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questions Flashcards

1
Q

neurobiology of fear what does the amygdala do

A

integrates sensory and cognitive info

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2
Q

types of ischaemic strokes

A

intracranial small vessel atherosclerosis
large vessel atherosclerosis (eg carotid artery stenosis)
cardio-embolic (AF)
rare causes: vasculitis, arterial dissection, prothrombotic states

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3
Q

what is a haemorrhagic stroke

A

rupture of a cerebrospinal artery
either primary or subarachnoid

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4
Q

oligoclonal bands in CSF

A

MS

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5
Q

definition of TIA

A

episode of neurological dysfunction due to temporary focal cerebral or retinal ischaemia without infarction
usually lasting seconds to minutes with complete recovery

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6
Q

presentation of a stroke

A

asymmetrical
- sudden weakness of limbs
- sudden facial weakness
- sudden onset dysphasia
- sudden onset visual or sensory loss

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7
Q

what is TACS

A

Involves the anterior AND middle cerebral arteries on the affected side

Defined by:
- Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
- Homonymous hemianopia
- Cortical signs (dysphasia, neglect)

Most severe type of stroke

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8
Q

what is PACS

A

Involves the anterior OR middle cerebral artery on the affected side

Defined by:
- 2 out of the 3 features present in a TACS OR
- Higher cerebral dysfunction alone e.g. dysphagia

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9
Q

what is LACS

A

Lacunar infarcts are small infarcts in the deeper part of the brain (basal ganglia, thalamus, white matter) and in the brain stem

Caused by occlusion of a single deep penetrating artery, affect 2 of face arm and leg

should be NO: visual field defect, higher cerebral dysfunction, or brainstem dysfunction

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10
Q

posterior circulation syndrome

A

cranial nerve palsy
involves the vertebrobasilar arteries and associated branches (supplying the cerebellum, brainstem and occipital lobe)
defined by:
- bilateral motor and/or sensory deficits
- conjugate eye movement disorders
- isolated homonymous hemianopia
- cortical blindness
- cerebellar deficits without ipsilateral motor/sensory signs

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11
Q

acute stroke management

A

urgent imaging
thrombolysis/thrombectomy
blood pressure lowering- IV labetalol, IV GTN
stroke unit carre
swallow assessment, nutrition and hydration
antiplatelets
DVT prevention

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12
Q

contraindication to thrombolysis

A

on anticoagulant
previous ICH
recent stroke
pregnancy/post partum
recent head injury
recent surgery
seizure

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13
Q

timing for thrombolysis

A

up to 4.5 hours

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14
Q

guidance on thrombectomy

A

as soon as possible and within 6 hours, with IV thrombolysis if not contraindicated

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15
Q

anticoagulant reversal

A

Vitamin K/Prothrombin complex for warfarin

Specific antidotes to direct thrombin (idarucizumab) and factor Xa inhibitors (andexanet alpha)

If unavailable, prothrombin complex advised

Other options of tranexamic acid and rFVIIa have been tried and are recommended by some guidelines

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16
Q

Malignant MCA syndrome

A

rare syndrome usually seen in very large anterior territory stroke
tends to occur 2-5 days post stroke,
generally problematic in younger patients
treatment- hemicraniotomy

17
Q

Amaurosis fugax

A

temporary loss of vision in one or both eyes due to a lack of blood flow to the retina

18
Q

what is amaurosis fugax a clinical sign of

A

if it is caused by a TIA then it is evidence of internal carotid artery stenosis
- a warning sign of incipient ICA territory stroke

19
Q

investigations for a TIA

A

history- TIA is often based on its description
carotid duplex US
ECG
blood tests

20
Q

management of TIA

A

immediate antiplatelet therapy
secondary prevention interventions- antihypertensive therapy, statins
surgery and stenting for carotid stenosis

21
Q

Wernicke’s dysphasia

A

speech fluent, comprehension abnormal, repetition impaired

22
Q

first line management for trigeminal neuralgia

A

Carbamazepine

23
Q

epileptic drugs that are suitable during pregnancy

A

lamotrigine
Levetiracetam
carbamazepine

24
Q

which antihypertensives should be stopped during pregnancy

A

ace inhibitors
ARBs
thiazide diuretics

25
Q

why should phenytoin be avoided in pregnancy

A

it can cause cleft lip and palate

26
Q

most common pattern for progression of MS

A

relapsing-remitting

27
Q

fluctuating confusion and consciousness after a fall

A

subdural haematoma

28
Q

management of cerebral oedema in brain tumours

A

dexamethasone

29
Q

causes of foot drop

A

L5 root lesion (radiculopathy)- loss of inervsion
distal motor neuropathy- glove and stocking sensory disturbance
small cortical lesions

30
Q

drugs that are risk factors for idopathic intercranial hypertension

A

combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium

neuro (20 decks)

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