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Phase 3a > Neurology > Flashcards

Neurology Flashcards

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1
Q

What is a stroke

A

Infarction of bleeding in the brain manifesting with sudden onsent focal CNS signs

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2
Q

What are the risk factors for a stroke?

A

CVD-: Angina, MI, PVD
TIA, Stroke
AD, carotid artery disease
HTN, diabetes, smoking , vasculitis , thrombophilia, OCP

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3
Q

What is the aetiology of a stroke?

A

Cerberal microangiopathic and thrombosis
Cardiac emboli - AF, endocarditis, atherosclerosis
Shock - sudden BP - vasculitis
Carotid artery dysplasia/ dissection
Venous sinus thrombosis
Antiphosphilipid
Aneurysm rupture
Anticoagulation
Thrombolysis
SAH
MI
Respiratory arrest

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4
Q

What’s the pathophysiology of an ischaemic

A

Ischaemic tissue leads to inflammatory responses and oedema and lack of perfusion to the brain

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5
Q

What is the pathophysiology of the haemorrhagic stroke?

A

SAH - blood causing vasospasm - increasing ICP - vasoconstriction - lack og oxygen
Then ICP is greater than MAP so decrease of cerebral perfusion pressure - brain Ischaemia - lack of cerebral perfusion pressure - brain ishcaemia - increase sympathetic s - increase blood pressure , decrease HR - brainstem dysfunction

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6
Q

What are the signs and symptoms of a stroke?

A

Sudden limb weakness
Facial Weakness
Wernickes dysphagia - cant understand or communicate
Broca’s aphasia - cant formulate words
Visual/ sensory loss
Facial drooping
Arm weakness
Speech difficulties

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7
Q

What are the signs one symptoms of a lacunar stroke

A

Ataxic hemiparesis
Pure motor, sensory
Sensorimotor
Dysarthia
Cognition and sensory intact

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8
Q

How do you manage a stroke

A

Exclude hypoglycaemia
Immediate CT to exclude haemorrhage - negative do diffusion weighted MRI
Aspirin 300mg for 2 weeks
Thrombolysis with alteplase IV within 4.5 hours
Mechanical thrombectomy up to 48 hours
Long term clopidogrel/ warfarin
IV manitol for brain oedema

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9
Q

What is an ACA stroke presentation

A

Contralateral weakness and sensory loss of the lower limb
Incontinence
Drowsiness
Thinking and personality
Truncated ataxia

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10
Q

What is MCA stroke presentation

A

Contralateral motor and sensory weakness
Hemiparesis
Speech impairment
Facial droop

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11
Q

What are the features of a PCA stroke

A

Perception changes
Homonymous hemianopia

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12
Q

What is a vertebrobasilar artery stroke features?

A

Coordination and balance affected

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13
Q

What is lateral medullary syndrome

A

Sudden onset vomiting and vertigo
Ipsilateral horners syndrome - reduced sweating, facial numbness , dysarthria , limb ataxia and dysphagia

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14
Q

What are symptoms of a brainstem infarction

A

Quadraiplegia
Facial paralysis
Numbness
Gaze
Vision
Coma
Locked in syndrome
Altered consciousness
Vertigo
Vomiting

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15
Q

What is a SAH

A

Bleeding between the arachnoid and pia mater into the SA space where the CSF is located

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16
Q

How does a SAH present?

A

Sudden onset occipital headache - thunderclap
Collapse, seizures, vomiting, coma
Neck stiffness
Headache
Fever
Photophobia
Kernings
Focal neurological signs

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17
Q

What causes a SAH?

A

Berry Aneurysm rupture either at the posterior/anterior communicating bifurcations
Encephalitis
Vasculitis
Tumours
AV malformations

More at risk if bleeding disorders or blood thinners

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18
Q

How do you investigate a suspected SAH

A

CT Head
Lumbar Puncture - high red cells, xanthochromia, angiography

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19
Q

What is the management of SAH

A

Neurosurgery
Ventilation
Hydrated
Nimodipine - prevents vasospasm
Antiepileptic

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20
Q

How do you investigate a TIA

A

Diffusion weighted CT and MRI
Carotid Doppler US
Carotid Doppler angiography

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21
Q

How long can a TIA last

A

Less than 24 hours

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22
Q

How do you manage somone post TIA

A

Calculate a ABCD^2
Control CVD risk factors - BP, lipids , smoking
Antiplatlets - 2 weeks aspirin for hen clopidogrel ( Aspirin and SR dipyramidole)
Carotid endcardectomy - 2 weeks
No driving for a month
If AF warfarin

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23
Q

What is an extradural haemorrhage

A

Bleeding between the skull and dura mater usually due to a skull fracture affecting the middle meningeal artery

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24
Q

What is the aetiology of an extradural haemorrhage?

