MM neuro tutorial Flashcards
1
Q
What are the types of haemorrhages?
A
Subdural
Extradural/epidural
Subarachnoid
2
Q
What effect would an extradural haemorrhage compressing the right motor cortex have?
A
Loss of motor function on the left side of the body
3
Q
Where do the arteries in the brain run?
A
Under the arachnoid mater and pia mater
4
Q
What are the meningeal layers from outer to innermost
A
Dura
Arachnoid
Pia
5
Q
What does a subdural haemorrhage look like on a scan?
A
Like a crescent
6
Q
What does an epidural haemorrhage look like on a scan?
A
Lenticular (like a half ball shape)
this is because its outside the brain under the skull
7
Q
What does an subarachnoid haemorrhage look like on a scan?
A
Bright spots in the cisterns (spaces in the brain)
8
Q
What are the risk factors for subdural haemorrhage?
A
Elderly and alcoholics
9
Q
What are the risk factors for extradural haemorrhage?
A
Trauma
10
Q
What are the risk factors for subarachnoid haemorrhage?
A
Burst aneurysm or trauma
11
Q
How does extradural haemorrhages present?
A
Acute onset after lucid interval (accident occurs, unconscious for a few mins then fine and then rapid deterioration)
Deterioration of GCS
Syncope, nausea, vomiting
Severe pain
12
Q
What is the main cause of extradural haemorrhage? What artery is usually involved?
A
Trauma, usually middle meningeal artery
13
Q
What investigations are done for extradural haemorrhage?
A
Non contrast CT of the head straight away
MRI
14
Q
What is the epidemiology for extradural haemorrhage?
A
Young, male
15
Q
Why is non contrast CT used for extradural haemorrhage?
A
Blood appears bright when its fresh
16
Q
What blood vessel is mainly associated with an extradural haemorrhage?
A
Middle meningeal artery
17
Q
Where does the middle meningeal artery run?
A
Pterion
18
Q
How is GCS calculated?
A
There are 3 categories: Eye opening (scored 1-4) Verbal response (scored 1-5) Motor response (scored 1-6) The higher the score the better (suggesting the patient is ok)
19
Q
What is the max GCS?
A
15
20
Q
How many GCS are there?
A
Adult and paediatric
21
Q
What does localise pain mean on the GCS?
A
They move their hands/ legs towards where pain is inflicted
22
Q
What is the minimum GCS?
A
3
23
Q
At what GCS are patients intubated?
A
A score below 9
24
Q
How does sub arachnoid haemorrhage present?
A
Sudden onset thunderclap headache at the back of their head (occipital region)
Neck may be stiff
May have meningeal symptoms
Syncope, nausea, vomiting
Very severe headache (worst in their life)
25
How should you report a GCS score
E 1-4
V 1-5
M 1-6
ie not just the total, report each section differently
26
What is epidemiology for subarachnoid haemorrhage?
50-55 year old woman
| higher incidence in black people
27
What are causes of subarachnoid haemorrhage?
Rupture of sacular aneurysm (80%)- is spontaneous
Arterial venous malformation
Arterial dissections
28
What is a sacular aneurysm?
Not a full length aneurysm but it looks like a sac
29
What is arterial venous malformation?
When artery and vein blend together but they shouldn't
30
What are risk factors of subarachnoid haemorrhage?
Smoking
hypertension
alcohol misuse
31
What is the first line investigation for subarachnoid haemorrhage and second line? What other investigations are done?
Non contrast head CT
if negative and you think they have it do a lumbar puncture
Serum electrolytes (they may be hyponatraemic if they have SIADH)
ECG
Serum glucose (1/3 are hypoglycaemic)
32
Which nerves are most affected by haemorrhages?
CN III and IV
33
When can you do a lumbar puncture? Why?
At least 12 hours post beginning of symptoms, you need to leave time for the haemoglobin to break down
34
How many tubes need to be filled in lumbar puncture?
3
35
What are cisterns?
Where CSF flows but not ventricles
36
What colour is CSF on CT?
Black
37
What syndrome is affected with head trauma?
SIADH
38
How will SIADH affect electrolytes?
Hyponatraemia
39
What test is done on all neuro patients?
ECG
40
How does subdural haemorrhage present?
Gradual onset
Fluctuating consciousness, personality change
Diminished response, nausea, vomiting
41
What are causes of subdural haemorrhage?
Trauma
42
What are risk factors for subdural haemorrhage?
