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402: Neurology and neurosurgery > Stroke + Head > Flashcards

Stroke + Head Flashcards

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1
Q

Total anterior cerebral stroke features

A
  • Homonymous hemianopia
  • Contralateral hemiparesis
  • Higher cortical dysfunction: i.e. aphasia, neglect

PACI= 2 of those features

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2
Q

Posterior cerebral infarct features

A

Cerebellar features (DANISH)

Bilateral motor/sensory loss

Isolated hemianopia

Bilateral visual field loss

CN palsy + contralateral motor/sensory deficit

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3
Q

Features of a lacunar cerebral stroke

A

Pure sensory or motor dysfunction ALONE

Ataxic hemiparesis

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4
Q

Risk factors for ischaemic stroke [7]

A

Hypertension

Atrial fibrillation

Hyperlipidaemia

Diabetes

Smoking

Previous TIA

Valvular heart disease

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5
Q

Acute treatment for ischaemic stroke (<4.5 hours)

A

Thrombolysis
- IV Alteplase

If suitable
- Thrombectomy

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6
Q

Acute treatment for ischaemic stroke (>4.5 hours)

A

High dose aspirin
- 300mg
- Given rectally/ enteral tube if dysphagia present
- Continue for 2 weeks or until discharge

PPI

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7
Q

Acute treatment of cerebral venous thrombosis

A

1st= heparin

Then wafarin

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8
Q
A

Antiplatelet
- first line= Clopidogrel 75mg OD

Statin
- Artovastatin 80mg OD

BP and DM control

Carotid endarterectomy for carotid disease.

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9
Q

Risk factors for haemorrhagic stroke

A

Anticoagulant use

Illicit drug use

AV malformations

Coagulopathy

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10
Q

Examples of higher cortical dysfunction in stroke

A

Expressive and receptive dysphasia

Neglect

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11
Q

Second line antiplatelet for stroke prevention

A

Dipyridamole 200mg BD

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12
Q

First line management for TIA

A

High dose aspirin= 300mg

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13
Q

Imaging in suspected TIA

A

MRI to identify ischaemia/ bleed

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14
Q

A carotid endarterectomy should be offered in TIA patients with…

A

> 50%

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15
Q

The hallmark features of horner syndrome are..

A

Miosis (constricted pupils)

Anhihydrosis

Ptosis (drooping eyelid|)

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16
Q

Causes of horner syndrome

A

Infarction
- Stroke (lateral medullary/ sympathetic tracts)

Demyelination

Trauma
- Spinal cord/ thoracic outlet, lung apex

Carotid dissection/ thrombosis

Cavernous sinus aneurysm

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17
Q

Post-ganglionic lesions in Horner’s syndrome present …

A

Without anhidrosis

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18
Q

Cause of post-ganglionic lesions in Horner’s syndrome

A

Carotid artery dissection / aneurysm

Cavernous sinus thrombosis

Cluster headache

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19
Q

Pre-ganglionic lesions in Horner’s syndrome present as…

A

Anhidrosis of the face only

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20
Q

Causes of pre-ganglionic lesions in Horner’s syndrome

A

Pancoast’s tumour

Thyroidectomy

Trauma

Cervical rib

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21
Q

Central lesions in Horner’s syndrome present as…

A

Anhidrosis of the face, trunk and arm

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22
Q

Causes of central lesions in Horner’s syndrome

A

Stroke

Multiple sclerosis

Tumour

Encephalitis

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23
Q

The 4 types of migraines are…

A
  1. Migraines without aura
  2. Migraines with aura
  3. Silent migraine
  4. Hemiplegic migraine
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24
Q

