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43 Cards in this Set
- Front
- Back
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Cerebellar signs
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gait and posture - rebound overshoot, broad atactic gait
past pointing and intention tremor course horizontal nystagmus halting, jerky dysarthria |
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Types of tremor
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postural tremor (physiological)
resting tremor coarse tremor |
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enhanced postural tremor - causes
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anxiety, caffeine
drugs valproate, lithium, sympathom alcohol essential tremor mercury poisoning |
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LMN signs
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weakness
wasting (after 3 weeks) hypotonia reflex loss fasciculation (contracture, trophic changes in long term) |
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LMN causes
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CN - bell's palsy, motor neuron disease, polyomyelitis
spinal - disc prolapse trauma mononeuritis multiplex entrapment |
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Biceps reflex - spinal level?
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C5-6
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Triceps - spinal level?
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C7
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Knee - spinal level?
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L3-4
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Ankle - spinal level?
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S1
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Lhermitt's sign
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electric-shock sensation down trunc and limbs on flexion of neck
cervical spine lesion (MS, SCDC) |
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loss of pain and temperature with a clear level below. Light touch preserved - where is the lesion?
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spinothalamic tract
syringomylia |
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progressive spastic paraparesisi
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spinal cord compression
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numbness in one leg and weakness in the other
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Brown-Sequard syndrome
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how does the patient describe thalamic pain?
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deep-seated, burning pain
high morbidity! suicide risk |
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CSF - normal values
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Pressure 6-15
Cell count <5 No polymorphs, mononuclear cells only Protein 0.2-.4g/L glucose 1/3-1/2 of serum |
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Other causes that may clinically mimick (microembolic) TIA
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sudden loss of perfusion pressure
rarely subdural or tumor |
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sources of thrombembolism
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carotid artery
cardiac (valvular, mural) aorta |
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effects of stopping smoking on stroke risk
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50% in one year
normalised in 5 years |
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effects of statin on stroke risk
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30% risk reduction
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rare risk factors of stroke
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polycythaemia
anti-phospholipid syndrome endocarditis vasculitis COX-II inhibitors, cocain, vasoconstricting nasal sprays |
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within which boundaries does cerebral autoregulation work?
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60-12mmHg MAP
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Amourosis fugax - which territory?
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anterior circulation
internal carotid artery stenosis |
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Transient global amnesia
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posterior circulation
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TIA - which embolic sources should be considered?
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carotid artery bruit
atrial fibrillation valvular heart disease/endocarditis recent myocardial infarction differences right and left brachial BP |
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Prognosis after a TIA in regards to further cardiovascular events
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30% develop stroke in 5 years
15% have MI |
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stroke syndrome with neck pain
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think carotid/vertebral artery dissection
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brainstem infarction which vessel
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PICA
posterior inferior cerebellar artery vertigo and cerebellar signs with other signs (depending on location) |
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hypertensive encephalopathy - features
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high BP
headache, stroke/TIA, papilloedema, SAH sometimes |
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multiinfarct dementia - features
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stepwise deterioration in intellectual function
shuffling gait with small steps pseudobulbar palsy |
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When are ischaemic strokes detectable on CT scan?
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usually at 1 week
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Which imaging can visualise ischaemic stroke the earliest?
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Diffusion-weighted MRI - within minutes of onset
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BP management after stroke
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transient hypertension normal
no urgent treatment unless diastolic BP >100 |
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indications for anticoagulants rather than antiplatelets after stroke
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atrial fibrillation
valvular heart disease (esp. mitral stenosis) recent MI - intracardiac thrombus Arterial dissection cerebral venous thrombosis recurrent TIAs on maximal antiplatelets |
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headache and rapid reduction of consciousness, nystagmus, ocular palsies, gaze deviation. Lesion and cause?
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cerebellar haemorrage
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Causes of SAH
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70% saccular aneurysms
10% AVM 20% no lesion found |
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Associations with intracranial aneurysms
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APKD
marfan's, ehlers-danlos coarcation of the aorta |
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common sites of intracranial aneurisms
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posterior communicans
anterior communicans middle cerebral artery |
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AVM - what is the prognosis in terms of rebleeds?
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once bled, 10% will rebleed annually
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SAH urgent management once confirmed
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control BP
nimodipine MRA to identify aneurysm surgery if <65 and not comatose |
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SDH clinical symptoms
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headache, drowsyness and confusion
often fluctuating (trivial)head trauma at risk: alcoholics and eldery |
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Extradural bleeding symptoms
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head trauma
initial LOC then lucid interval then stupor, hemiparesis ipsilateral dilated then contralateral dilated pupil then respiratory arrest |
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ocular pain, proptosis and chemosis. External and internal ophtalmoplegia with papilloedema
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sinus vein thrombosis
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sinus vein thrombosis - management
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MRI/MRA to confirm
heparin then warfarin for 6/12 |
