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Flashcards in Neurology Deck (126)
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1

List the advantage of MRI head over CT head
List the CIs of MRI

No ionising radiation in MRI

Any metal containing implants / bullets + shrapnel
Claustrophobic

2

What are the CSF findings seen in MS? (3)

Lymphocytes upto 50
Protein - moderately raised (<1g)
Oligoclonal IgG bands on electrophoresis

3

List the Irreversible (6) + Reversible (9) RFs for ischaemic stroke

Age/Gender
PMH/FH
Hypercoagulable state / AF

Poor diet / exercise
Smoking / alcohol
HTN / Hyperchol
DM / Obese
COC

4

List some rarer RFs for ischaemic stroke (6)

Endocarditis / Vasculitis
Migraine / Polycythaemia
Antiphospholipid syndrome / Amyloidosis

5

List some RFs for haemorrhagic stroke (5)

FH
Vascular abns (aneurysm / AVM / HHT)
Uncontrolled HTN
Coagulopathies / anticoags
Heavy recent alcohol intake

6

What are the 3 diff types of cerebral ischaemia

Regional (affects cortical areas)
Lacunar (subcortical - from microinfarcts/small vessel disease)
Global ischaemia (post-arrest: can reverse/transient sx but risk reperfusion injury // severe can cause cortical laminar necrosis = vegetative)

7

What are the 3 zones in cerebral ischaemia called?

Infarct core - defo will die
Oligaemic periphery - survives from collaterals
Ischaemic penumbra - uncertain outcome

8

List the main clinical features of an ischaemic stroke (4)

Contralateral mm weakness / hemiplegia
Facial weakness
Higher dysfunction
Visual disturbance
Rare - epileptic fit

9

List some examples of higher dysfunction (6)

Agnosia
Asterognosis
Receptive aphasia
Expressive aphasia
Apraxia
Inattention (neglect)

10

Describe the practical management of ?Stroke coming onto the ward

Quick focussed Hx / NIHSS score
Assess for CIs (fam/GP/Notis)
IV access + baselines (FBC, clotting, Glucose, UEs)
Weight (estimate)
Catheterise (if required)
Consultant review + urgent CT / thrombolysis

11

Post-thrombolysis, what features would indicate complications/haemorrhage?

What aspects of management should be delayed during thrombolysis infusion?

Acute HTN
Severe headache
Nausea/vomiting
-> discontinue infusion + urgent CT

During 1st 24hrs/ during infusion:
Avoid catherisation
Avoid NG
Avoid aspirin

12

What are the secondary prevention measures post-stroke? (5)

Antihypertensive therapy
Statin
Antiplatelet therapy
Identify/tackle RFs
Manage co-morbidities e.g. AF/DM

13

What are the laws regarding driving after a stroke?

Cannot drive for 4wks post stroke
After 4wks if clinical improvement satisfactory, may return to driving w/o having to inform DVLA

14

List some post-stroke complications (8)

Post-stroke pain
Incontinence
Pressure sores
Depression

DVT/PE
Aspiration/hydrostatic pneumonia

Malignant MCA syndrome
Seizure

15

What is malignant MCA syndrome and its features / Tx

Neuro deterioration due to cerebral oedema following middle cerebral aa stroke

Variable but:
Increased agitation
Reducing GCS
Haemodynamic / thermal instability
Signs of raised ICP

Decompressive hemicraniectomy

16

What are some high-risk features of a further stroke post-TIA?

Recurrent TIAs in short period
TIA on anticoag / AF
ABCDD score of ≥4

Age >60
BP at presentation (>140/90)
Clinical features - unilateral weakness (2) / speech disturbance w/o weakness (1)
Duration of Sx - 60mins+ (2) / <60mins (1)
Diabetes - pre-existing (1)

17

How are high-risk and low-risk TIAs managed?

High-risk:
Statin (e.g. simva 40mg)
300mg aspirin (unless CI)
Arrange 24hr urgent clinic
Advise don't drive until seen specialist

Low risk:
Same but less urgent clinic referral (1wk)

18

What further Ix / prophylactic interventions can be done after TIAs (1+2)

Carotid USS in specialist clinic

Carotid endarterectomy if stenosed >50%
OR
Percutaneous luminal angioplasty ± stenting

19

List the RFs for venous sinus thrombosis (7)

Pro-thrombotic state (85%):
Pregnancy / puerperium
Oral contraceptive
Malignancy
Genetic thrombophilia

Head injury
Recent LP
Infection

20

What are the clinical features for cortical (5) / dural (5) / sagittal lateral (5) venous sinus thrombosis

Cortical:
Thunderclap headache
Fever
Focal signs
Seizures
Encephalopathy

Dural: (ophthal signs + fever)
Proptosis/chemosis
Ocular pain
Ophthalmoplegia
Papilloedema
Fever

Sagittal lateral: (raised ICP signs)
Headache
Vomiting
Fever
Papilloedema
Seizures

21

What are the diff types of intra-cerebral haemorrhage?

Deep intra-cerebral: subcortical
from micro aneurysms (Charcot-Bouchard) and degen of small penetrating aa's

Lobar intra-cerebral: in cerebral cortex
Normotensive / >60

22

Describe the immediate management for intra-cerebral haemorrhage

Reverse anticoag
Lower BP to <140/90 within 1hr (IV betolol)
Neurosurgical intervention possibly

23

What are the presenting features of a SAH? (5 + 3)

Thunderclap headache (after transient HTN)
Vomiting
Photophobia
Drowsiness / coma
Focal signs

Neck stiffness
+ve Kernig's
Papilloedema

24

What are the predisposing abnormalities causing SAH? (3)

Berry (saccular) aneurysm (70%)
AVM (10%)
No lesion found (20%)

25

What are the RFs for berry aneurysm development?
What is the most common site of berry aneurysm?

Polycystic kidney disease
FH
HTN
Smoking
Ehlers-Danlos / Marfans

Commonest site is anterior communicating aa

26

What are some complications of SAH (4)

Death (30% immediate)
Rebleed
Hydrocephalus (from CSF pathway fibrosis)
Cerebral vasospasm (poss -> ischaemic damage)

27

What investigations are done in SAH? (4)

Bloods: FBC, clotting, UEs, LFTs, ESR
CT*
LP if CT normal
CT angio - for all pts fit for surgery

28

How is SAH managed? (7)

4wks bed rest
HTN control
Nimodipine - prevents vasospasm
IV fluids - prevents further vasospasm
Analgesia
Stool-softeners (prevent straining)
Neurosurgical referral/discussion

29

What pt groups are subdural haemorrhages seen in?

Acute: major trauma pts

Subacute/Chronic:
Elderly
Coagulopathy
Alcoholics (clotting)

30

How do subacute/chronic subdurals present? (4)

S/O raised ICP 3wks post-insult:
Headache
Drowsy/confusion
Focal neuro signs
Stupor/coma (late: coning)