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Neuro Flashcards

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1
Q

What is a subarachnoid haemorrhage

A

An intracranial haemorrhage which causes a bleed into the subarachnoid space
Type of haemorrhagic stroke

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2
Q

Describe the types of subarachnoid haemorrhages

A

Traumatic - mc
Atraumatic (spontanteous)

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3
Q

Name 3 causes of spontaneous subarachnoid haemorrhage

A

berry aneuryesm mc spontaneuos SAH (mc anterior communicating and cerebral artery)

arteriorvenous malfunctinon

mycotic aneurysm - bc of bacterial infection eg infective endocarditis

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4
Q

What conditions are associated with berry aneurysms

A

Polycystic kidney disease
Ehlers and Danlos syndrome

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5
Q

What are the risk factors for a subarachnoid haemorrhage

A

HTN
Smoking
>50yrs age
Alcohol
FHx

(PCKS/ ED)

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6
Q

What are the symptoms of a subarachnoid haemorrhage

A

Headache
- severe
- sudden (1-5min)
- thunderclap headache
- “worst ever headache”
- occipital

Meningism: photophobia, headache, neckstiffness
N+V
Coma, seizures, confusion

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7
Q

WHat are the signs for a subarachnoid haemorrhage

A
  • 3rd nerve palsy: fixed pupil dilation
  • 6th nerve palsy: non-specific sign of incr intracranial pressure
  • reduced glasgow coma scale (GCS)
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8
Q

What are the first line investigations for a subarachnoid haemorrhage

A
  • urgent, non-contrast head CT scan
    star shaped lesions
  • ECG -> ST elevation arrhythmias
  • Bloods; glucose, fbc
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9
Q

In a suspected subarachnoid haemorrhage, if the CT scan is negative what is the second line investigation and result

A
  • Lumbar punchar
  • done after 12 hours
    xanthchromia- yellow pigmentation of CSF due to the breakdown of Hb into bilirubin
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10
Q

What test is done to determine the source of a subarachnoid haemorrhage

A

CT head angiogram

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11
Q

What is the management/ treatment of a subarachnoid haemorrhage

A
  • neruosurgery- endovascular coiling
  • nimodipine- CCB which decr vasospasms and BP
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12
Q

What are 2 differential diagnoses of a subarachnoid haemorrhage

A

Meningitis- presents w no thunderclap headache and signs of infection
Migraine

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13
Q

What are the complications of a subarachnoid haemorrhage

A

death
seizures
rebleed
hydrocephalus

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14
Q

What is an extradural haemorrhage

A

A bleed into the potential space between the dura and the skull (extradural/ epidural space)
The collection of blood is refered to as a extradural haematoma

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15
Q

What vessel rupture is most commonly associated with an extradural haemorrhage and where is it located

A

Middle meningeal artery
Pterion bone in temporal region

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16
Q

What are the causes of an extradural haemorrhage

A

mainly traumatic
- mc arterial rupture - middle meningeal artery
- venours- dural sinuses lanceration

also nontraumatic eg infection/ coagulopathy

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17
Q

What are the risk factors for an extradural haemorrhage

A

age >65

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18
Q

Pathophysiology for extradural haemorrhage

A
  • initial trauma/ rupture
  • inital LOC - due to formation of haematoma
  • rapid deterioration
    • bc of incr ICP as the haematoma is autolysed and takes up water (as is osmotically active)
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19
Q

Symptoms of extradural haemorrhage during rapid deteriration

A

Incr ICP -> cushings triad
- irreg resp
- bradycardia
- widened pulse pressure
(behaviour change, HTN)

uncal herniation
- CN3 palsy -> ipsilateral fixed dilated pupil
- contralateral hemiparaesthesia

  • coma/ confusion/ seizures
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20
Q

What is the most common vessel affected in an extradural haemorrhage

A
  • middle meningeal artery
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21
Q

What is cushing’s triad and breifly describe the pathophysiology

A

-irreg resp
-bradycardia
-widened pulse pressure
- incr in intercranial pressure causes cushing reflex causing cushings triad
- also behavior change and HTN

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22
Q

What are the investigations and results for an extradural haemorrhage

A

urgent noncontrast CT scan
- Sickle/ rounded- bicinvex, well demarkated hyperdense bleed in the epidural space
- well confined to the suture lines
- often in the temporal lobe

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23
Q

What is the treatment for an extradural haemorrhage

Study These Flashcards
A
  • 1st line: neurosurgery: crainoectomy and haematura drainage
    alongside with IV mannitol to reduce ICP
24
Q

