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Phase 2a > Neuro > Flashcards

Neuro Flashcards

1
Q

What is a stroke

A

Rapid onset of neurological defecit caused by an infarction

- Lasting >24hrs

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2
Q

What are the 2 types of strokes

A

Ischaemic

Haemorrhagic

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3
Q

Causes of ischaemic strokes (4)

A
  1. occlusion of small vessels
  2. Cardiac emboli
    • IE
    • AF
    • MI
  3. Atherothromboembolism
  4. Hypoxic
    • Sepsis
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4
Q

Risk factors for stroke

A 
Obesity
Smoking 
Diabetes
AF
Family hx
Age 
Combined pill 
Vasculitis
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5
Q

What is white on a CT

A

Fresh blood
bone
calcium

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6
Q

What is dark on a CT

A

Air
fat
old blood
water

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7
Q

Sx of anterior circulation stroke

A 
Hemiplegia 
Weakness
Hemisensory loss
Speech problems 
Amarausis fugax
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8
Q

Sx for prosterior circulation

A
  • CN palsy
  • Contralateral motor/sensory loss in brainstem stroke
  • Cerebellar dysfunction
  • Blindness
  • Vertigo
  • Nausea/vomitting
  • Swallowing issues
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9
Q

Haemorrhagic stroke causes

A 
Trauma 
Aneurysm rupture
Carotid artery dissection 
SAH 
Tumour
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10
Q

Stroke investigations

A

CT - GOLD
- Bleeds appear as white
areas

ECG - Atrial fibrillation

Bloods
Glucose - hypoglycaemia
FBC - Polycythaemia 
          Thrombocytopenia
ESR - Vasculitis
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11
Q

What constitutes an urgent head CT

A 
- Pt presenting in 
  thrombolysis time frame 
- Recent head injury 
- Severe headache at sx 
  onset 
- Pt on anti-coag 
- Decrease consciusness 
  (GCS < 13)
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12
Q

Stroke differential diagnosis

A 
Hypoglycaemia 
Subdural haemorrhage 
Head injury 
Intracranial tumour 
Hepatic encephalopathy 
- Wernickes E
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13
Q

Time frame fir thrombolysis tx

A

4.5 hrs of onset
- IV Tissue plasminogen
activator

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14
Q

CI to thrombolysis

A 
Intracranial bleed
clotting disorder
recent surgery
acute pancreatits 
severe liver disease 
onset > 4.5hrs ago
unclear time of sx onset
seizures at onset
low platelets 
Warfarin/Heparin 
Known aneurysm 
Active bleed
- GI
- Urinary
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15
Q

Stroke tx if intracranial haemorrhage is ruled out and time of onset is unknown
- Ischaemic

A
  1. 300MG Asprin

2 weeks

  1. Clopidogrel - long term
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16
Q

Thrombolysis pathway for ischaemic stroke

A
  • CT head
  • If within < 4.5 hrs
  • IV Alteplase
    • -> 24hrs –> Clopidogrel
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17
Q

Haemorrhagic stroke tx

A

Surgical - clipping
coiling

Reverese anticog

Lifestyle advice

Tx BP - Long term

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18
Q

Stroke secondary prevention

A 
Clopidogrel - 75mg
Atorvastatin - 80mg
Stenting in CAD pts - carotid
Tx modifiable RF
- HTN
- DM
- Smoking 
- Alcohol
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19
Q

What is a transient ischaemic attack

A

Temporary focal cerebral ischaemia without infarction

  • Lasting <24hrs
  • Complete clinical recovery
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20
Q

What is a crescendo TIA

A

2 or more TIAs in a week

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21
Q

TIA causes

A
  • Emboli from the carotis

arteries

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22
Q

TIA differential diagnosis

A
  • Hypoglycaemia
  • Focal epilepsy
    Shaking limbs
  • Todd’s paralysis
    Transient arm/leg
    weakness after seizure
  • GCA
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23
Q

What risk tool is used to assess if a pt is going to have a further stroke following a TIA

A 
ABCD2
Age
BP
Clinical features
- Unilateral weakness
- Speech disturbance 
Duration of sx 
DM

> 3 - Assesment within 24hrs

< 3 - Assesment within 1
week

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24
Q

Amourosis fugax presentation

A

Clot passing through retinal artery
- Curtain descending over
vision
- double blindness

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25
Q

TIA management

A
  • ABCD2
  • Asprin 300mg
    Clopidogrel 75mg - LT
  • Secondary prevention for
    Stroke
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26
Q

TIA - driving notes

A
  • NO DRIVING for 4 WEEKS
  • Don’t need to tell DVLA
    after 1 single TIA
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27
Q

TIA investigations

A

Carotis artery doppley

24hr ECG
- Atrial fibrillation

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28
Q

Intracanial haemorrhage risk factors

A
  • HTN
  • Excess alcohol
  • Increase Age
  • Smoking
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29
Q

