Neurology

Question 1

Consent for thrombolysis

Answer 1

NNT 10 - for every 10 people that receive treatment one will have an improved outcome

NNH 42 - for every 42 people treated 1 will develop a significant intracranial haemorrhage

No mortality benefit

Risk of death is 1/122

NIHSS score > 4 < 25 (NIHSS > 6 for ECR)

Question 2

Stroke thrombolysis

Answer 2

0.9mg/kg max 90mg over 60 minutes with 10% given as bolus over 1 minute

Question 3

Complications of tPA

Answer 3

Angio-oedema
Sudden drop in GCS - may be ICH
Hyper/hypotension - may be sign of ICH

If ICH:
Stop the infusion.
Give cryoprecipitate 10u and repeat while monitoring fibrinogen until < 200mg/dl
Give TXA 1g IV
Consider pooled platelets
Call NSx

Question 4

Stroke syndromes

Answer 4

MCA - contralateral UL motor and sensory, L aphasia, R neglect
ACA - contralateral leg motor and sensory, L dysphasia
PCA - hemianopia macular sparing

AICA - cerebellar and CN 7,8 palsy, horner’s, facial droop, deafness
PICA - cerebellar, CN 9,10 palsy
Basilar - locked in syndrome, dysphagia, dysarthria
Vertebrobasilar - horner’s syndrome, ataxia

M1 - contralateral face/arm/leg, L aphasia, R neglect, CL gaze paresis
M2 (sup) - contralateral face/arm > leg, L expressive dysphasia (broca’s), R neglect
M2 (inf) - neglect, receptive dysphasia (wernicke’s)

Question 5

Dizziness differentials

Answer 5

Central cause:
Posterior circulation stroke
Infection: meningoenchalitis
TBI
Seizure
PRES
Carotid/vertebral artery dissection

Peripheral cause:
Meniere’s
BPPV
Acute otitis media
Labyrinthitis
Peripheral neuritis

Others:
Wernickes
Hypoglycaemia
Electrolyte disturbance
Cardiac
ACS
Anaemia
Hypo/hyperthyroidism
Meds: lithium, alcohol, salicylate