopidogrel 75mg OD

Statin
- Artovastatin 80mg OD

BP and DM control

Carotid endarterectomy for carotid disease.

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9
Q

Risk factors for haemorrhagic stroke

A

Anticoagulant use

Illicit drug use

AV malformations

Coagulopathy

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10
Q

Examples of higher cortical dysfunction in stroke

A

Expressive and receptive dysphasia

Neglect

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11
Q

Second line antiplatelet for stroke prevention

A

Dipyridamole 200mg BD

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12
Q

First line management for TIA

A

High dose aspirin= 300mg

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13
Q

Imaging in suspected TIA

A

MRI to identify ischaemia/ bleed

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14
Q

A carotid endarterectomy should be offered in TIA patients with…

A

> 50%

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15
Q

The hallmark features of horner syndrome are..

A

Miosis (constricted pupils)

Anhihydrosis

Ptosis (drooping eyelid|)

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16
Q

Causes of horner syndrome

A

Infarction
- Stroke (lateral medullary/ sympathetic tracts)

Demyelination

Trauma
- Spinal cord/ thoracic outlet, lung apex

Carotid dissection/ thrombosis

Cavernous sinus aneurysm

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17
Q

Post-ganglionic lesions in Horner’s syndrome present …

A

Without anhidrosis

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18
Q

Cause of post-ganglionic lesions in Horner’s syndrome

A

Carotid artery dissection / aneurysm

Cavernous sinus thrombosis

Cluster headache

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19
Q

Pre-ganglionic lesions in Horner’s syndrome present as…

A

Anhidrosis of the face only

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20
Q

Causes of pre-ganglionic lesions in Horner’s syndrome

A

Pancoast’s tumour

Thyroidectomy

Trauma

Cervical rib

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21
Q

Central lesions in Horner’s syndrome present as…

A

Anhidrosis of the face, trunk and arm

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22
Q

Causes of central lesions in Horner’s syndrome

A

Stroke

Multiple sclerosis

Tumour

Encephalitis

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23
Q

The 4 types of migraines are…

A
  1. Migraines without aura
  2. Migraines with aura
  3. Silent migraine
  4. Hemiplegic migraine
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24
Q

A chronic migraine is defined as…

A

Having migraine episodes at least 15 days per month

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25
Q

Examples of triggers for migraines [8]

A

Psychological
- Stress
- Abnormal sleep

Sensory
- Bright lights
- Strong smells

Physical
- Dehydration
- Menstruation
- Foods= caffeine, cheese
- Trauma

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26
Q

The pattern of a migraine typically occurs as _______

A

Aura followed by headache

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27
Q

Features of an aura in a migraine

A

Sparks in vision/ blurred vision

Loss of visual fields

Sensory symptoms: paraesthesia, numbness

Dysphasia

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28
Q

A headache in migraines lasts for…

A

4-72 hours

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29
Q

Describe the nature of a headache in migraines

A

Commonly unilateral

Pounding/throbbing

Accompanied by
- Photophobia/ Phonophobia
- nausea/ vomiting.

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30
Q

A hemiplegic migraine can mimic a______

A

Stroke

31
Q

Features of a hemiplegic migraine

A

Hemiplegia

Ataxia

Changes in consciousness

32
Q

Initial, non-pharmacological management of a migraine

A

Migraine diary
- Triggers, duration, treatment use

Avoiding triggers
- Stress, foods, sleep

33
Q

Pharmacological management of an acute migraine attack

A

Simple analgesia
- Paracetamol, NSAIDs

Triptans

34
Q

_________ is indicated for nausea and vomiting in mirgaines

A

Metoclopramide

35
Q

________ is the first line triptan used for acute migraines

A

Sumitriptan

36
Q

Medication overuse headaches occur when…

A

Analgesia are taken for continuous periods >3 months.
- At least 15+ a month for simple analgesia

37
Q

In medication-overuse headaches, treatment involvements…

A

Stopping medication for at least 1 month

38
Q

_______ is first line indicated for prophylaxis in migraines

A

Propranolol

39
Q

__________ is second-line indicated for prophylaxis in migraines

A

Topiramate

40
Q

__________ is a non-pharmacological treatment recommended for migraine prophylaxis

A

Acupuncture

41
Q

Tension headache lasts for….

