Neurology and Stroke Flashcards
Name 4 conditions that are stroke mimics. How are they differentiated from an acute stroke?
HEMI:
-Hypoglycaemia
- Epilepsy
- Migraine (hemiplegic)
- Intracranial tumours/infections
The Recognition of Stroke in the Emergency Room (ROSIER) scale
How should you treat Bell’s palsy?
commence on a course of prednisolone (if present within 72 hours of onset) and give eye care advice
Eye care is important in Bell’s palsy - drops, lubricants and night time taping should be considered to prevent exposure keratopathy
What are the localising features of focal seizures?
1. Temporal lobe (HEAD)
2. Frontal lobe
3. Parietal lobe
4. Occipital lobe
- Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/
Dysphasia post-ictal) - Motor- Head/leg movements, posturing, post-ictal weakness, Jacksonian march
- Sensory- Paraesthesia
- Visual - floaters/flashes
What is Todd’s paresis?
Post ictal weakness common in focal seizures
How is GCS scored?
In GCS, take the best response from each side!
Motor:
6. Obeys commands
5. Localises to pain
4. Withdraws from pain
3. Abnormal flexion to pain (decorticate posture)
2. Extending to pain
1. None
Verbal:
5. Orientated
4. Confused
3. Words
2. Sounds
1. None
Eye opening:
4. Spontaneous
3. To speech
2. To pain
1. None
Describe some of the key clinical features of MND. How is it managed? (medication, resp care and nutrition)
Features:
fasciculations
mixture of lower MN and upper MN signs
wasting of small hand muscles/tibialis anterior is common
the absence of sensory signs/symptoms
Management:
Riluzole: used mainly in amyotrophic lateral sclerosis
Respiratory care: non-invasive ventilation (usually BIPAP) is used at night
Nutrition: Percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition
What is Uhthoff ’s phenomenon?
where neurological symptoms are exacerbated by increases in body temperature - typically associated with multiple sclerosis
What is Myasthenia Gravis?
What is the key feature and how does this manifest itself?
Myasthenia gravis is an autoimmune disorder resulting in insufficient functioning acetylcholine receptors.
The key feature is muscle fatigability - muscles become progressively weaker during periods of activity and slowly improve after periods of rest:
extraocular muscle weakness: diplopia
proximal muscle weakness: face, neck, limb girdle
ptosis
dysphagia
What other conditions is myasthenia gravis associated with?
thymic hyperplasia in 50-70%
thymomas in 15%
autoimmune disorders: pernicious anaemia, autoimmune thyroid disorders, rheumatoid, SLE
How is myasthenia gravis investigated and managed?
Investigations
single fibre electromyography: high sensitivity (92-100%)
CT thorax to exclude thymoma
Management
long-acting acetylcholinesterase inhibitors
pyridostigmine is first-line
What is amaurosis fugax ?
a form of stroke that affects the retinal/ophthalmic artery- ‘curtain coming down’ over vision
How are TIAs managed acutely?
Immediate antithrombotic therapy:
give aspirin 300 mg immediately, unless contraindicated e.g. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging- CT head- to exclude a haemorrhage)
If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
discuss urgently with a stroke specialist
If the patient has had a suspected TIA in the last 7 days:
arrange assessment within 24 hours by a stroke specialist
If the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
