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pbls > Week 17 - Nervous System > Flashcards

Week 17 - Nervous System Flashcards

1
Q

What are the 2 main types of stroke?

A

Ischaemic
Haemorrhagic

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2
Q

What are some common symptoms of a stroke?

A

Typically asymmetrical
- limb weakness
- facial weakness
- dysphagia
- visual field defects
- sensory loss
- ataxia
- vertigo

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3
Q

What defines a TIA?

A

Temporary neurological dysfunction (<24hrs)
Caused by ischaemia but without infarction

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4
Q

What are crescendo TIAs?

A

2 or more TIAs within a week

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5
Q

What can be the causes of ischaemia in a stroke?

A

Embolism
Thrombosis
Systemic hypoperfusion
Cerebral venous sinus thrombosis

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6
Q

What is the classification system of Ischaemic stroke? What are the types?

A

Bamford classification
- total anterior circulation stroke
- partial anterior circulation stroke
- posterior circulation syndrome
- lacunae stroke

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7
Q

What is the criteria for a total anterior circulation stroke?

A

All 3 of the following must be present:
• Unilateral weakness (and/or sensory deficit) of the face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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8
Q

What is the criteria for a partial anterior circulation stroke?

A

2 of the following need to be present:
• Unilateral weakness (and/or sensory deficit) of the face, arm and leg
• Homonymous hemianopia
• Higher cerebral dysfunction (dysphasia, visuospatial disorder)*

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9
Q

What is the criteria for posterior circulation syndrome?

A

1 of the following needs to be present:
• Cranial nerve palsy and a contralateral motor/sensory deficit
• Bilateral motor/sensory deficit
• Conjugate eye movement disorder (e.g. horizontal gaze palsy)
• Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
• Isolated homonymous hemianopia

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10
Q

What is the criteria for a lacunae stroke?

A

1 of the following needs to be present:
• Pure sensory stroke
• Pure motor stroke
• Sensori-motor stroke
• Ataxic hemiparesis

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11
Q

What is a total anterior circulation stroke?

A

Large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries

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12
Q

What is a partial anterior circulation stroke?

A

Less severe form of TACS
Only part of the anterior circulation has been compromised

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13
Q

What is posterior circulation syndrome?

A

Involves damage to the area of the brain supplied by the posterior circulation e.g. Cerebellum and brainstem

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14
Q

What is a lacunar stroke?

A

Subcortical stroke
Occurs secondary to small vessel disease
No loss of higher cerebral function

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15
Q

What are the 2 subtypes of haemorrhagic stroke?

A

Intracerebral haemorrhage
Subarachnoid haemorrhage

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16
Q

What is the most common cause of a subarachnoid haemorrhage?

A

Berry aneurysm in the circle of Willis

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17
Q

Where do posterior cerebral arteries supply?

A

Mixture of medial and lateral areas of the posterior cerebrum

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18
Q

Where do the middle cerebral arteries supply?

A

Majority of the lateral cerebellum

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19
Q

Where do the anterior cerebral arteries supply?

A

Ateromedial area of the cerebrum

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20
Q

What symptoms are seen in a blockage of the anterior cerebral artery?

A

Weakness of contralateral leg
Behaviour changes

Typically present with weakness and sensory loss in the lower leg and foot opposite the lesion, incontinence and behaviour changes

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21
Q

What symptoms are seen in a blockage of the middle cerebral artery?

A

Weakness of contralateral face and arm
Speech disturbance
Visual field defect
Intattention to stimuli
Sensory defecits

Typically present with symptoms most associated with stroke

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22
Q

What symptoms are seen in the blockage of the posterior cerebral artery?

A

Visual field defects
Sensory defecits

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23
Q

What symptoms are seen with a lesion in the vertebrobasilar system?

A

Dizziness
Ataxia
Impaired balance
Pupil and eye movement abnormalities
Changes in voice and swallowing
Weakness and sensory changes
Decreased level of consciousness

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24
Q

What is found in grey matter?

A

Cell bodies
Cerebral cortex

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25
Q

What is found in the white matter?

A

Glial cells and myelinated axons

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26
Q

What are the 4 lobes of the brain?

A

Frontal
Parietal
Temporal
Occipital

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27
Q

What is the function of the frontal lobe?

A

Higher intellect
Personality
Mood
Social conduct and language

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28
Q

Where is the broca region located?

A

Frontal lobe

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29
Q

What is the function of the parietal lobe?

A

Language
Calculation
Visuospatial function

30
Q

What is the function of the temporal lobe?

A

Memory
Language
Hearing

31
Q

Where is wernickes area located?

A

Temporal lobe

32
Q

What is Broca’s area for?

A

Language retrieving

33
Q

What is wernickes area for?

A

Language articulating

34
Q

What is the function of the occipital lobe?

A

Vision

35
Q

What is the function of the pons?

A

Handles unconscious processes and jobs
E.g. sleep wake cycle, breathing

36
Q

What is the function of the medulla?

