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Year 3 MedEd > Neuro3 > Flashcards

Neuro3 Flashcards

Acute Neurology

1
Q

What is the scoring for the “eyes” in the GCS?

A

4- spontaneous movement
3- eyes open to vocal
2- eyes open to pain
1- no response

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2
Q

What is the scoring for the “verbal” in the GCS?

A 
5- speaks coherently
4- confused
3- mumbles random words
2- makes random noises
1- no response
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3
Q

What is the scoring for the “motor” in the GCS?

A 
6- normal movement
5- moves towards localised pain
4- extends away from localised pain
3- abnormal flexion
2- abnormal extension
1- no response
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4
Q

What is the definition of a stroke?

A

A sudden onset focal neurological deficit of presumed vascular origin which lasts longer than 24 hrs

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5
Q

What is the definition of a transient ischaemic attack?

A

A sudden onset focal neurological deficit of presumed vascular origin which resolves fully within 24 hrs

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6
Q

What are the two types of strokes?

A

Ischaemic (80%)

Haemorrhagic (20%)

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7
Q

What are the causes of ischaemic stroke?

A

Thrombosis
Embolic (eg. AF)
Hypotension

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8
Q

What are the causes of haemorrhagic stroke?

A

Hypertension
Charcot-Bouchard microaneurysm
Amyloid angiopathy
AV malformations

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9
Q

What are some non-common causes of strokes?

A

Vasculitis
Cocaine use
Trauma
Tumour

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10
Q

What are the risk factors for a stroke?

A 
Age
BP
Cardiac disease
DM
Exercise
FHx
Hyperlipidaemia
Smoking
(ABCD...)
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11
Q

What is the epidemiology of a stroke?

A

3rd commonest cause of death after heart attack and cancer
M>F
Age >70
Hx of TIA

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12
Q

What are the clinical features of a cerebrovascular accident (CVA)?

A 
Sudden onset
Weakness
Sensory/visual/speech impairment
Impaired co-ordination
Head/neck pain
Memory often intact
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13
Q

What are the UMN lesion signs?

A 
Spasticity/clonus
Weak arm extensors, leg flexors
Hyper-reflexia
Upgoing plantars
Pronator drift
No fasciculations, muscle wasting
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14
Q

What are the LMN lesion signs?

A 
Hypotonia
General weakness
Hyporeflexia
Normal plantar response
Fasciculations, muscle wasting
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15
Q

What are the signs of an anterior cerebral artery infarct?

A 
Contralateral hemiparesis
Lower limb > upper limb
Abulia (absence of willpower to act decisively)
Confusion
Gait apraxia
Frontal release sign
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16
Q

What are the signs of a middle cerebral artery infarct?

A

Contralateral hemiparesis
Upper limb > lower limb
Contralateral hemisensory loss
Apraxia
Hemineglect
Receptive/expressive dysphagia (if left sided)
Quadrantanopia (if Meyer’s/Baum’s loop affected)

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17
Q

What is the presentation if Meyer’s loop is affected?

A

Contralateral homonymous superior quadrantanopia

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18
Q

What is the presentation if Baum’s loop is affected?

A

Contralateral homonymous inferior quadrantanopia

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19
Q

What are the signs of a posterior cerebral artery infarct?

A

Macular sparing homonymous hemianopia

Visual agnosia

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20
Q

What are the signs of a basilar artery infarct?

A

Cranial nerve pathology (III-XII)
Visual impairments
Cerebellar pathology
Impaired consciousness

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21
Q

What are the signs of a superior cerebellar artery infarct?

A

Dizziness

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22
Q

What are the signs of an anterior inferior cerebellar artery infarct?

A

Dizziness

Deaf

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23
Q

What are the signs of a posterior inferior cerebellar artery infarct?

A

Dizziness
Dysphagic
Dysphonic
(Lateral medullary syndome)

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24
Q

What are the signs of a lacunar infarct?

A

Internal capsule- pure motor deficit
Pontine- dizziness/vertigo, bilateral affects
Thalamus- affects consciousness
Basal ganglia- dyskinaesia

