Selected Notes neuro 2 Flashcards
(59 cards)
What would you expect to see on a NCCT head of a patient with an SAH?
<ul><li>Hyperdense blood in basal cisterns/sulci</li></ul>
What would be seen on a LP of a patient with a SAH?
<ul><li>Xanthochromia: breakdown of RBC</li></ul>
What patient group is most commonly affected by an extradural haematoma?
<ul><li>Young patients with head injury-sports etc</li></ul>
What proportion of patients will have <b>bilateral </b>subdural haemorrhages?
<ul><li>15% adults</li><li>80% infants</li></ul>
Why are alcoholics and infants and the elderly more at risk of a subdural haemorrhage?
<ul><li>Brain atrophy</li><li>fragile/taut bridging veins</li></ul>
What proportion of strokes are ischaemic?
<ul><li>85%</li><li>15% haemorrhagic</li></ul>
What scoring system in used for those with a potential ischamic stroke?
<ul><li>ROSIER score</li><li>>0 makes a stroke likely</li></ul>
When is thrombolysis contraindicated in a patient with an ischaemic stroke?
<ul><li>Previous haemorrhage</li><li>GI bleed</li><li>Recent surgery</li><li>Hypertension</li><li>Increased INR</li></ul>
When should thrombectomy be considered as a treatment for an acute ischaemic stroke?
<ul><li>If confirmed occlusion of proximal anterior circulation on CTA or MRA (with IV alteplase if <4.5 hours, on its own if 6-24 hours)</li><li>Consider: <24 hours: confirmed occlusion of prxomial posterior circulation on MRA/CTA/potential to salvage brain tissue</li></ul>
What part of the brain is supplied by the posterior cerebral artery?
<ul><li>Posterior cerebral cortex:</li><li>Occipital lobe, thalamus etc</li></ul>
What symptoms would you expect with a middle cerebral artery infarction?
<ul><li>Contralateral loss of sensation and motor control to face and UPPER limbs</li><li>Broca's aphasia</li></ul>
What symptoms would you expect with an anterior cerebral artery infarction?
<ul><li>Contralateral loss of sensation and motor control to lower body</li></ul>
What symptoms would you expect with a posterior cerebral artery infarction?
<ul><li>Contralateral homonymous hemianopia</li></ul>
What symptoms would you expect with a basilar artery infarction?
<ul><li>Locked in syndrome-> bilateral loss of corticospinal tracts</li></ul>
What symptoms would you expect with an anterior inferior cerebellar artery infarction?
<ul><li>Contralateral loss of pain and temperature sensation</li><li>Lateral pontine syndrome</li></ul>
<div>Ipsilateral:</div>
<div>-CN3 palsy</div>
<div>-Vertigo/nystagmus/deafness</div>
<div>-Poor coordination/tone/balance</div>
What vessels are implicated in Weber’s syndrome?
<ul><li>Upper basilar and posterior cerebral</li></ul>
What vessel is involved in a Wallenberg stroke?
<ul><li>Posterior inferior cerebellar artery</li></ul>
What vessels are implicated in a total anterior circulation stroke?
<ul><li>Middle cerebral/anterior cerebral-> large cortical</li></ul>
What vessels are implicated in a partial anterior circulation stroke?
<ul><li>Only part of anterior circulation-> ACA/MCA</li></ul>
What parts of the brain are affected in a posterior circulation stroke?
<ul><li>Cortical</li><li>Cerebellum</li><li>Brainstem</li></ul>
<div>Vertebrobasilar arteries</div>
What will a CN3 palsy result in?
Occulomotor<br></br><ul><li>Ptosis</li><li>‘down and out’ eye</li><li>Dilated fixed pupil</li></ul>
What will a CN4 palsy result in?
Trochlear<br></br><ul><li>Defective downward gaze-> vertical diplopia</li></ul>
What part of the brain is most commonly affected by HSV1 encephalitis?
<ul><li>Temporal and inferior frontal lobes</li></ul>
Which bacteria is most likley to result in DIC and what does it look like under microbiology?
<ul><li>N.meningitidis</li><li>Gram egative diplococcus</li></ul>
- Swollen pale disc and blurred margins
- LMN palsy: affects facial nerve after its entered the brainstem
- Contrast stroke: innervation from both hemispheres of the brain
- Urgetn ENT referral if no improvement after 3 weeks
- Plastic surgery referral if long standing weakness(month)
- Carbamazepine
- Carbamazepine
- Generally most of them except for barbituates(ohenobarbitol etc)
- After the 2nd seizure
- Tarsometatarsal joints
- Can involve any joint in a limb that has lost sensation due to neuropathy
- Truncal ataxia and gait instability with fewer cerebellar signs in the limbs
- Signs in ipsilateral limb
- Early/prominent autonomic dysfunction
- Degree of cerebellar involvement
- Dementia occurs <1yr after onset of motor sx/come first
- Early and prominent cognitive dysfunction/hallucinations
- Domperidone
- Streptococcus-mc
- Sytaph
- Gram negatives
- TB
- Fungi
- Parasites
- Breast
- Lung
- Melanoma primaries
- Pleomorphic tumour cells border necrotic areas
- Falx cerebri
- Superior sagittal sinus
- Convesity
- Skull base
- Spindle cells in concentric whorls and calcified psammoma bodies
- Rosenthal fibres(corkscrew eosinophilic bundle)
- Small, blue cells
- Rosette pattern of cells with many mitotic figures
- 4th ventricle
- Hydrocephalus
- Perivascular ppseudorosettes
- Foam cells and high vascularity
- One off vaccine advised for those in tehir 70s
- COCP
- Tetracyclines
- Retinoids
- Lithium
- Thyroxine
- Nitrofurantoin
- No sensory signs/symptoms
- Doesn't affect external ocular muscles
- No cerebellar signs
- Eye and sphincter dysfunciton usually not present until late
- Loss of vibraiton and proprioception
- Pain, sensation and temperature
- Flaccid paralysis of the upper limbs
- Pain and temperature
- Avoid in women of childbearing age
- Teratogenic and can reduce effectiveness of hormonal contraceptives
- Spreading sinus infection
- Descending lateral corticospinal
- Ascending dorsal column
- Ascending spinothalamic
- C5-C7