A

Helps control vital processes
E.g. heartbeat, breathing, BP

37
Q

What is the function of the cerebellum?

A

Helps maintain balance and posture

38
Q

What is the secondary prevention after someone’s had a stroke?

A

Clopidogrel 75mg once daily
Atorvostatin 20-80mg (delayed to at least 48 hours after event)
BP and diabetes control
Manage modifiable risk factors e.g. smoking, obesity and exercise

39
Q

What are the driving restrictions after a stoke?

A

Not allowed to drive for 1 month
Don’t need to tell DVLA if it’s TIA or Ischaemic stroke
Need to notify DVLA if it’s a haemorrhagic stroke

Should always personally tell DVLA of attack especially if HGV driver

40
Q

What is the function of the primary motor cortex when communicating with corticospinal tract?

A

Execution of movement

41
Q

What is the function of the premotor cortex when communicating with the corticospinal tract?

A

Control of behaviour especially of trunk muscles

42
Q

What is the function of the supplementary motor cortex when communicating with the corticospinal tract?

A

Stabilisation and coordination of the body during bimanual movements

43
Q

Where do nerves of the lateral corticospinal tract cross?

A

Medulal

44
Q

Where do nerves of the anterior corticospinal tract cross?

A

At level the spinal nerves enter

45
Q

Where do UMN and LMN synapse in the corticospinal tract?

A

Ventral horn

46
Q

Where do UMNs from the trigeminal (corticobulbar) tract arise?

A

Lateral aspect of the primary motor cortex

47
Q

Where do nerves of the trigeminal (corticobulbar) tract supply?

A

Muscles of head and neck

48
Q

What are the 3 layers of the meninges?

A

Dura mater - adhears to skull
Arachnoid Mater - directly beneath dura
Pia mater - adhears to brain and spinal cord

49
Q

What are the 2 functions of the meninges?

A

Provide a supportive framework for vessels
Form distinct comoartments to prevent injury

50
Q

Where is CSF produced?

A

Choroid plexus

51
Q

What is the function of CSF in the ventricles of the brain?

A

Protect brain against trauma
Provide nutrients
Removes waste product

52
Q

What connects the lateral ventricles to the 3rd ventricle?

A

Interventricular foramina

53
Q

Where CSF reabsorbed?

A

Arachnoid granulations

54
Q

What type of cells are found in the choroid plexus?

A

Cuboidal epithelial cells

55
Q

What is the main Thrombolysis given in Ischaemic stroke?

A

Alteplase

56
Q

What 2 conditions must be met before giving Alteplase Thrombolysis in a stroke event?

A

Must be administered within 4.5hrs of stroke symptoms
Haemorrhage must be definitively excluded

57
Q

What are the most common causes of an UMN lesion?

A

Stroke
MS
B12 deficiency
Brown-sequard syndrome
Trauma
Tumours
Severe infection
Dementia

58
Q

What does babinskis sign show?

A

UMN lesion

59
Q

What are some clinical signs of an UMN lesion?

A

• Disuse atrophy (minimal) or contractures
• Increased tone (spasticity/rigidity) +/- ankle clonus
• Pyramidal pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)
• Hyperreflexia
• Upgoing plantars (Babinski sign)

60
Q

What 2 features are associated with an UMN lesion and which 2 are associated with a LMN lesion?

A

UMN = hypertonia, spastic paralysis
LMN = hypotonia, flaccid paralysis

61
Q

What are some causes of LMN lesions?

A

Trauma to peripheral nerves
Viruses that attack ventral horn cells

62
Q

What clinical signs are seen in a LMN lesion?

A

• Marked atrophy
• Fasciculations
• Reduced tone
• Variable patterns of weakness
• Reduced or absent weakness
• Downgoing plantars or absent response

63
Q

What symptoms does damage to Broca’s area cause?

A

○ Dysfluency
○ Impaired grammatical structure
○ Absence of small linking words
○ Slow, but comprehensible speech

64
Q

What symptoms are seen when there is damage to wernickes area?

A

○ Fluent speech lacking in meaningful content
○ Patients unaware of the scale of their aphasia

65
Q

What is the angular gyrus responsible for?

A

Reading and writing
Allows us to associate multiple types of language related info

66
Q

What symptoms are seen in damage to the angular gyrus?

A

○ Alexia - inability to recognize or read written words or letters, typically as a result of brain damage
○ Agraphia - inability to write letters, symbols, words, or sentences, resulting from damage to various parts of the brain.

67
Q

What is dysdiadochokinesia?

A

Inability to do rapid alternating movements

68
Q

What is the most common cause of a subarachnoid haemorrhage?

A

Uncontrolled hypertension

69
Q

What is the first investigation done in suspected stroke?

A

Non contrast CT head
Rule out haemorrhage

70
Q

What is the suggested treatment for Bell’s palsy?

A

Prednisolone 30mg if symptoms presented in last 72hrs

pbls (19 decks)

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