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25
What are the signs of an intracerebral haemorrhage?
Headache and meningism Focal neurological signs Raised ICP Seizures
26
What are the characteristics of a TIA?
Usually lasts 10-15 minutes By definition can last up to 24hr Amaurosis fugax Global events like syncope/dizziness is atypical
27
What are the investigations for a stroke?
``` CT head Bloods ECG CTA Carotid Doppler MRI MRA (gold standard, way too expensive) ```
28
What is the hyperacute management for a Pt with an ischaemic stroke presenting <4.5 hrs?
ABCDE -maintain airway -maintain BP (to prevent brain hypoperfusion) -maintain glucose CT Head IV alteplase (0.9mg/kg) thrombolysis (if no contraindication)
29
What are the contraindications for thrombolysis?
``` Haemorrhagic stroke Recent trauma/surgery Varices/portal hypertension GI bleeds Known clotting disorder BP >180/105 ```
30
What is the acute management for a Pt with an ischaemic stroke?
``` Conservative: -SALT assessment -GCS monitoring Medical: -300mg aspirin daily -heparin (VTE prophylaxis) ```
31
What is the primary prevention for a stroke?
Control risk factors - stop smoking - lower hypertension - control diabetes/hyperlipidaemia
32
What is the secondary prevention for a stroke?
75mg aspirin for 2 weeks Switch to clopidogrel/dipyramidole Give lifelong anticoagulation (aspirin)
33
What is the surgical prevention for a stroke?
Carotid endarterectomy
34
When would you perform a carotid endarterectomy?
If the carotid stenosis is >70% on Doppler scanning
35
What is the general management of haemorrhagic strokes?
``` Refer to ICU/stroke unit Monitor glucose/GCS etc Antipyretic- paracetamol BP monitor- labetalol/nicardipine Coagulopathy- reverse warfarin/heparin/dabigatran DVT prophylaxis- heparin/enoxaparin ```
36
How is warfarin reversed?
Phytomenadione Fresh frozen plasma/prothrombin complex concentrate Platelet transfusion
37
How is heparin reversed?
Protamine sulphate | Platelet transfusion
38
How is dabigatran reversed?
Idarucizumab
39
How are thrombolytic agents reversed?
Fresh frozen plasma/prothrombin complex concentrate Crypoprecipitate Platelet transfusion
40
What are the complications of CVAs?
``` Aspiration Cerebral odemea Immobility Infection DVT Seizures Cardiovascular events Death ```
41
What is the prognosis of a CVA?
10% mortality in 1 month 10% recurrence in 1 year Haemorrhagic has a worse prognosis
42
What is used to calculate the risk of a TIA progressing into a stroke?
ABCD2 score
43
What should you do if the ABCD2 score is >=4?
Refer to a stroke specialist
44
What does an ABCD2 score >=6 indicate?
8. 1% risk of stroke in 2 days | 35. 5% risk of stroke in 1 week
45
What is a seizure?
Abnormal excessive synchronised discharge of cerebral neurons
46
What is epilepsy?
Tendency for recurrent unprovoked seizures | >2 seizures to be classed as epilepsy
47
What is the aetiology of epilepsy?
70% idiopathic | 30% secondary to brain injury, tumour, stroke, infection, head injury, autoimmune
48
What are the risk factors for epilepsy?
FHx Childhood infections Neurodevelopmental disorders eg. autism Metabolic disease eg. storage disorders, PKU
49
What is the classification of epilepsy?
Focal | Generalised
50
What is the difference between a partial and complex seizure?
Partial- no LoC | Complex- LoC
51
What are the types of generalised seizures?
``` Tonic-clonic Absence Myoclonic Tonic Atonic ```
52
What is the description of a tonic-clonic seizure?
Prodrome- auras Tonic- stiffening of muscles Clonic- contractions Post-ictal- drowsy state
53
What is the description of a absence seizure?
Loss of consiousness Cessation of activity Brief upward rolling of eyes
54
What is the description of a myoclonic seizure?
Jerking of specific muscle groups
55
What is the description of a tonic seizure?
Bear hugging posture
56
What is the description of a atonic seizure?
Complete loss of muscle tone
57
What is the presentation of a temporal focal seizure?
Automatisms Hallucinations Dysphagia
58
What is the presentation of a frontal focal seizure?
Jacksonian march Todd's palsy Leg motor disturbance
59
What is the presentation of a parietal focal seizure?
Sensory deficits
60
What is the presentation of a occipital focal seizure?
Visual deficits
61
What are the investigations for epilepsy?
``` Bloods -glucose (severe hyper/hypoglycaemia) -WCC (CNS infx) EEG CT/MRI head ```
62
What is the management for a focal seizure?
Carabamazepine/lamotrigine
63
What is the management for a generalised seizure?
Sodium valproate
64
What is status epilepticus?
A continous seizure lasting >30 minutes
65
What is the management for status epilepticus?
``` Secure airway High flow O2 Assess cardiac and resp function Check blood glucose Secure IV access in both arms ``` IV lorazepam IV phenytoin/phenobarbital General anaesthetic eg. midazolam Seek expert advice
66
What are the complications of epilepsy?
SUDEP (sudden death in epilepsy) Status epilepticus Fractures Drug SEs
67
What is a dissociative seizure?
Seizure with no identifiable organic cause Often last much longer than epilepsy Variable in presentation Patients most likely able to recall event Clinical diagnosis
68
What is hydrocephalus?
Enlargement of the cerebral ventricular system
69
What are the types of hydrocephalus?
Communicating/non-obstructive Non-communicating/obstructive Hydrocephalus ex vacuo
70
What are the causes of communicating hydrocephalus?
SAH Meningitis Normal pressure hydrocephalus
71
What are the causes of obstructive hydrocephalus?
3/4th ventricle lesion Cerebral aqueduct stenosis Posterior cranial fossa tumour