A chronic migraine is defined as…

A

Having migraine episodes at least 15 days per month

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25
Examples of triggers for migraines [8]
Psychological - Stress - Abnormal sleep Sensory - Bright lights - Strong smells Physical - Dehydration - Menstruation - Foods= caffeine, cheese - Trauma
26
The pattern of a migraine typically occurs as _______
Aura followed by headache
27
Features of an aura in a migraine
Sparks in vision/ blurred vision Loss of visual fields Sensory symptoms: paraesthesia, numbness Dysphasia
28
A headache in migraines lasts for...
4-72 hours
29
Describe the nature of a headache in migraines
Commonly unilateral Pounding/throbbing Accompanied by - Photophobia/ Phonophobia - nausea/ vomiting.
30
A hemiplegic migraine can mimic a______
Stroke
31
Features of a hemiplegic migraine
Hemiplegia Ataxia Changes in consciousness
32
Initial, non-pharmacological management of a migraine
Migraine diary - Triggers, duration, treatment use Avoiding triggers - Stress, foods, sleep
33
Pharmacological management of an acute migraine attack
Simple analgesia - Paracetamol, NSAIDs Triptans
34
_________ is indicated for nausea and vomiting in mirgaines
Metoclopramide
35
________ is the first line triptan used for acute migraines
Sumitriptan
36
Medication overuse headaches occur when...
Analgesia are taken for continuous periods >3 months. - At least 15+ a month for simple analgesia
37
In medication-overuse headaches, treatment involvements...
Stopping medication for at least 1 month
38
_______ is first line indicated for prophylaxis in migraines
Propranolol
39
__________ is second-line indicated for prophylaxis in migraines
Topiramate
40
__________ is a non-pharmacological treatment recommended for migraine prophylaxis
Acupuncture
41
Tension headache lasts for....
30 mins to 7 days
42
The distribution of tension headaches is...
Pain across head in "band-line" pattern
43
Negative features of tension headaches:
Nausea + vomiting Aggravated by physical activity
44
List 8 red flags for headaches
Sudden onset= thunderclap headache, new in >50. Headache worse on laying or standing Headache that wakes from sleep Headache associated with vomiting Papilloedema Focal neurological deficit Meningitic features: fever, photophobia, rash Change in personality/ cognition
45
A headache worse on standing could indicate....
A CSF leak
46
A headache worse on laying down could indicate...
Space occupying lesion Cerebral venous sinus thrombosis
47
Non-pharmacological treatment of a tension headache
Identifying and avoiding triggers Relaxation techniques Hot towels
48
Cluster headaches are associated with...
Heavy smoking and drinking A family history Trauma
49
The pathophysiology of cluster headaches involve the abnormal activation of...
The trigeminal autonomic reflex
50
Cluster headaches typically occur, how frequently?
A least 3-4 a day for weeks.
51
Cluster headaches commonly radiates to....
The temporal and maxillary region
52
Associated features of a cluster headache
Lacrimation Rhinorrhea Non-anhidrosis horner syndrome
53
The duration of a cluster headache typically lasts for...
15mins- 3 hours.
54
Cluster headaches can be exacerbated by...
Light (photophobia) Sound (hyperacusis/ phonophobia)
55
What inflammatory marker is elevated in cluster headaches?
ESR
56
Non-pharmacological advice for cluster headaches
Avoid heavy alcohol
57
What is the first-line management of an acute cluster headache
Subcutaneous sumatriptan + high flow 100% oxygen
58
What is the second-line management of an acute cluster headache
Intranasal zolmitriptan
59
What medication is used as prophylaxis for cluster headaches
Verapamil Short-term prednisolone
60
Lithium can be used as prophylaxis for _______
cluster headaches (2nd line)
61
Indications for a CT head in trauma for <16 [5]
NAHI suspicion Seizure (no epilepsy hx) GCS <14 or 15 (in <1 year) GCS <15 after 2 hours Focal neurological deficit
62
Indications for a CT head in trauma for adults
GCS <13 or <15 after 2 hours Open/ depressed skull fracture Seizure Focal neurological deficit >1 vomiting episode
63
Motor, sensory and autonomic innervation of the facial nerve (CN7)
Motor - Muscle of facial expression Sensory - Anterior 2/3 of tongue - External auditory canal - Pinna Autonomic - Salivary glands (sympathetic)
64
Motor, sensory and autonomic innervation of the facial nerve (CN7)
Motor - Muscle of facial expression Sensory - Anterior 2/3 of tongue - External auditory canal - Pinna Autonomic - Salivary glands (sympathetic)
65
Symptoms of Bell's palsy usually peaks...
Within 3 weeks
66
Features of Bell's palsy
Unilateral, complete facial weakness (involves forehead) Reduced lacrimation Hyperacusis Loss of taste in anterior 2/3 tongue
67
Bell's palsy is associated with a history of recent....
Viral illness (HSV especially)
68
Most people make a full recovery for Bell's palsy within...
3-4 months
69
Refferal to a neurologist should be made in Bell's palsy if treatment does not improve symptoms in...
3 weeks.
70
General advise given for Bell's palsy
Eye care: - Lubricating drops - Taping eyes closed when sleeping - Avoiding irritation like dust/ swimming - Wearing sunglasses when outdoors
71
___________ is the first line pharmacological treatment indicated in Bell's palsy
Oral prednisolone
72
Triad for normal pressure hydrocephalus
Abnormal gait Dementia Urinary incontinence
73
Management of normal pressure hydrocephalus
ventriculoperitoneal shunting

402: Neurology and neurosurgery (11 decks)

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