Recent trauma
Coagulopathy/ anticoagulants
Over 65
Elderly and alcoholics
43
What is the epidemiology of subdural haemorrhages?
After falls, elderly patients, coagulopathy
44
Whats the main difference between subdural and extradural haemorrhage?
```
Subdural= gradual onset
Extradural= sudden onset
```
45
Why must you be careful if you suspect someone has a change in behaviour due to a subdural haemorrhage?
Rule out whether this could be because of dementia etc as usually the patients are old
46
What are the 2 types of subdural haemorrhages?
Acute and chronic
47
How do you differentiate acute subdural and epidural
If there is trauma involved and if the person is young it is more likely epidural
48
What should you look for when examining eyes in a neuro patient?
Are their eyes responsive to light and can they follow a light (shows CN 1-4 are fine)
49
What medication may be given to those with subdural haemorrhage?
Anti epileptics
50
What are the 2 ways to treat a subdural haemorrhage?
```
Watchful waiting (they might just get better)
Drill a burr hole and remove the haematoma
```
51
What are the 2 ways to treat a subdural haemorrhage?
```
Watchful waiting (they might just get better)
Drill a burr hole and remove the haematoma
```
52
When should you use a burr hole to treat a subdural haemorrhage?
If it is starting to affect their memory
| If they have a really poor GCS
53
What does plegic mean?
Paralysed/ can't move
54
How do you differentiate between an acute and chronic subdural haemorrhage on CT?
Acute will show blood to be white
| Chronic will show blood to be black
55
What is the biggest complication of a subdural haemorrhage? List some of the others too
```
Biggest= epilepsy
Others= Coma, stroke, neuro deficits eg plegia
```
56
How do you treat a subdural haematoma?
Acute, below 10mm, below 5mm midline shift, no CNS dysfunction= observe and wait
Acute, above 10mm, above 5mm midline shift, CNS dysfunction= surgery burr holes and prophylactic antiepileptics
Chronic haematoma= anti epileptics
57
What anti epileptics may be given for prophylaxis in subdural haematoma?
Levitiracetam or phenytoin
58
What may levitiracetam also be called?
Cepra
59
What disease is subarachnoid haemorrhage associated with?
Polycystic kidney disease
60
What symptom will a brain bleed commonly present with?
Headache
61
What are the 2 types of stroke?
Ischaemic or haemorrhagic
62
Define stroke
A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24 hours
63
Define TIA
A sudden onset focal neurological deficit of presumed vascular origin which lasts under 24 hours
64
What is an ischaemic stroke?
Loss of blood flow to a region of the brain due to stenosis or occlusion
65
What is a haemorrhagic stroke?
A burst blood vessel
66
How will a haemorrhagic stroke present?
Sudden onset
Loss of function
Vision changes
67
What are causes of haemorrhagic stroke?
Hypertension
| Drugs (cocaine, amphetamines)
68
How should you investigate stroke?
CT head (exclude haemorrhage if its ischaemic)
69
What treatment do you need to start if someone comes in with an ischaemic stroke? Why would you not do this if the stroke is haemorrhagic?
Alteplase IV
| If stroke is haemorrhagic this would make them bleed more
70
What is the epidemiology of haemorrhagic stroke?
Most are intracerebral, rest are subarachnoid
More common in men
More come in elderly
More common in asains
71
How is haemorrhagic stroke treated?
Refer them to neurosurgery
| Go through ABCDE and protect airway etc
72
If weakness in a stroke is right sided which side will the bleed be on?
Left
73
What area has been affected if there is expressive aphasia?
Broca's
74
What area has been affected if there is recepetive aphasia?
Wernicke's
75
If the arm is more affected than the leg in stroke which artery is more likely affected?
Middle cerebral (supplies the lateral parts of the brain and this is what controls the arms)
76
How does ischaemic stroke present?
```
Sudden onset
Loss of function
Vision changes
Headache
Aphasia
```
77
What is the epidemiology of ischaemic stroke?
```
Older people
Black people
Hispanic people
Lower levels of education
Men more than women
```
78
What are causes of ischaemic stroke?
Those with vascular sclerosis or occulsion eg diabetics atrial fibrillation, high cholestrol
Cerebral venous thrombosis
79
What is the first line investigation for haemorrhagic stroke?
Non contrast CT head
80
How will ischaemic stroke appear on CT?
Hypo attenuated ie area is less intense than the surrounding area
81
What should you think when you see hypo attenuation on a CT?
