Stroke and Palsy Flashcards by Isobel Bryson

What is Bell’s palsy?

Isolated dysfunction and inflammation of the facial nerve (CN7)

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What is a possible cause of Bell’s palsy?

HSV-1 re-activation

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What are some symptoms of Bell’s palsy?

Unilateral facial weakness of lower motor neurons
Postauricular otalgia
Hyperacusis
Altered taste to front 2/3rds of the tongue
Dry mouth and eyes

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What is the treatment for Bell’s palsy?

Prednisolone if within 72 hours of symptom onset

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What is Ramsay Hunt syndrome?

Re-activation of VZV in the facial nerve

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What is the presentation of Ramsay Hunt syndrome?

Severe ear pain
Tender and painful vesicular rash in and around ear, face, mouth
Vertigo
Deafness

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What is the treatment for Ramsay Hunt syndrome?

Prednisolone and Acyclovir within 72 hours

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What is bulbar palsy?

Lower motor neuron lesion affecting cranial nerves 9, 10 and 12

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Which cranial nerves are affected in bulbar palsy?

Glossopharyngeal
Hypoglossal
Vagus

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What are the main causes of bulbar palsy?

MND
MG
GBS
Brainstem stroke

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What is the presentation of bulbar palsy?

Absent jaw jerk and gag reflex
Flaccid fasciculation of the tongue
Quiet nasal speech

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What are some causes of cerebral palsy?

HIE
Infection
Meningitis
Trauma
Haemorrhage

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What is spastic cerebral palsy?

The most common
Damage to pyramidal pathways and UMN
Hypertonia and hyperreflexia
Scissor gait
Clasp knife spasticity

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What is dyskinetic cerebral palsy?

Damage to basal ganglia pathways presenting with choreiform movements

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What is ataxic cerebral palsy?

Damage to cerebellar pathways and cerebellum
Presents with uncoordinated movements

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What are some early signs and symptoms of cerebral palsy?

Hand preference before 18 months
Increased or decreased tone
Failure to meet milestones

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What does broad based ataxic gait suggest?

Cerebellar lesions

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What is normal pressure hydrocephalus?

Excess CSF accumulates in the ventricles, increasing the pressure and causing symptoms?

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What is the triad of NPH?

Dementia
Magnetic gait
Incontinence
Wet, wacky and wobbly
Hakim-Adams triad

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What does MRI show for NPH?

corpus callosum bowing

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What can be used to manage NPH?

Therapeutic LP
Ventriculoperitoneal shunt - shunt CSF from brain to abdomen

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What is GCA?

Inflammatory granulomatous arteritis of large cerebral arteries and other large vessels

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What artery is affected in GCA?

Temporal artery - in segments

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What is the presentation of GCA?

Severe headache
Scalp or temple tenderness
Jaw claudication
Amaurosis fugax

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What is the diagnostic criteria for GCA?

3 or more of - Over 50 New headache Temporal artery tenderness Raised ESR Abnormal artery biopsy

What is the 1st line diagnosis for GCA?

Raised ESR or CRP

What is gold standard for GCA diagnosis?

Temporal artery biopsy - sample 3-5cm

What is the treatment for GCA?

Prednisolone - oral without vision changes IV methylprednisolone - with visual changes

What is a brain abscess?

Pus filled swelling in the brain

What is the management of brain abscess?

Craniotomy Simple aspiration

What is an ischaemic stroke?

Reduction in cerebral blood flow due to artery occlusion or stenosis

What are some risk factors for stroke?

Smoking Obesity HTN Diabetes Previous TIA

What is the presentation of an anterior circulation stroke?

Hemiplegia Weakness Hemisensory loss Speech problems

What is the presentation of a posterior circulation stroke?

DANISH

What is the presentation of a brainstem stroke?

Quadriplegia - locked in

Where causes a pure sensory stroke?

Lacunar infarcts in the basal ganglia/ pons/ thalamus

What is the diagnosis for ischaemic stroke?

non contrast head CT to rule out haemorrhagic

What is the management for ischaemic stroke?

300mg aspirin Thrombolysis with alteplase within 4.5 hours of symptom onset Thrombectomy

What is given after ischaemic stroke for prevention?

Clopidogrel daily life-long Aspirin 75mg for first 2 weeks High dose statin

What is a SAH?

Bleeding between arachnoid and pia mater often due to spontaneous rupture of a berry aneurysm in the circle of willis

What is the presentation of SAH?

Thunderclap headache Meningism N+V Speech changes Weakness Confusion Coma

What is the diagnosis of SAH?

Urgent non-contrast head CT shows a star shape If negative, LP after 12 hours shows yellow CSF from bilirubin breakdown

What is the treatment for SAH?

Nimodipine Endovascular coiling Surgical clipping

What sort of drug is nimodipine?

Ca2+ antagonist to reduce vasospasm

What is an epidural/ extradural haemorrhage?

Bleeding between the skull and dura due to rupture of the middle meningeal artery commonly due to trauma

In what age group and why is an extradural haemorrhage more likely?

Younger adults because the middle meningeal artery is more exposed

Where is the most common site of an extradural haemorrhage?

Pterion - where the parietal, temporal, sphenoid and frontal bones meet

What is the presentation of an epidural haemorrhage?

Reduced GCS with latent period Headache Vomiting Nausea Seizures Confusion

What is the diagnosis of an epidural haemorrhage?

Non contrast head CT shows a lemon shape (ePIEdural = lemon)

What is the management of an epidural haemorrhage?

Mannitol to reduce ICP Clot evacuation - craniotomy then ligate MMA

What is a subdural stroke?

Bleeding between the dura and arachnoid from rupture of bridging veins under low pressure

What is the cause of a subdural stroke?

Brain atrophy in the elderly and alcohol abuse makes vein walls thin Bridging veins are under low pressure and bleed slowly It can increase ICP and cause a midline shift Beyond suture lines

What is the diagnosis of subdural haemorrhage?

Head CT - crescent banana shape

What is the treatment of a subdural haemorrhage?

Mannitol to reduce ICP Burr hole washout or craniotomy for drainage

What is an intracerebral stroke?

Bleeding within the cerebellum

What is the treatment for intracerebral stroke?

craniotomy to drain accumulated blood mannitol for raised ICP

What is a TIA?

Transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia Lasts minutes to 24 hours Resolves spontaneously usually within 1 hour

What is the presentation of TIA?

Contralateral sensory or motor deficits Facial and limb weakness Ataxia Vertigo Dysphasia Diplopia

What is the diagnosis of a TIA?

1st line - diffusion weighted CT/ MRI Then carotid imaging with doppler USS

What is the management of a TIA?

300mg aspirin Carotid endocardectomy within 2 weeks

What is the ABCD2 score?

Risk of stroke after TIA A - age over 60 = 1 B - blood pressure over 140/90 = 1 C - unilateral weakness = 2 Speech disturbance without weakness = 1 Diabetes = 1 Duration over 60 mins = 2 10-59 minutes = 1 Score under 4 = 7 day referral 4-6 = 24 hours Over 6 = immediate

What cannot you do after TIA?

Drive for 1 month

Stroke and Palsy Flashcards

(62 cards)