Neuro - stroke, MMA, VST + brain haemorrhages Flashcards by Izzy Burns

Def stroke

Acute focal neurological deficit
CV in origin
Persisting >24hrs

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Def TIA

Acute focal neuro deficit persisting <1hr
No longlasting signs on MRI

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Def amaurosis fugax

Sudden transient LOV in 1 eye

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RF stroke - irreversible (4)

age
PMHx/FHx
Hyper-coagulable states
AF

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RF stroke - reversible (8)

HTN
Hypercholesterol
DM
Smoking
Alcohol
Poor diet/exercise
Obese
COCP

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What are the 2 broad categories of stroke + prevelance

Ischaemic - 85%
Haemorrhagic - 15%

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What is an ischaemic stroke due to

Arterial embolus from distal site
Or aa thrombosis from carotid/vertebral/basilar aa

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What are the 2 types of haemorrhagic stroke

SAH - 5%
Intra-cerebral - 10%

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Where has stroke happened in TACS

Proximal MCA occclusion

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TACS

all 3 of:
High dysfunction
Homonous hemianopia
Hemiplegia + sensory loss

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Where has stroke happened PACS

Distal MCA/or ACA occlusion

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PACS

2/3 of:
High dysfunction, homonymous hemianopia, hemiplegia/sensory loss
Higher dysfunction alone

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Where has stroke happened - LACS

Lacunar branch of MCA

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LACS

2/3 of: face, arm, legs
Pure motor
Pure sensory
Pure sensorimotor
Ataxic hemiparesis

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where has stroke happened - POCS

PCA occlusion

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POCS

CN palsy + contralat deficit
Bilat motor or sensory deficit
Eye movement problems
Cerebellar dysfunction
Isolated homonous hemianopia

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% who die from TACS in a year

60%

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% dead from PACS in a year

15%

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% dead from LACS in a year

10%

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What is NHISS

15 item neuro exam assessing stroke on various levels

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Ix stroke

Bloods - FBC, U+E, gluc, lpipids, coag, ESR
Imaging - MRI (gold standard)/ CT
ECG

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Acute Mx stroke

A-E
Withold antiplatelets until CT headh
Arrange thrombolysis if <4.5hrs

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Thrombolysis

Check C/I
Alteplase 0.9mg/kg 10% bolus 1 min
Remainder over 60 mins

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What Mx stroke if thrombolysis C/I

300mg aspirin daily

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2' prevention stroke

lifestyle mods antiHTN therapy Aspirin 300mg od 2w Clopidogrel 75mg life statin LMWH stated day 3 post stroke

Non-pharma Mx stroke

SALT (assess within 2w) physio OT Nursing + SSKIN

Driving + stroke

No driving 4 w

complications stroke

Malignant MCA syndrome DVT/PE Aspiration pneumonia P sores Depression Incontinence

What is malignant MCA syndrome?

Rapid neuro deterioration due to effects cerebral oedema

PS Malignant MCA syndrome

Incr aggression/restlessness Decr GCS Haemodynamic instability/thermal instability Incr ICP

Mx malignant MCA syndrome

Decompressive hemicraniotomy

High risk features TIA (3)

Rec TIA AF/TIA whilst anti-coag'd ABCD score 4 or more

ABCD scores

Age >60 BP >140/90 Unilateral weakness = 2 points Speech disturbance w/o weakness = 1 point >60mins - 2 points 10-59 mins = 1point Diabetes = 1 point

Mx - high risk TIA (3)

Statin 300mg aspirin specialist clinic within 24hrs

Mx - low risk TIA (3)

Statin 300mg aspirin specialist clinic within 1 week

What is done at specialist TIA clinic

Carotid USS If stenosis >50% - carotid endarterrectomy offered

What is venous sinus thrombosis

Venous infarction --> vascular congestion --> haemorrhagic necrosis

When to suspect venous sinus thrombosis

If thunderclap headache + incr ICP W/ no signs meningtitis + + no changes on CT

What are the 2 types venous sinus thrombosis?