Intracranial bleeds causes

A
  • HTN
  • Micro-aneurysms
    Charcot - bouchard
  • Vasculitis
  • Vascular tumour
  • Secondary to ischaemic
    stroke
  • Head injury
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30
Q

Intracranial haemorrhage pathology

A 
Bleeding raises ICP
- Tissue death 
- Herniation 
Falx cerebri/Tentorium cerebelli 
Foramen magnum
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31
Q

Intracranial haemorrhage presentation

A 
Severe headache
sudden LOC
seizures
weakness
vomitting
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32
Q

SAH aetiology

A
  1. Berry aneurysm rupture

2. Arterivenous malformations

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33
Q

What increases the risk of a berry aneurysm rupture

A
  • Marfans syndrome
  • Rupture with Increased
    ICP
  • PCA junction with ICA
  • ACA junction with anterior
    cerebral artery
  • Birfucation of MCA
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34
Q

SAH Presentation + signs

A 
Thunderclap headache 
- occipital 
- severe pain 
Vomitting 
Collapse
Seizure 
Neck stiffness
Kernig's sign 
Brudzinski's sign 
Retinal and viterous bleeds
Diplopia
Vision loss
35
Q

Kernig’s sign

A

Can’t extend leg when hip is flexed

36
Q

Brudzinski’s sign

A

When neck is flexed patient flexes hip and knees

37
Q

SAH common assosciations

A

Cocaine

Sickle cell anaemia

38
Q

SAH investigations

A 
CT 
- < 24 hrs
- Hyper-attenuation 
  Star shaped lesions 
- Blood fills in gyrus 
  patterns

Lumbar puncture

  • > 12hrs after headache
  • Xanthochromia
  • L4/L5
39
Q

What causes subdural haemorrhages

A

Bleeding of bridging veins
between cortex + venus sinsues - saggital sinus

Between Dura and Arachnoid mater

  • Head trauma
  • Dural metasteses
40
Q

Subdural haemorrhage risk groups

A

Elderly

  • Brain atrophy
  • Bridging veins more vulnerable

Alcoholics + Epilleptics
- Falls
- Alcohol is also an anti
coagulant

41
Q

Subdural haemorrhage presentation

A
  • Fluctuating consciousness
  • Drowsy
  • Headache
  • Personality change
Signs:
Increase ICP
Seizures
Unequal pupils 
Haemiparesis
42
Q

Subdural haemorrhage investigations

A

CT

  • Clot +/- Midline shift
  • CRESENT shape

MRI
- Smaller haematoma

43
Q

Subdural haemorrhage tx

A

Haematoma
> 10mm or midline shift

  • Surgery
    Craniotomy
    Burr holes
44
Q

What is an extradural haemorrhage

A

Middle meningeal artery
- Blood collects between
skull and dura mater

45
Q

Extradural haemorrhage aetiology

A

Traumatic head injury

  • Fracture of temporal bone
  • Rupture of MMA
46
Q

Extradural haemorrhage investigations

A

CT head

  • Biconcave haematoma
  • Lemon

Limited by cranial sutures

47
Q

Tx for increased ICP

A

IV Mannitol

48
Q

What is Epilepsy

A

recurrent tendancy to spontaneous intermittent abnormal electrical activity in a part of the brain

49
Q

Epilepsy aetiology

A 
Flashing lights
Idiopathic
Cortical scarring 
- Head injury years before 
- CVD infarction 
- CNS Infection 
Tumour 
Alcohol
50
Q

Excitatory and Inhibitory NT and receptors in the brain

A

Excitatory
Glutamate –> NMDA receptor
Ca2+ enters

Inhibitory
GABA –> GABA receptors
Cl- enters

51
Q

What is the prodrome

A

Prodrome -

  • Not part of the seizure
  • Causes change in mood
  • Lasts hours/days
52
Q

What is the Aura

A

Aura -

  • Part of a seizure
  • 30-120 seconds
  • Tounge biting
  • Strange gut feeling
  • Deja vu
  • Strange smells
  • Focal seizure - Temporal
53
Q

What is a primary generalised seizure + features

A

Electrical activity throughout the whole cortex
- Loss of consciousness
- Bilateral motor
manifestations

54
Q

Descibe a tonic clonic sezure

A

Tonic phase - stiff limbs
Clonic phase - Rhythmic muscle jerking

  • LOC
  • Eyes open + tounge bitten
  • Incontinence
  • Post-ictal
    Drowsiness
    Confusion
    Coma
55
Q

Descibe Absence seizures

A 
Childhood disorder
- Activity 
  Stares + pales
- Brief < 10 seconds 
- ECG --> 3-Hz spike 
- No memory 
- Often have tonic clonic 
  seizures in adulthood
56
Q

Describe a partial/focal seizure

A

Originate in networks linked to 1 hemisphere + often seen in underlying structural disease