A

30 mins to 7 days

42
Q

The distribution of tension headaches is…

A

Pain across head in “band-line” pattern

43
Q

Negative features of tension headaches:

A

Nausea + vomiting

Aggravated by physical activity

44
Q

List 8 red flags for headaches

A

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

45
Q

A headache worse on standing could indicate….

A

A CSF leak

46
Q

A headache worse on laying down could indicate…

A

Space occupying lesion

Cerebral venous sinus thrombosis

47
Q

Non-pharmacological treatment of a tension headache

A

Identifying and avoiding triggers

Relaxation techniques

Hot towels

48
Q

Cluster headaches are associated with…

A

Heavy smoking and drinking

A family history

Trauma

49
Q

The pathophysiology of cluster headaches involve the abnormal activation of…

A

The trigeminal autonomic reflex

50
Q

Cluster headaches typically occur, how frequently?

A

A least 3-4 a day for weeks.

51
Q

Cluster headaches commonly radiates to….

A

The temporal and maxillary region

52
Q

Associated features of a cluster headache

A

Lacrimation

Rhinorrhea

Non-anhidrosis horner syndrome

53
Q

The duration of a cluster headache typically lasts for…

A

15mins- 3 hours.

54
Q

Cluster headaches can be exacerbated by…

A

Light (photophobia)

Sound (hyperacusis/ phonophobia)

55
Q

What inflammatory marker is elevated in cluster headaches?

A

ESR

56
Q

Non-pharmacological advice for cluster headaches

A

Avoid heavy alcohol

57
Q

What is the first-line management of an acute cluster headache

A

Subcutaneous sumatriptan + high flow 100% oxygen

58
Q

What is the second-line management of an acute cluster headache

A

Intranasal zolmitriptan

59
Q

What medication is used as prophylaxis for cluster headaches

A

Verapamil

Short-term prednisolone

60
Q

Lithium can be used as prophylaxis for _______

A

cluster headaches (2nd line)

61
Q

Indications for a CT head in trauma for <16 [5]

A

NAHI suspicion

Seizure (no epilepsy hx)

GCS <14 or 15 (in <1 year)

GCS <15 after 2 hours

Focal neurological deficit

62
Q

Indications for a CT head in trauma for adults

A

GCS <13 or <15 after 2 hours

Open/ depressed skull fracture

Seizure

Focal neurological deficit

> 1 vomiting episode

63
Q

Motor, sensory and autonomic innervation of the facial nerve (CN7)

A

Motor
- Muscle of facial expression

Sensory
- Anterior 2/3 of tongue
- External auditory canal
- Pinna

Autonomic
- Salivary glands (sympathetic)

64
Q

Motor, sensory and autonomic innervation of the facial nerve (CN7)

A

Motor
- Muscle of facial expression

Sensory
- Anterior 2/3 of tongue
- External auditory canal
- Pinna

Autonomic
- Salivary glands (sympathetic)

65
Q

Symptoms of Bell’s palsy usually peaks…

A

Within 3 weeks

66
Q

Features of Bell’s palsy

A

Unilateral, complete facial weakness (involves forehead)

Reduced lacrimation

Hyperacusis

Loss of taste in anterior 2/3 tongue

67
Q

Bell’s palsy is associated with a history of recent….

A

Viral illness (HSV especially)

68
Q

Most people make a full recovery for Bell’s palsy within…

A

3-4 months

69
Q

Refferal to a neurologist should be made in Bell’s palsy if treatment does not improve symptoms in…

A

3 weeks.

70
Q

General advise given for Bell’s palsy

A

Eye care:
- Lubricating drops
- Taping eyes closed when sleeping
- Avoiding irritation like dust/ swimming
- Wearing sunglasses when outdoors

71
Q

___________ is the first line pharmacological treatment indicated in Bell’s palsy

A

Oral prednisolone

72
Q

Triad for normal pressure hydrocephalus

A

Abnormal gait

Dementia

Urinary incontinence

73
Q

Management of normal pressure hydrocephalus

A

ventriculoperitoneal shunting

402: Neurology and neurosurgery (11 decks)

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