Cortical venous thrombosis Dural venous sinus thrombosis

Sx cortical venous thrombosis

Headache (thunderclap) focal signs seizures fever encephalopathy

Sx dural venous sinus thrombosis - cavernous sinus

Ocular pain (incr on movement) Proptosis Ophthalmoplegia Papilloedema Fever

Sx saggital/lateral dural sinus vv thrombosis

Sx of Incr ICP

Ix venous sinus thrombosis

CT = norm LP = incr ICP MRI angio = diagnosis

RF venous sinus thrombosis (7)

OCP Pregnancy Malig Thrombophilia Head injury Recent LP Infection

Cause - deep intra cerebral haemorrhage (2)

Rupture microaneurysms - Charcot Bouchard Degen small deep aa

Who suffers from lobar intra-cerebral haemorrhage

Normotensive indivs >60

Ix intracerebral haemorrhage

CT- can see immediately MRI - can see after 2hrs

Mx intracerebral haemorrhage

NO antiplatelet/coags Reverse coag Lower BP within 1hr using IV betalol Rx to neurosurgery

PS - SAH (5)

thunderclap headache Vom after headache Incr drowsiness/coma Photophobia Focal signs may point to lesion

O/E SAH

Neck stiffness +ve Kernigs sign Papilloedema

2 vascular abnormalities that predispose to SAH

Berry aneurysm AV malformations

Most common location Berry aneurysm

ACA

which conditions are associated w/ increased development of berry aneurysms

PKD ED Marfans

What can PCA Berry aneuysms lead to

Painful CN3 palsy

Ix SAH

Bloods: FBC, U+E, LFT, ESR, clotting CT - LP if CT norm CT/MRI angio

LP findings SAH

CSF will be xanthochromic

Mx SAH

4 w bed rest HTN control Nimodipine IV fl Analgesia/anatiemetics Stool softeners

Neurosurgery Mx SAH

Coiled by IR

What % SAH rebleed within weeks

10-20%

What % of pt w/ SAH develop hydrocephalus

11%

Role of nimodipine in Mx SAH

Prevents vasospasm Which reduces mortality

% death from SAH immediately

30%

When do berry aneurysms rebleed after SAH

3-4 days

when do AVM bleed after sah

years after

why do you get hydrocephalus after SAH

due to fibrosis in CSF pathway

what is a subdural haemorrhage

collection of blood in subdural space between arachnoid and dura

cause acute subdural haemorrhage

severe acceleration - deceleration head injury

PS acute subdural haemorrhage

Young adults Dilated pupil Decreased GCS

Mx acute subdural haemorrhage

craniotomy + early evacuation of clot ICP monitoring

Consequences of acute subdural haemorrhage (3)

epilepsy neuro disability death

RF subacute subdural haemorrhage (3)

elderly alcohol abuse coagulopathy

PS subacute subdural haemorrhage

3w after insult headache drowsy confusion stupor/coma

Mx subacute subdural haemorrhage

craniostomy/craniotomy

Ix subdural haemorrhage

CT findings - acute subdural haemorrhage (4)

cresent shape incr density (white) midline shift showing compression of ventricles

CT findings - chronic subdural haemorrhage

Blood darker lentiform

Norm ICP

0-10mmHg

Causes of raised ICP

Tumour Trauma ischaemia infection cytotoxic - cell death obstructive hydrocephalus

PS raised ICP (9)

Headache - worse on lying, PS on waking and worsened by straining vom seizure irritability GCS decline progressive dilatation of pupil on affected side cushing reflex cheyne stokes breathing papilloedema

Mx raised ICP

A-E elevate head 30' mannitol 0.2./kg IV over 15 mins CCS fl restirct neurosurgery

Neuro - stroke, MMA, VST + brain haemorrhages Flashcards

(80 cards)