Neuro Flashcards
(18 cards)
Arteries and supply of brain
Anterior CA - feet, legs Middle CA - hands, arms, face, speech Posterior - Visual cortex Basilar/vertebral - syncope Cerebellum - coordination
(think posterior vision, then middle works its way down)
Investigations for Stroke
- Non-contrast CT
- Tpa or not
- Echo, ecg, carotid US
- (longer term)- cvs risk factors - DM, cholesterol, BP, smoking, ect.
Treatment acute and longer term
Acute
tpa, aspirin, BP (permisive HTN)
Chronic
lmwh to bridge for afib/aflut, aspirin or NOAC, DM, Ace, diuretic
Treatment acute and longer term
Acute
tpa, aspirin, BP (permissive HTN)
Chronic
lmwh to bridge for afib/aflut, aspirin or NOAC, DM, HTN - Ace, diuretic
Carotid artery stenosis management
> 80% then stent (only for patients who cannot tollerate surgery) or edarectomy
Red flags for Headache and what it could be and what to do for each
New onset headache >50 - CT
Sudden crescendo headache - SAH –> CT, neuro surgery, control BP
Fever + headache - meningitis –> LP, culture, Abx (ceftriaxone)
Focal neuro deficit + F + H - abcess –> CT scan (drain), ABx
Progressive N & V, worse in morn - cancer –> CT, biopsy, chemo, radio, surg
Primary headaches + IIH
Primary - tension, cluster, migrane, analgesic rebound
Cluster - unilateral eye pain, Horners syndrome, and clusters
Treat - Oxygen, triptans, calcium channel blockers
Migraines
-POUND (pulsatile, one day in duration, unilateral, N/V, disabling) 3 is diagnostic
-triggers, unilateral pounding, photophobia,
Mild - NSAIDs
Severe - triptan
-beta blocker phrophylaxixs, or calcium channel blocker
Tension - over counter
Medication overuse - withdrawal
Idiopathic intracranial hypertension
- Increase ICP with no tumour. (women, obese, childbearing age)
- LP, tap relieve headaches. acetazolamide
Trigeminal neuralgia - cold foods, pain across jaw, carbamazepine is treatment.
Horners
3rd nerve palsy
Horners - Miosis, anhydrosis, pitosis (damage to sympathetic nerves of face)
3rd nerve - pitosis, diploplia, dilated pupil (mydriasis)
Side effects of levodopa
- excessive sleepiness, hallucinations and impulse control disorders
unwanted effects: dyskinesia (involuntary writhing movements), ‘on-off’ effect, dry mouth, anorexia, palpitations, postural hypotension, psychosis, drowsiness
Indications if have headache and need CT
Vomiting more than once with no other cause.
New neurological deficit (motor or sensory).
Reduction in conscious level (as measured by the Glasgow coma score).
Valsalva (associated with coughing or sneezing) or positional headaches.
Progressive headache with a fever.
What drugs not to give with lewy body dementia?
Antipsychotics should be avoided in patients with dementia due to adverse reactions and increased mortality in the elderly. In Lewy body dementia, severe antipsychotic sensitivity reactions have been reported in 50% of patients- these include rigidity, immobility, postural falls, and confusion. They may lead to irreversible parkinsonism, particularly risperidone and typical antipsychotics such as Haloperidol.
contraindications of thrombolysis
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
cluster headaches
- unilateral, runny nose
- oxygen first line
- verapamil -
metoclopramide side effects
extrapyrimidal side effects
dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
common reflexes
Ankle S1-S2
Knee L3-L4
Biceps C5-C6
Triceps C7-C8
facial nerve palsy
Supply - ‘face, ear, taste, tear’
face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands
Causes of bilateral facial nerve palsy
sarcoidosis
Guillain-Barre syndrome
Lyme disease
bilateral acoustic neuromas (as in neurofibromatosis type 2)
as Bell’s palsy is relatively common it accounts for up to 25% of cases f bilateral palsy, but this represents only 1% of total Bell’s palsy cases
Types of aphasia
wernickes aphasia - make no sense but can talk, comprehension impaired
brocas - speech is non-fluent , comprehension normal
conduciton aphasia - arcuate fasiculus - cannot comprehend well but can talk normally
global - receptive and expressive aphasia
Ataxic gait pneumonic
P - Posterior fossa tumour A - Alcohol S - Multiple sclerosis T - Trauma R - Rare causes I - Inherited (e.g. Friedreich's ataxia) E - Epilepsy treatments S - Stroke
Ataxic gaits typically occur following cerebellar injury, the causes of which can be remembered by the mnemonic ‘pastries’
