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YEAR 3 & 5 CORE CONDITIONS > Neuro 1 > Flashcards

Neuro 1 Flashcards

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1
Q

Define stroke and TIA - specifying the differences

A

Stroke = sudden onset of focal/global neurological disturbance lasting over 24 hours

TIA = less than 24 hour neurological dysfunction caused by ischaemia without evidence of acute infarction

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2
Q

What heart diseases particularly predispose you to ischaemic stroke?

A

AF
Infective endocarditis
Valve disease
Heart failure

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3
Q

What can cause a haemorrhagic stroke?

A

Rupture of an aneurysm
High blood pressure
Head injury

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4
Q

When do you anticoagulate after a stroke?

A

2 weeks after the stroke if they have AF

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5
Q

What is the mechanism of aspirin?

A

Inhibits COX1 which suppresses production of prostaglandins and thromboxane

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6
Q

What is the mechanism of clopidogrel?

A

It irreversibly binds to ADP which prevents platelet aggregation.

It is independent of COX so it is synergistic with aspirin

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7
Q

What is the most common cause of ischaemic stroke in young people?

A

Carotid artery dissection - usually caused by hitting their chin and hyperextending their neck, rupturing the carotid artery

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8
Q

What can cause a central venous thrombosis?

A

Pregnancy
Infection
Dehydration
Malignancy

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9
Q

How would an infarct of the superficial division of the middle cerebral artery present?

A
  • Expressive aphasia - Broca’s
  • Receptive aphasia - Wernicke’s
  • Face and arm motor weakness - motor cortex
  • face and arm sensory loss - sensory cortex
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10
Q

How would an infarct of the lenticulostriate branches of the left middle cerebral artery present?

A

Right upper-motor hemiparesis - damage to basal ganglia

Aphasia

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11
Q

How would an anterior cerebral artery infarct present?

A

Leg weakness - foot drop
Leg sensory loss
Frontal lobe behavioural abnormalities

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12
Q

What makes up the anterior circulation of the brain?

A

Internal carotid arteries
Middle cerebral artery
Anterior cerebral artery

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13
Q

How would a total anterior circulation infarct present?

A 
Hemiparesis (but with sparring of the forehead) 
Hemisensory loss 
Homonymous hemianopia 
Visuo-spatial deficit 
Dysphasia
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14
Q

What makes up the posterior circulation of the brain?

A

Vertebral arteries (branches from the subclavian arteries. In the cranium, the 2 vertebral arteries form the basilar artery)
Basilar artery
Posterior cerebral artery
Posterior communicating artery

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15
Q

How does a posterior circulation infarct present?

A

Cerebellar dysfunction
Homonymous hemianopia (superficial branch of posterior cerebral artery to occipital lobe)
Hemisensory loss
Hemiparesis

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16
Q

What percentage of strokes are due to infarction or haemorrhage?

A

85% - cerebral infarction
10% - primary haemorrhage
5% - subarachnoid haemorrhage

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17
Q

What symptoms point more towards a bleed than ischaemia?

A

Meningism
Severe headache
Coma
Seizure

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18
Q

What symptoms are in cerebellar dysfunction?

A

DANISH

Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
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19
Q

Aside from stroke, what else can cause cerebellar syndrome?

A

PASTRIES

Posterior fossa tumour
Alcohol
MS
Trauma
Rare
Inherited
Epilepsy medication
Stroke
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20
Q

What is the first thing that should be done in suspected stroke?

A

CT head within 1 hour in order to rule out haemorrhage - don’t want to thrombolyse or anticoagulate if bleeding

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21
Q

What is the acute management of an ischaemic stroke?

A

Give alteplase within 4.5 hours once haemorrhage is excluded

If post-4.5 hours, given aspirin 300mg

Thrombectomy (particularly with large artery occlusion in proximal anterior circulation)

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22
Q

What is alteplase? When should it not be given?

