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Neurology Flashcards

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1
Q

extradural haematoma location

A

btw skull and dura

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2
Q

causes of extradural haematoma

A

low-impact trauma

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3
Q

presentation of extradural haematoma

A

LOC –> lucid interval –> rapid decline in consciousness

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4
Q

signs of extradural haematoma

A

due to mass effect: - - uncal herniation| - fixed, dilated pupil (CN3 compression)

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5
Q

CT fts of extradural haematoma

A

hyperdense (bright) biconvex/lentiform collection around the surface of the brain

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6
Q

definitive management of extradural haematoma

A

craniotomy and evacuation

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7
Q

Definition of acute subdural haematoma

A

fresh collection of blood btw dura and meninges

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8
Q

causes of acute subdural haematoma

A 
trauma (> common) - high speed-injuries/ acc-deceleration vascular lesions (AV malformations)
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9
Q

presentation of acute subdural haematoma

A

spectrum - from asx to comatosed

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10
Q

CT imaging for ACUTE subdural haematoma

A

hyperdense (bright) crescenteric collection surrounding the brainNot limited by suture lines

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11
Q

Definitive tx for acute subdural haematoma

A

decompressive craniotomy

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12
Q

Define chronic subdural haematoma

A

old collection of blood btw dura and meninges

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13
Q

common groups of pts w/ chronic subdural haematoma

A
  • elderly- alcoholics- anticoagulated- infants
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14
Q

Presentation of chronic subdural haematoma

A
  • several weeks after mild head injury| - progressive confisions, LOC, weakness or higher cortical function
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15
Q

CT fts of CHRONIC subdural haematoma

A

hypodense (dark) crscenteric collection around the surface of the brainnot limited by suture lines

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16
Q

Definitive tx chronic subdural haematoma

A

burr hole drainage

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17
Q

Definition intracerbral haematoma (ICM)

A

collection of blood w/in the substance of the brain

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18
Q

causes/risk factors for intracerebral haematoma

A
  • HTN- vascular lesion (aneurysm, AV malformation)- cerebral amyloid angiopathy- brain tumour- infarct (stroke pts undergoing thrombolysis)
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19
Q

presentation intracerebral haematoma

A

! similar to ischaemic stroke

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20
Q

CT fts intracerebral haematoma

A

hyperdensity (bright) w/in the substane of the brain

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21
Q

Tx of intracerebral haematom

A

Conservative - under stroke Dr| Surgical evac for large clots in pts w/ impaired consciousness

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22
Q

define subarachnoid haemorrhage

A

bleed into the subarchnoid space (deep to subarachnoid layer of the meninges)

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23
Q

causes of subarachnoid haemorrhage

A
  • trauma (> common)- ruptured aneurysm (> common spontaneous cause)- AV malformation- mycotic aneurysm- pituitary apoplexy- idiopathic
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24
Q