What are the complications for an extradural haemorrhage

Study These Flashcards
A

death fron resp arrest
ICP and hernation
seizure
infection

25
What is a subdural haemorrhage
- is a bleed of bridging veins into the subdural space- between the dura mater and arachnorid of the meningeal layers - the collection of blood is a haematoma
26
What vessels are mainly involved in a subdural haemorrhage
bridging veins
27
Who is most at risk of a subdural haemorrhage
infants and children (abused eg shaking) those with cortical atrophy eg elderly w dementia or alcoholics
28
What is the main cause of a subdural haemorrhaeg
trauma
29
Describe the onset of symptoms for subdural heamorrhaeg
- latent period- feel fine - gradual deteriortation
30
Describe the pathophysiology of a subdural haemorrhage
- latent period - gradual deterioration due to slow bleeding of vessels and then gradual accumalation and autolysis of blood cauisng incr in ICP -> sx
31
What are the signs and symptoms of subdural haemorrhage
Incr ICP - Cushings triad (bradycardia, irreg bleeding, widened PP) -HTN Focal neurological deficits (depending on where bleed is) - eg cn3 palsy-> ipsilateral fixed dilated pupil - contralateral hemiparaesthesia - temporal region coma/ seizure/n/v
32
WHat are the investigations and results for subdural haemorrhage
Noncontrast ct scan - crescent shaped, haematoma, not confined by suture lines - midline shift - hyperdense if acute <3 days -isodense if subacute 3-21 days - hypodense if chonic >21 days
33
Tx of subdural haemorrhage
- neurosurgery: craniotomy and burr hole surgery - IC mannitol to reduce ICP
34
Complications of subdural haemorrhage
seizures death icp iinfection
35
what medication is given to reduce ICP
IV mannitol
36
What is a migraine
- is a primary and mostly episodic headache - is a recurrent throbbing headache often preceeded by an aura and usually associated with nausea and vomiting
37
What are the triggers for a migraine
CHOCOLATE Chocolate Hangovers Orgasms Cheese Oral contraceptives Lie-ins/ lack of food Alcohol - red wine / anxiety Tumolt- loud noise / travel Exercise
38
What/ who is most at risk of hangovers
w>m decr in age stress CHOCOLATE (triggers)
39
What is the pathophysiology of a migraine
neuronal hyperexcitability trigeminal nerves cause a an inflam response causing meningeal vasodilation and sensitisation of pain causing a pain response
40
What are the symptoms of a migraine
- headache: severe, unilateral, recurrent, throbbing/ pulsatile for upto 72 hrs - photophobia/ phonophobia nauea and vomiting - preceeeded by an aura - visual - zigzag/ black hole in visual field - sensory - paraesthesia (pins and needles) weakness, dysphasia
41
What are the investigations and criteria for a migraine
clinical diagnosis - no investigations unless a secondary pathological cause is suspected
42
What is the treatment for a migraine
- acute - triptan/ aspirin -Chronic- propanolol or topiramate (teatrogenic) - avoid triggers, antiemtics, mindfulness
43
What causes an aura in a migrane
- cortical depression - wave of depolarisation of the cerebral cortex
44
Name 5 UMM signs
- hyperreflexia - hypertonia - + ve Babinskis sign - arm stronger extensor than reflexor - leg stronger flexor than extensor - no fasciculations - contralateral
45
Are UMN signs contralateral or ipsilateral to the lesion
contralatetal
46
Where would a UMN lesion be located
from pre-central gyrus to the anterior horn of the spinal cord
47
Name 5 LMN signs
- hypotonia and muscle wasting - hypo/ absent reflexes - -ve Babinskis sign - limbs generally weaker - fasciculations
48
Are LMN signs contralateral or ipsilateral to the lesion
ipsilateral
49
Where would a LMN lesion be located
from anterior horn of the spinal cord to the peripheries
50
What type of neurone causes LMN signs
a- motor neurone
51
Name 5 descending motor tract
corticospinal (pyramidal) corticobulbar (pyramidal) Reticulospinal (extrapyramidal) Tectospinal (extrapyramidal) Rubrospinal (extrapyramidal) Vestibulospinal (extrapyramidal)
52
What are the function of extrapyramidal tracts
- sends involuntary autonomic motor information from cortex to LMN - eg balance, tone, posture, locomotion
53
What are the function of pyramidal tracts
- sends voluntary control of all muscles- face and body - corticospinal is to body - corticobulbar is to face
54
What is motor neuron disease
it is a neurodegenerative disease affecting both the UMN and LMN
55
What are the 4 types of MND
1. ALS- amylotrophic lateral sclerosis 2. PLS- Primary lateral sclerosis 3. PMA Progressive muscle atrophy 4. PBP Progressive bulbar palsy

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