A

Recombinant tissue plasminogen activator

Thrombolytic drug

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23
Q

When should alteplase not be given?

A

Do not give after 4.5 hours since onset of stroke or if there is no clear onset time

Contraindications:

  • Previous haemorrhage
  • Aneurysm
  • Recent head injury
  • Known clotting disorder
  • Intracranial cancer
  • Acute pericarditis
  • Seizure at onset of stroke (suggests haemorrhage or tumour)
  • Recent lumbar puncture
  • Systolic BP > 185 mmHg
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24
Q

What causes a unilateral progressive vision loss ‘like a curtain descending’?

A

Amaurosis fugax = TIA of a retinal artery

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25
If carotid stenosis is > 70% what do you do?
A carotid endarterectomy = removal of material on inside of artery
26
What is the long term management post-stroke?
Clopidogrel 75mg daily If they cannot tolerate clopidogrel, give aspirin 75mg + modified-release dipyridamole 200mg bd (inhibits phosphodiesterase to block platelet aggregation) Statins Blood pressure control
27
Diagnose: Thunderclap headache/worst headache ever
Subarachnoid haemorrhage
28
What usually causes a SAH?
Rupture of a Berry aneurysm in Circle of Willis. Most are saccular aneurysms (i.e. not congenital) - elastic lamina damaged by stressors such as hypertension and smoking
29
What is the second most common cause of SAH?
Arterio-venous malformations
30
What is the most common cause of blood in the subarachnoid space?
Traumatic injury | spontaneous SAH is aneurysm though
31
Name some genetic disorders that can predispose you to a subarachnoid haemorrhage
Marfan's syndrome Autosomal dominant polycystic disease Ehlers-Danlos syndrome Neurofibromatosis
32
What can come on 6 hours after onset of SAH?
Neck stiffness Kernig's sign - positive when thigh is flexed at hip and knee is at 90 degrees, then subsequent extension of knee is very painful
33
How would an aneurysm in the posterior communicating artery present?
Pupil dilatation due to CNIII palsy (compression)
34
What is the most common cause of a CNIII palsy?
Diabetes | Down and out pupil
35
What usually causes a CNVI palsy?
Raised intracranial pressure
36
Why might there be hypertension in SAH?
Sympathetic reflex to intracerebral haemorrhage
37
What investigations should be done in suspected SAH?
Urgent CT head - detects >95% of SAH within 24 hours LP - if CT head negative but history is suggestive - yellow CSF due to bilirubin Angiography - to identify aneurysms
38
How do you manage a subarachnoid haemorrhage?
Prevent vasospasm - Calcium channel blockers - nimodipine Prevent rebleeding - Clipping = craniotomy with clips around neck of aneurysm - Coiling = obliterate aneurysm by causing clot to form in it
39
What does blood look like on a CT head?
Hyperdense = white - recent blood Hypodense = dark - old blood
40
How do you differentiate between extradural and subdural haematoma on CT head?
Extradural haematoma - lens shape of bleeding - can't cross sutures of skull - can cross midline Subdural haematoma - crescent shape of bleeding - can cross sutures of skull - can't cross midline
41
How do you differentiate between extradural and subdural haematoma with symptoms?
Extradural haematoma - LOC then lucid interval then 2nd LOC Subdural haematoma - slow progression + confusion
42
What most commonly causes peripheral neuropathy?
Diabetes - poor glycaemic control
43
What is Guillan-Barré syndrome?
Autoimmune disorder that causes acute demyelination. 75% had prior infection usually of GI or respiratory systems e.g. Mycoplasma, EBV, Campylobacter Presents with muscle weakness starting in feet and hands
44
What are some complications of Guillan-Barré syndrome? What investigation must be done?
It can affect proximal muscles e.g. trunk, respiratory and cranial nerves (progressive facial drooping) Respiratory depression - check vital capacity (it is likely to get worse before ABG shows signs of hypoxia)
