Neurology Flashcards
(26 cards)
What is a TIA?
Symptoms of stroke that resolve within 24 hours - transient neurological dysfunction secondary to ischaemia without infarction
What is a crescendo TIA?
Where there are two or more TIAs within a week - carries high risk of developing in to a stroke
Symptoms of stroke
Typically asymmetrical
Sudden weakness of limbs
Sudden facial paralysis
Sudden onset dysphagia
Sudden onset visual or sensory loss
Risk factors for Stroke
Cardiovascular disease - Angina, MI, peripheral vascular disease
Previous TIA or stroke
AF
Carotid artery disease
HTN
Diabetes
Smoking
Vasculitis
Thrombophilia
COCP
What is FAST?
A tool for identifying a stroke in the community
F - face
A - arm
S - speech
T - time (act fast and call 999)
What is ROSIER?
A tool for recognition of stroke in the emergency room.
Based on clinical features and duration - stroke is likely is patient scores anything above 0
Management of stroke
Admit to specialist stroke centre
Exclude hypoglycaemia
Immediate CT brain to exclude primary intracerebral haemorrhage
Aspirin 300 mg stat and continued for 2 weeks
Thrombolysis with alteplase - within 4-5 hours and patient needs post thrombolysis complications such as intracranial or systemic haemorrhage
Thrombectomy (not used after 24 hours since onset of symptoms)
Management of TIA
Aspirin 300 mg stat
Start secondary prevention measures for cardiovascular disease
Refer to stroke specialist within 24 hours
Stroke specialist imaging
Diffusion-weighted MRI - gold standard (CT is alternative)
Carotid USS - used to assess carotid stenosis
Endarterectomy used to remove plaques or carotid standing to widen the lumen should be considered in carotid stenosis
Secondary prevention of stroke
Clopidogrel 75 mg OD
Atorvastatin 80mg
Carotid endarterectomy or stenting in patients with carotid artery disease
Treat modifiable risk factors such as HTN and diabetes
Stroke rehabilitation - multidisciplinary teams
Nurses
SALT
Dieticians
Physio
Occupational therapy
Social services
Psychology
Optometry and Opthalmology
Risk factors for intracranial bleeds
Head injury
HTN
Aneurysms
Ischaemic stroke can progress to haemorrhage
Brain tumours
Anticoagulants such as warfarin
Presentation of intracranial bleeds
Sudden onset headache - key features
Seizure
Weakness
Vomiting
Reduced consciousness
Other sudden onset neurological symptoms
Typical history of subarachnoid haemorrhage
Sudden onset occipital headache - thunderclap - that occurs during strenuous activity such as weight lifting or sex. Associated with cocaine and sickle cell anaemia
Management of intracranial haemorrhage
Immediate CT to establish diagnosis
Check FBC and clotting
Admit to specialist stroke unit
Discuss with specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and ICU care if unconscious
Correct clotting abnormalities
Correct severe HTN but avoid hypotension
Subarachnoid haemorrhage associations
Cocaine use
Sickle cell anaemia
Connective tissue disorders - Marfan’s or Ehler dances
Neurofibromatosis
ADPKD
Investigating subarachnoid haemorrhage
CT head - first line investigation
Lumbar puncture - red cell count raised and xanthachromia (yellow colour of CSF due to bilirubin)
Angiography - to confirm location of bleeding
Management of subarachnoid haemorrhage
Refer to specialist stroke unit
Surgical intervention - to treat aneurysms
Nimodipine - used to prevent vasospasm (common complication that can result in brain ischaemia following subarachnoid haemorrhage)
What is Parkinson’s disease?
A condition where there is a progressive reduction of dopamine production from the substantia nigra.
Symptoms of parkinsons
Characteristically asymmetrical
Triad:
Resting tumour
Rigidity
Bradykinesia
Shuffling gait
Reduced arm swing
Stooped posture
Postural instability
Cognitive impairment and memory problems
Differentiating between Parkinson’s tremor and benign essential tremor
What are Parkinson’s-plus syndromes
Multiple system atrophy - autonomic dysfunction (hypotension, constipation, sexual dysfunction) and cerebellar dysfunction (Ataxia)
Dementia with Lewy bodies - visual hallucinations
Progressive supranuclear palsy
Corticobasal degeneration
Diagnosis of parkinsons
Clinical diagnosis
Treatment of Parkinson’s
Levodopa + carbidopa (peripheral decarboxylase inhibitors)
COMT inhibitors - entacapone
Dopamine agonists - bromocryptine, carbergoline
MOA-B inhibitors - selegiline and rasagiline