57
Q

Seizures investigations

A
  • Clinical dx
    > 2 unprovoked seizures occuring > 24hrs after
  • Electrocencephalogram
58
Q

Focal seizures tx

A
  1. Carbamazepine
    Lamotrigine
  2. Sodium valporate
59
Q

Generalised tonic clonic seizures tx

A
  1. Sodium valporate

2. Carbamazepine

60
Q

Status epilepticus

  • description
  • aetiology
  • tx
A
  • Seizures with no recovery
    of consciousness
  • Seizures > 30 mins
  • Stopping anti-epileptic tx
  • Alcohol abuse
  • Poor compliance to therapy
  • Lorazepam
  • Phenytoin
  • Phenobarbital
61
Q

Sodium valporate S/E

A 
Teratogenic 
Liver damage 
Hepatitis
Hair loss
Tremor
62
Q

Carbamezapine S/E

A

Agranulocytosis
Aplastic anaemia
Induce P450 - Drug interactions

63
Q

Migrane

  • Duration
  • Site
  • Character
  • Severity
  • Triggers
  • Associated sx
  • Acute tx
A
  • 4-72 hrs
  • Unilateral
  • Throbbing
  • Moderate to severe
  • Chocolate mneumonic
- Nausea
  Vomitting 
  Photophobia
  Phonophobia 
  Aura
  • Sumatriptan
64
Q

Primary headaches

A

Migrane
Tension
Cluster

65
Q

Secondary headaches

A

Medical overuse
SAH
Meningitis

66
Q

Chocolate mneumonic

- Migranes

A 
C - Chocolate 
H - Hangovers
O - Orgasms 
C - Cheese
O - Oral contraceptive
L - Lie ins
A - Alcohol 
T 
E - Excercise
67
Q

Tension headaches

  • Duration
  • Site
  • Character
  • Severity
  • Triggers
  • Associated sx
  • Acute tx
A
  • Mins to days
  • Bilateral
  • Pressing tight band
  • Mild to moderate
  • no triggers
  • no assosc sx
  • Paracetamol

Normal everyday headaches

68
Q

Cluster heacache

  • Duration
  • Site
  • Character
  • Severity
  • Triggers
  • Associated sx
  • Acute tx
A
  • 15 to 180 mins
  • Retro-orbital
    Unilateral
  • Boring/hot poker
  • V. severe
  • No triggers
  • Miosis
    Ptosis
    Nocturnal pain
    Vomitting
    Lacrimation
    Blood shot
  • Sumatriptan
    100% O2
69
Q

Trigeminal neuralgia

  • Duration
  • Site
  • Character
  • Severity
  • Triggers
  • Associated sx
  • Acute tx
A
  • Few seconds
  • Unilateral
    V1/V2/V3 distribution
  • Stabbing pain
  • Severe
  • no triggers
  • no assosciated sx
  • Carbamazepine
    Phenytoin
70
Q

What is multiple sclerosis

A

Chronic AI demyelination of CNS - Oligodendrocytes

- Disseminated in time and space

71
Q

What is Uhthoff’s phenomenon

A
  • Increase temp causes worsening of pre-existing sx
  • Hot bath
  • Excercise
72
Q

What is Lhermitte’s phenomenon

A
  • Electric shock sensation down spine when neck is flexed
73
Q

What does MND in cranial nerve nuclei lead to

A

Mixed UMN + LMN sx

74
Q

What does MND in the anterior horn cells lead to

A

LMN signs

75
Q

Meningitis aetiology

A

Children

  • Neisseria meningitides
  • Strep pneumoniae
  • Haemophilius Infuenza

Neonates:
- E-coli
- Strep agalactiae
Group B haemolytic strep

76
Q

Common bacteria for meningitis in pregnant women

A

Listeria monocytogenes

- found in cheese

77
Q

Meningitis presentation

A
  • Fever
  • Neck stiffness
  • Photophobia
  • Papilloedema
    Blurred vision/Headache
  • Headache
  • Rash
78
Q

When is there no rash in meningitis

A

Viral

79
Q

Meningitis investigations

A

Lumbar puncture
Bloods
- Glucose/CRP/FBC
- Clutures

80
Q

Meningitis tx

  • GP
  • Hospital
  • Pregnant
A

GP - IM Benzylpenicillin

Hospital -
Cefotaxime / Ceftriaxone

Immunocompromised/pregnant -
Cefotaxime + Amoxicillin
(Covers listeria)

81
Q

Meningitis prophylaxis

A

Ciprofloxacin

82
Q

CI to Lumbar puncture

A 
Drowsy
Signs of raised ICP 
Seizures
Immunocompromised
Hx of CNS disease
83
Q

Encephalitis tx

A

Aciclovir - High dose

84
Q

What is encephalitis

A

Inflammation of brain parenchyma - Mainly viral

  • Herpes simplex
  • CMV
  • Mumps
  • Enterovirus

Phase 2a (11 decks)

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