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neurology STEP 2 > stroke, headache, SAH > Flashcards

stroke, headache, SAH Flashcards

1
Q
  1. stroke - MCA

2 the SINGLE most important treatable risk factor for both the primary and secondary prevention of stroke.

A
  1. middle cerebral artery (more than 90%)

2. Hypertension

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2
Q

stroke in MCA - manifestation

A
  1. Weakness or sensory loss on the opposite side (face + upper limb)
  2. homonymous hemoanopsia (loss of visual field on the opposite side
  3. aphasia: if in the speech center (left side on 90%)
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3
Q

stroke in ACA - manifestation

A
  1. Weakness or sensory loss on the opposite side (lower ext and trunk
  2. urinary incontinence
  3. personality/cognitive defects (such as confusion)
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4
Q

stroke in PCA manifestation

A
  1. ipsilateral loss of the face, 9th and 10th CNs
  2. Limb ataxia
  3. Contralateral sensory loss of the limbs
  4. contralateral hemianopia with macular sparing
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5
Q

stroke - best initial test / Most accurate (explain)

A
  1. best initial: CT without contrast
  2. most accurate: MRI
    - CT first to exclude hemorrhage
    - CT needs 5 days to reache greater than 95% sensitivity. MRI 48h
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6
Q

the best initial therapy for nonhemorrhagic stroke

A
  1. less than 3 hours since osnet of stroke (some places 4.5): thrombolysis
  2. more than 3 hours: aspirin: if the patient already on aspirin: add dipyridamole or switch to clopidogrel
  3. hemorrhagic: nothing, reversal anticoagulationm control BP and control ICP (mannitol, hyperventilation, nanesthesia)
    if the patient already on aspirin: add dipyridamole or switch to clopidogrel
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7
Q

hemorrhagic stroke - surgery

A

it will not help outside the posterior fossa

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8
Q

prevention of stroke

A
  • either aspirin or clopidogrel (started on the first 48h)
  • not combine them –> combination only adds bleeding
  • you can combine dipyrodamole with aspirin
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9
Q

statin - stroke

A

every patient with stroke should be started on statins regardless of LDL
goal: 70 or less than 100

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10
Q

test to evaluate the cause of stroke

A
  1. EKG (for AF)
  2. Echo (damaged valves, thrombi, patent foramen ovale)
  3. Holter
    Carotid duplex US
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11
Q

Carotid endarterectomy (CEA) is indicated in

A

symptomatic patients with >70% carotid artery stenosis or asymptomatic patients with >60% stenosis. CEA should be performed within 2 weeks to reduce the risk of stroke
NO point to operate 100%

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12
Q

TIA - definition / management

A

symptoms last less than 24h, then resolve

aspirin: if the patient already on aspirin: add dipyridamole or switch to clopidogrel
3. hemorrhagic: nothing

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13
Q

stroke - hypertenion treatment

A

do not treat it immediately unless it is extreme (more than 220/120) or the patient has CAD in order to maintain cerebral perfusion
(nicardipine or labetolol)

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14
Q

Headache - MCC, how to diagnose

A

Tension headache
diagnosis of exclusion
exclude migraine, .cluster, giant, pseudotumor

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15
Q

Pseudotumor cereberi - associated with, mimics brain tumor, physical findings

A
  • obesity, venous sinus thrombosis, OCPs, vit A toxicity
  • mimics brain tumor with nausea, vomiting, visual disturbances
  • papilledema with diplopia from from 6th CN palsy
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16
Q

pseudotumor cerebri - diagnosic test

A

cannot be made without CT (or MRI) to exclude an intracranial mass lesion and a LP showing increased pressure (the CSF itself is normal)

17
Q
  1. cluster headache - treatment

2. migraine - treatment

A
  1. triptans, ergotamine, 100% O2, predinosone, lithium as abortive therapy
  2. triptans or ergotamine as adorptive therapy
18
Q

pseudotumor cerebri - treatment

A

weight loss, acetazolamide (decreases CSF production), steroid help, repeated LP rapidly, ventriculoperitoneal shunt or fenestrate into optic nerve if medical therpay does not control)

19
Q
  1. differences in treatment between cluster and migraines
A
  1. verapamil

2. cluster –> 02 100%, prednisone, lithium

20
Q

preventive therapy for migraine + cluster

A
  1. migraine: patients experiencing 3 or more per mounth
    - -> medication. the vest is propranolol. Other: CCB, amitriptyline, SSRI, topiramate, Botulinum toxin injections, sodium valproate
  2. not as clear: verapamil, sodium valproate
21
Q

Trigeminal Neuralgia - treatment

A
  • oxcarbazepine or carbamazepine
  • Baclofen and lamotrigine olaso effective
  • if meds do not control –> gamma knife or surgical decompression
22
Q

how to reduce the incidence of postherpetetic neuraligia

A
  • treatment of vesicular lesions with acyclovir, famciclovir or valganciclovir seems to reduce the incidence of posthherpetic neuralgia (steroids do not)
  • prevention Zoster vaccine indicated in all above 60. Similar to the varicella (much higher dose)
23
Q

postherpetetic neuraligia - treatment of pain

A
  1. TCA, gabapentin, pregabalin, carbamazepine, phenytoin

2. topical capsaicin is helpful

24
Q

Willis aneyrisms are more frequent in those with

how to determine the site

A
  1. PKD 2. tobacco 3. HTN 4. hyperlipidemia

5. alcohol 6. coartraction

25
Q

1, SAH - fever, loss of consiousness, focal neurological complications

A
  1. fever: 2ry to blood irritating the meninges
  2. loss of consciousness in 50% from sudden increases in intracranial pressure
  3. focal neurological complications in 30%
26
Q

how SAH deffers from meningitis

A
  1. very sudden in onset
  2. loss of consciousness in 50%
  3. SAH also has increased WBCs in CSF but the ratio of WBCs to RBCs will be NORMAL (1WBC to 1000 RBCs)
27
Q

SAH - best initial, most accurate test

A

Best initial: CT without contrast (95% sensitivity)

most accurate: LP showing blood (or xanthochromia from breakdown) –> necessary only in 5% (FN CT)

28
Q

SAH - how to determine the site

A

angiography is used to determine the site of the aneyrism in order to guide repair of the lesion
the only way to to tell precisely which vessel ruptured i the CT angiography, stadnard angiography with catheter or MRA

29
Q

EKG is SAH

A

large or inverted T waves (cerebral T waves) (excessive sympathetic activity

30
Q

SAH - treatment

A

no treatment is able to reverse:

  1. nimodipine: prevent subsequent iscehmic stroke
  2. embolization: catheter to clog up the site of bleeding to prevent repeated hemorrhage (platinum wire). Embolization is suprerior to surgical clipping in survival and complications
  3. Ventriculoperitoneal shunts if hydrocephalus
  4. seizure prophylaxis: phenytoin
31
Q

SAH - prognosis if rebleed

A

50-70% die

32
Q

SAH - when consultation is the right answer

A

when you want a particular procedureand the procedure is not given as a choice
when the embolization is the right answer but there is only interventional neuroradiology consultation, then pick this

neurology STEP 2 (8 decks)

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