45
How do you treat Guillan-Barré syndrome?
IV immunoglobulins for 5 days
46
What should you investigate in peripheral neuropathy?
Glucose levels B12 levels Folate levels Neuro-conduction studies
47
What is Romberg's sign?
Sensoriataxia - when patient closes their eyes they wobble. NOT a cerebellar test because they would wobble even with their eyes open
48
What drug can cause peripheral neuropathy?
Nitrofurantoin Phenytoin Amiodarone Metronidazole
49
What congenital conditions can cause peripheral neuropathy?
Charcot-Marie-Tooth syndrome | Freidrich's ataxia
50
Name some LMN signs
- Muscle paralysis - Fasciculations - spontaneous involuntary twitching - Hypotonia - Reduced reflexes - Muscle wasting
51
Name some UMN signs
- Spasticity - increased tone that is velocity dependent (the faster you move the muscle, the greater the resistance until it gives way like a clasp-knife) - Pronator drift - Babinski's sign - dorsiflexion of foot - Clonus - rapidly dorsiflexing the foot then many downbeats of the foot - Hyper-reflexia - Reduced power
52
What drugs can be given for peripheral neuropathy?
Tricyclic antidepressants e.g. amitryptiline | Gabapentin
53
What is epilepsy?
Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures
54
Describe the different elements of a seizure
Prodrome (hours/days) - change in mood/behaviour Aura - focal seizure (often from temporal lobe), deja vu, strange smells, flashing lights Post-ictal phase - headache, confusion, myalgia, temporary weakness, dysphasia
55
What causes epilepsy?
2/3rd = idiopathic Space-occupying lesion e.g. neoplasm Head injury or cortical scarring from previous head injury CNS infections Stroke Hippocampal sclerosis after febrile convulsion Vascular malformations
56
Name some triggers for a seizure in epilepsy?
Alcohol Stress Flashing lights
57
What is a sign of neurofibromatosis?
Café au lait spots
58
What is a focal seizure?
Start in one area of one side of the brain Often seen with underlying structural disease
59
What are generalised seizures? Name some different types
Involve both hemispheres of the brain 1. Absence seizures - brief (less than 10 sec) pauses e.g. stares into space for 5 seconds then resumes talking 2. Tonic-clonic - LOC, stiff limbs (tonic) then jerk (clonic). Tongue biting, incontinence. Post-ictal confusion and drowsiness 3. Myoclonic - sudden jerk of a limb/trunk/face 4. Atonic - all muscles relax and drop to floor, no LOC
60
What investigations should you do in epilepsy?
Anti-epileptic levels - check compliance EEG MRI - if focal onset or if seizures continue with medication ECG - in all patients with altered consciousness LP - if infection suspected
61
What are 1st and 2nd line treatments for focal/partial seizures?
1st line - carbamazepine or lamotrigine 2nd line - sodium valproate
62
What are 1st line treatment for all generalised seizures
Sodium valproate
63
What type of seizures should you avoid carbamazepine in ?
Myoclonic seizures - may worsen them
64
What are some side effects of sodium valproate?
Hair loss due to hypersensitivity - regrowth is curly hair Nausea (always take with food) Thrombocytopenia Tremor
65
Which drug should you avoid if someone is taking sodium valproate?
Aspirin - it displaces sodium valproate from its binding sites which increases the adverse effects
66
Why is phenytoin no longer first line treatment for epilepsy?
Risk of toxicity --> nystagmus, diplopia, tremor, ataxia Side effects --> reduced cognition, depression, acne, gum hypertrophy, polyneuropathy
67
Which anti-epileptic drug must be strictly avoided in pregnancy? Which is preferred? What must be thought about in terms of contraception?
Sodium valproate is the most teratogenic Lamotrigine is preferred Anti-epileptic drugs are P450 enzyme inducers so they make progesterone-only contraception unreliable. Oestrogen-containing contraceptives lower lamotrigine levels so need increased dose.

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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