presentation of subarachnoid haemorrhage

A

sudden onset severe headache, meck stifness and photophobia

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25
CT fts subarachnoid haemorrhage
hyperdensitiy (white) w/in cisterns/sulci
26
diagnosis of subarachnoid if CT unconclusive
LP done after 12hrs| xanthochromia
27
Tx of subarachnoic haemorrhae
manage cause of the bleed
28
Definitino of intraventricular haemorrhage
collection of blood w/in the ventricular system of the brain
29
causes of intraventricular haemorrhage in children
prematurity of the periventricular vascular structures
30
causes of intraventricular haemorrhage in adults
- extension of a subarachnoid haemorrhage- vascular lesions (aneurysms, AV malformation)- tumours
31
CT fts of intraventricular haemorrhage
hyperdensity (bright) in the dark CSF spaces w/in ventricles
32
Complication of intraventricular haemorrhage + management of this
obstructive hydrocephalus| surgical CSF diversion (external ventricular drain)
33
Which bleed may result in vasospasms
subarachnoid haemorrhage
34
Fts Duchenne musclar dystrophy
- progressive prox muscle weakness from 5yrs old - calf pseudohypertrophy - Gower's sign (arms used to sit up) - 30% have intellectual impairment - X linked recessive
35
Becker muscular dystrophy fts
- after 10yrs - unlikey intellectual impairment - X linked recessive
36
Idiopathic Parkinson's disease a) Key/classic fts b) other fts
a) Asymmetry of clinical signs b) Unilateral extrapyramidal fts
37
Vascular Parkinsonism a) Key/classic fts b) other fts
a) Predominant lower body signs b) Tremor less common; rigidity (lower>upper limbs); lack of facial expression
38
a) Key/classic fts b) other fts
a) b)
39
Dementia with Lewy bodies a) Key/classic fts b) other fts
a) Triad: dementia; parkinsonism and visual hallucinations b) Prominent visual hallucinations; fluctuating alertness
40
Drug induced parkinsonism a) Key/classic fts b) other fts
a) Hx of dopamine blocking drugs (anti-psychotics, metoclopramide) b) symetrical rigidity; lack of facial expression
41
Multi-systems atrophy (as a diff of parkinsonism) a) Key/classic fts b) other fts
a) Prominent early autonomic fts (hypotension, bladder instability b) Symmetrical Parkinsonism with autonomic complications
42
Progressive supranuclear palsy (as a diff of parkinsonism) a) Key/classic fts b) other fts
a) early falls, truncal rigidity, vertical gaze palsy b)
43
Normal pressure hydrochephalus (as a diff of parkinsonism) a) Key/classic fts b) other fts
a) Triad: dementia; gait disorder; bladder instability b) normal pressure hydrochephalus on neuro-imaging
44
Extrapyramidal fts0
tremor bradykinesia
45
Headache red flag sx (10)
- Thunderclap (first and worst) - a/w accelerated/malignant HTN - acute + papilloedema - acute + focal neurology - head trauma + raised ICP signs (gradual, diplopia, >morning) - a/w photophobia + nuchal rigidity + fever +/- rash - a/w reduced consciousness - a/w acute red eye - 3rd trimester pregnancy/early post-partum - head injury + elderly/alcoholic/anticoagulated
46
ICP symptoms
- precipitated (not worse) by valsava - papilloedema - wakes from sleep Others: - worse on waking/lying down - pulse synchronous tinnitus - episodes of transient visual loss when changing posture (standing) - vomiting
47
fts of headaches warantign 2WW (?Ca)
- ICP fts - a/w new onset seizures - a/w persistent new or progressive neurological deficit - hx of malignancy (?mets) - unexplained vomiting
48
Migrain fts
- throbbing pain lasting hrs - 3 days - sensitivity to stimuli - nausea - worst with physical activity +/- aura (evolves slowly, lasts few mins-60mins)
49
Acute tx for migraine
- aspiring dispersable 900mg - NSAID + metoclopramide/domperidone (with caution) - triptan (<10 days per mo, ideally <6/mo) NOT opiates
50
Tension type headache
- band-like - mostly featureless +/- mild photo/phonophobia NO nausea
51
Cluster headache
- M>F - most severe pain lasting 30-120mins - unilateral, side-locked - agistation, pacing - unilateral cranial autonomic fts (tearing, red conjunctiva, ptosis, miosis, nasal stuffiness)
52
Acute tx cluster headache
- sumatriptan injection 6mf s/c (CI for IHD and stroke) - Hi-flow oxygen NRB mask - pred 60mg OD 1 week
53
treatment tiptan overuse headache
stop triptan for 2-3 mo
54
Migraine prophylaxis 1st line - drug, dose, course
propanolol MR 80mg OD - incr to tolerance, max 240mg OD course: 3 months at highest tolerated target dose to assess efficacy
55
Migraine prophylaxis 2nd line (indication; drug, dose, course)
topimarate 25mg OD, incr by 15-25mg every fortnight, target 50mg BD course: 3 months at highest tolerated target dose to assess efficacy
56
Topimarate counselling pts
- teratogenic + interacts with oral contraceptives - paraesthesia - weight loss none above are causes to stop unless not tolerated - worsening depression
57
Tension type headache prophylaxis (medical, other)
- amitriptyline 10mg at night, incr by 10mg a week up to 100mg - OR gabapentin 100mg TDS increasing by 100mg TDS to 900mg TDS - acupuncture if available
58
investigations for 2ry headache (after excludign main 3)
Hb, Ca2+, TFTs, ESR, CRP review lifestyle review medications
59
TIA criteria
rapidly developign clinical signs of focal/global disturbance of cerebral function self-resolving in <24hrs
60
Risk assessment for TIA
ABCDD Age >60 - pt BP>140/90 at presentation - 1pt Clinical fts (unilateral weakness - 2pts; speech disturbance w/out weakness - 1pt) Duration sx >1hr - 2pts; 10-59mins - 1pt Diabetes -1pt OR AF - 4pts High risk = 4pts - see within 4hrs
61
Tx ischaemic stroke
alteplase (thrombolysis) mechanical embolectomy (8-12hrs onset)

General med (14 decks)

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