A

Traumatic skull fracture usually between temporal and parietal bone

Damage to MMA and extradural blood accumulation that’s limited to suture lines that leads to tissue compression

Frontal : Anterior Ethmoïdal
TP: MMA
Occipital: transverse and sigmoid sinuses
Vertex : SSS

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25
What are the risk factors for an extradural haemorrhage
Pregnancy , SLE , vasculitis, under 60
26
How does an extradural haemorrhage present
Initial loss of consciousness - lucid state as blood slowly pools then GCS suddenly drops and ICP rises - brain stem compression Severe Headache, vomiting , confusion, seizures and haemiparesis with brisk reflexes and up going planters + dilated ipsilateral pupil, deep coma , bilateral weakness, deep breathing , shallow , high BP loss HR and resp failure
27
What are the differential for an extradural?
Epilepsy, carotid dissection , CO poisoning
28
How do you investigate an extradural
CT - biconvex shaped lemon and lime limited by dural attachements X Ray skull to find fracture
29
How do you manage an extradural
Clot Evacuation, bleeding ligation, craniectomy, ventilation, intubation and mannitol Stop Aspirin and antiplatlets
30
What are complications of an extradural?
High ICP supratentorial herniation Arterial compression - stroke Brain stem compression - heart and resp arrest Paralysis and sensory loss Seizures
31
What is a subdural haemorrhage
Bleeding between the dura and arachnoid mater due to tearing of the bridging veins between cortex and venous sinuses - deceleration
32
What are the risk factors for subdural
Brain atrophy , epileptics , alcohol, anti coagulation Acute changes are white chronic are grey
33
What is the etiology of a subdural hemorrhage
Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations
34
What is the etiology of a subdural hemorrhage?
Trauma, low ICP, dural mets, coup contre coup, shaken baby, vascular malformations
35
What is the pathophysiology of subdural?
Head trauma leads to the tearing of the bridging veins, and small cortical arteries and blood accumulate leading to compression
36
What are the symptoms of subdural haemorrhage?
Fluctuating consciousness (GCS) , headache, sleepiness,, unsteadiness, personality change
37
What are the signs of a subdural hemorrhage?
Raised ICP, seizures, unequal pupils, hemiparesis
37
What are the signs of a subdural hemorrhage?
Raised ICP, seizures, unequal pupils, hemiparesis
38
What is the differentials for subdural hemorrhage
Stroke, dementia, SOL, absence seizures
39
Are subdural hemorrhages chronic or acute?
Chronic - 14 days , sub-acute 2-14 acute 48-72 hours
40
How do you investigate a subdural hemorrhage?
CT/MRI - midline shift and clot, crescent shape, and blood collection in keeping with sickle cell shape Chronic is grey acute is white and hyperdense Manage by reversing clotting abnormalities Ligation via burr hole craniostomy Craniotomy Diuretics Frozen Plasma Vitamin K and Frozen VIII bypass inhibitor High ICP shifts midline - tentorial herniation Investigate cause e.g. Abuse
41
What are neonatal causes of meningitis?
E.coli Group B streptococcus - S. agalactiae Listeria Monocytogenes
42
What are young adult causes?
Neisseria Meningitidis Streptococcus Pneumoniae
43
What are elderly causes?
Streptococcus Pneumoniae Neisseria Meningitidis Listeria Monocytogenes
44
What is aseptic meningitis
Autoimmune, medications, malignancy,
45
What are the common viral causes of meningitis?
Enterovirus, HSV, VZV, CMV, cryptococcus candidia, TB, syphilis
46
Meningitis differentials?
Malaria, encephalitis, septicemia, SAH, dengue, tetanus
47
Meningitis Risk Factors?
Students, travel, immunocompromised, pregnancy
48
What are the complications of meningitis
Cerebral Oedema, herniation, deafness, epilepsy, hydrocephalus, cognitive defects
49
What are the signs and symptoms of meningitis?
Fever, neck stiffness, vomiting, headache, photophobia, altered consciousness, seizures Decreased GCS, coma, Seizures Nonblanching Peticheak rash ( meningococcal septicemia) - DIC and subcutaneous hemorrhage Kernings+ve: Spinal Pain, resistance to leg extension when the hip is flexed Brudinzkis: Lift head and neck of bed 0- flexion of hips and kness
50
How do you investigate meningitis?
Blood cultures Lumbar punctures
51
How to do you treat meningitis
Ceftriaxone/ Cefotaxime BenPen if community rash Chloramphenicol if allergy Cover with amoxicillin for listeria Dexamethasone can be used
52
What do you do if someone is septic with meningitis
Blood cultures IV antibiotics Intubation Fluid results - inotropes, vasopressors Urine output Delay LP
53
What are viral CSF changes?
Clear, normal pressure , 10-100 lymphocytes, normal glucose, high protien
54
What are viral CSF changes?
Clear, normal pressure, 10-100 lymphocytes, normal glucose, high protein
55
What is Fungal CSF?
Clear/Cloudy with normal pressure and mononuclear with high protein and India ink positive
56
What are bacterial CSF changes?
Cloydt, high pressure, neutrophils, low glucose, greater than 150 protien and gram stain and culture
57
What are TB CSF changes?
Fibrin web, opaque, mononucleosis, low glucose. 1-5 protein, acid-fast bacilli
58
What is encephalitis
Acute inflammatory brain disease due to pathogens
59
What is Aetiology
Viral: HSV-1, Arbovirus, VZV, measles, mumpsCMV, EBV Bacterial: listeria cytogenesis, mycobacteria, spirochetes - syphilis, legionella Parasites: Toxoplasma, Malaria Fungi: Aspergillus, cryptococcus, leptospirosis Autoimmune: NMDA, Acute dissimenated lymphoma
60
Risks for encephalitis?
Immunosuppression, travel, exposure
61
What are encephalitis complications
Seizures, SIADH, High ICP
62
What is S+S of encephalitis
Bizzare, confusion, low GCS, coma, fever, headache, focal neurological signs, seizures, nuchal rigidity, hallucinations
63
What are investigations for encephalitis?
Blood cultures Viral PCR Throat swab MSU toxoplasma IGM Malaria film Contrast CT LP and CSF culture and PCR
64
What is the definition of Guillan barre?
Acute paralytic polyneuropathy that affects the PNS causing ascending and sensory weakness Demyelinating

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