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)