72
What is hydrocephalus ex vacuo?
Compensatory enlargement of the ventricles due to parenchymal atrophy
73
What are the clinical features of hydrocephalus?
``` Acute drop in consciousness Diplopia Palsy Behavioural changes Seizure Raised ICP ```
74
What are the clinical features of hydrocephalus in neonates?
Increased head circumference | Sunset sign
75
What is seen in normal pressure hydrocephalus?
Hakim's triad - wet (urinary incontinence) - wacky (dementia) - wobbly (gait disturbance)
76
What are the investigations for hydrocepalus?
CT scan CSF LP (therapeutic in NPH)
77
What is the management for hydrocephalus?
Interventricular shunts
78
What is spinal cord compression?
Injury to the spinal cord with neurological symptoms dependant on the site and extent of injury
79
What are the common causes of spinal cord compression?
``` Trauma Metastases Inflammatory disease Spinal stenosis -> cauda equina Spinal abscess Pott's disease ```
80
What are the risk factors of spinal cord compression?
Bone disease Vertebral disc disease Cancer
81
What are the clinical features of spinal cord compression?
Back pain Spastic paresis (bilateral, lower limbs) Sensory loss Incontinence
82
What are the clinical features of cauda equina?
``` Flaccid paresis Loss of bowel/bladder control Saddle paraesthesia Radicular back/leg pain Areflexia ```
83
What are the clinical features of Brown-Sequard syndrome?
Ipsilateral proprioception loss Ipsilateral light sensation loss Ipsilateral paralysis Contralateral pain loss
84
What are the investigations for spinal cord compression?
Bloods -FBC, ESR, B12, syphilis serology, U+E, LFT, PSA Radiology MRI- definitive
85
What is Guillain-Barre syndrome?
Acute inflammatory demyelinating polyneuropathy
86
What is the aetiology of GBS?
Unclear | Link with campylobacter jejuni and lymphoma
87
What are the clinical features of GBS?
Progressive ascending paraesthesia and paresis Can lead to respiratory distress Can involve cranial nerves
88
What is the Miller-Fisher variant?
GBS with the following triad: Ophthalmoplegia Ataxia Areflexia
89
What are the investigations for GBS?
Lumbar puncture -high protein, normal cell count and glucose Nerve conduction studies -reduced conduction velocity Bloods -Anti-ganglioside antibodies in MF variant + 25% of GBS Spirometry -fixed vital capacity: ventilatory weakness ECG -may develop arrhythymia
90
A patient is rushed into hospital having collapsed on the street. After assessing airways, breathing and circulation you now assess their disability. They have not opened their eyes since arriving and only mumble incoherently when told to open their eyes. They do not respond to vocal commands to move however when you squeeze the patient’s trapezius muscle, they move to the appropriate shoulder to slap your hand away and briefly open their eyes. What is their GCS score? ``` A. 2 B. 5 C. 8 D. 9 E. 13 ```
C. 8 E- 3 V- 2 M- 5
91
An 85-year-old woman presents to A+E struggling to talk. Her husband brought her in 30 minutes ago after she was unsteady on her feet and fell over. You assess her consciousness and find she has a GCS of 15. On examination you find she has right-sided hemiparesis with positive Babinski sign. You assess her blood pressure and find it to be 170/100. What is the most appropriate next step? ``` A. ACEi IV B. Alteplase IV C. Urgent CT head scan D. Aspirin 300mg oral E. Urgent carotid doppler ```
C. Urgent CT head scan
92
A 65-year-old man presents with sudden onset left sided weakness. He is obese, type II diabetic and has high cholesterol. On examination you find a left-sided hemiparesis with his arm more affected than the leg. There is also an equal hemisensory loss. He is unable to see anything at the bottom of his vision on his left-hand side. Which vascular territory has likely been affected? ``` A. Right middle cerebral artery B. Right anterior cerebral artery C. Left middle cerebral artery D. Right carotid artery E. Right posterior cerebral artery ```
A. Right middle cerebral artery
93
A 25 year old woman has an episode of altered consciousness lasting a few minutes. She has no memory of the event but just beforehand she developed a sense of déjà vu and had a rising feeling in her stomach. What is the most likely cause? ``` A. Absence seizure B. Vasovagal episode C. Complex partial seizure D. Simple partial seizure E. Cardiac arrhythmia ```
A. Absence seizure
94
A 15 year old girl who is a known epileptic has arrived at hospital having a seizure. The seizure started over 30 minutes ago while she was having dinner and has not regained consciousness since. Her mother says she has had 3 seizures over the past 3 months before being diagnosed with and treated for epilepsy, but none were as bad as this. Life support examination reveals that the airways are open, patient is breathing and pulse is 110 bpm. Her GCS is 8/15. You set up two IV lines ready for the patient to be managed. What is the most appropriate next step? ``` A. Perform an EEG B. Check glucose C. Perform CT scan D. Give IV lorazepam E. Give IV thiopentone ```
D. Give IV lorazepam
95
A 26-year-old man was admitted for severe food poisoning and put on antibiotics, a week later in his hospital bed he's started to notice pins and needles across his lower limb, and he's been feeling weak in that region also. What’s the most likely diagnosis? ``` A. Guillain Barre Syndrome B. Meningism C. Antibiotic allergy D. B-12 deficiency E. Stokes-Adams attack ```
A: Guillain Barre Syndrome

Year 3 MedEd (29 decks)

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