Vascular occlusion
| Ischaemia
82
What should you think when you see white on a CT?
Blood
83
How is ischaemic stroke treated?
Non contrast head CT to rule out haemorrhage THEN
Less than 4.5 hrs= alteplase IV, aspirin after 24 hrs of IV, supportive care, swallowing assessment, VTE prophylaxis (heparin)
Over 4.5 hrs= Aspirin 300 mg, supportive care, swallowing assessment, VTE prophylaxis
Central venous sinus thrombosis= antioagulate using heparin and supportive care
84
How is secondary prevention for ischaemic stroke carried out?
Continue with aspirin for 2 weeks, then switch to lifelong clopidogrel or diphyramidole
If they have AF offer lifelong anticoagulation
85
When is alteplase IV given for ischaemic stroke?
Only if you are completely sure they have prevented in under 4.5 hours of symptoms
86
How does presentation/risk factors/ epidemiology/ of TIA differ from stroke?
It doesn't, everything is the same
87
What is the ABCD referral system?
It is a way of scoring patients to see how quickly they have to be referred for stroke eg score of above 2= refer within 24 hrs
88
How is TIA treated?
Depending on the cause
89
How is atherosclerotic TIA treated?
Antiplatelet (aspirin or clopidogrel)
Statin
Lifestyle modification
If carotid is obstructed over 50% do an enderartectomy
90
How is cardioembolic TIA treated?
Anticoagulation (warfarin or apixaban started in 2 weeks)
91
What is an enderartectomy?
When the plaque obstructing more than 50% of the carotid is surgically removed
92
What are complications of TIA?
Stroke
93
What are upper motor neurone signs?
```
Contralaterally:
Weakness
Higher spasticity
Hyperreflexia
Upgoing plantars
```
94
What signs are not present with upper motor neurone lesion?
No fasciculations or muscle wasting
95
What are the lower motor neurone signs?
```
Unilaterally:
Fasciculations
Muscle wasting
Hyporeflexia
Weakness
Normal plantar response
```
96
How are strokes/TIAs graded?
MRC grading (0-5)
97
Describe MRC grading
```
0= no muscle contraction
1= flicker of contraction
2= some active movement
3= active movement against gravity
4= active movement against resistance
5= normal power considering their age
```
98
On the motor homunculus what organs are associated with the lateral regions?
Arm, face etc
99
On the motor homunculus what organs are associated with the medial regions?
Legs
100
Which artery is associated with the lateral areas of the brain?
Middle cerebral artery
101
Which artery is associated with the medial areas of the brain?
Anterior cerebral
102
If arms are more affected in stroke what artery is likely to be involved?
Middle cerebral
103
If legs are more affected in stroke what artery is likely to be involved?
Anterior cerebral
104
What vessels are associated with the posterior circulation in the brain?
They arise from the basilar artery and mainly include the posterior cerebral
105
What vessels are associated with the anterior circulation in the brain?
They arise from the internal carotid artery and mainly include middle and anterior cerebral arteries
106
How will stroke of the anterior cerebral artery present?
Contralateral hemiparesis (more so the lower limb)
Abulia
Confusion
Gait apraxia
107
How will stroke of the middle cerebral artery present?
Contralateral hemiparesis (more so the upper limb and face)
Contralateral hemisensory loss
Apraxia
Hemineglect
if the left MCA is affected: receptive/expressive aphasia
if meyer's/baum's loop is affected quadrantopia
108
If the left MCA is affected what stroke sign will occur?
Receptive or expressive aphasia
109
What is quadtrantopia?
A quarter of the visual field is lost
110
If someone is right hand dominant what side will their language center be dominant?
Left side
111
What visual symptoms arise after stroke affecting the posterior cerebral artery?
```
Homonymous hemianopia (macular sparing)
Visual agnosia
```
112
What symptoms arise after stroke of the basilar artery?
Cranial nerve pathology (basilar artery is on the pons which also has the cranial nerves)
Visual impairments
Cerebellar pathology
Impaired consciousness
113
What does aneurysm of the superior cerebellar artery cause?
Trigeminal nerve neuralgia
| Dizziness
114
What is amaurosis fugax?
A type of TIA
115
What are complications of stroke?
```
Loss of function of half of body will affect mood
DVT (due to loss of movement)
Immobility
Seizures
Infections
Cardiovascular events
Cerebral oedema
Psychiatric/mood disturbance
Death
```
