Medicine Notes Neurology Notes
Clinically relevant notes covering a broad spectrum of Neurological conditions. Enough depth for the SAQ papers while still containing clinical information and tips for OSCE examinations. More complex conditions are simplified and every condition links back to the history and examination of the patient along with relevant investigations and management. Ideal for both the written and practical exams.
Each subject is colour coded and contains presenting features, aetiology and management....
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Stroke and TIA
Epidemiology
A major neurological disease of our time
100,000 new strokes/year in the UK (1 every 5 minutes)
Accounts for 11% of deaths in the UK (3rd cause of death)
History
Timing
Sudden onset
Usually reaches maximum deficit within an hour
TIA recover quickly (usually within 1hr, up to 24hrs)
Symptoms
Do they fit with a vascular territory?
Face, arms, legs, higher cortical, visual (amaurosis fugax, homonymous hemianopia)
Associated features
May go against a stroke i.e may suggest patient has a stroke mimic
LOC
Weight loss ? cancer
Headache ?migraine ?IOP ?SAH
Vomiting ?migraine ?ICP
Falls, trauma ?subdural
Vascular risk factors such as
Diabetes
Previous stroke/TIA
MI/CABG
Hypertension
Smoking
AF, valve disease
Hypercholesterolaemia
+ve family history
Alcoholism
Clotting/bleeding disorders (antiphospholipid syndrome)
Drug history
PMH
Examination
ABCDE
General exam
Clubbing (? Brain mets)
Splinter haemorrhages (?infective endocarditis)
Tar staining
Pyrexia (? Brain abscess)
Look for signs of
Hyperlipidaemia (corneal arcus, xanthalasma)
Peripheral vascular disease
Diabetes
Hypertension (LVH, proteinuria)
AF
DVT
Pregnancy/post partum
CT diseases (? Antiphospholipid syndrome)
CVS exam (looking for signs of cardiac disease that could cause a cardioembolic stroke
Neuro exam
Does neurology fit in a vascular territory?
If TIA, both symptoms and signs must resolve in 24 hours
Aetiology
Ischaemic
Thrombus (in situ i.e atherosclerosis)
Cardioembolic (AF, MI – ventricular wall thrombus)
Thromboembolic (cartoids)
Haemorrhagic
Raised BP
Anticoagulants
AVM
Tumour
Classification
OCSP (Oxford Community Stroke Project)
TACS = total anterior circulation syndrome
Higher cortical dysfunction e.g dyspraxia, dysphasia, inattention
Hemimotor/sensory loss
Hemianopia
Often cardioembolic (e.g from AF) – Big emboli – blocks internal carotid. 60% dead at 12 months
PACS = partial anterior circulation syndrome
Any combination of two
Or just higher cortical dysfunction
Often embolic – carotid>cardiac
POCS = posterior circulation syndrome
Hemianopia
Cerebellar dysfunction
Eye movement problems (CNIII)
Bilateral motor/sensory deficit
CN palsy +/- contralateral motor/sensory deficit
LACS = lacunar stroke
Pure motor deficit
Pure sensory deficit
Mixed deficit
Often from thrombus in-situ – smaller arteries
Change ‘S’ to ‘I’ (infact) or ‘H’ (haemorrhage) following CT scan
NIHSS (national institutes of health stroke survey) allows monitoring of progress. Barthel index gives indication of person’s independence wit their ADLs
Investigations
Bloods
FBC, U+E, LFT, glucose, lipids, platelets, clotting
Urine dip (proteinuria)
ECG
Carotid USS
CT
Echo? 24 hr tape? Cxr?
Stroke mimics
SAH
SDH
Venous infarcts
Primary/secondary malignancy
Abscesses
Hemiplegic migraine
Functional hemiparesis
Acute assessment
TIA
Is it a TIA?
Lasts mins-hours
Can be up to 24 hours
If >2hrs are they improving?
If definitely a TIA – fax referral to TIA clinic
High risk within a day
Low risk within a week
Start aspirin 300mg and Statin 30mg
Tell them not to drive (DVLA – 1month ban)
Highest risk of stroke in 2 weeks
Risk of subsequent stroke assessed by ABCD2 score
A = age > 60 +1
B = BP >140/90 +1
C = Clinical features – unilateral weakness +2 speech disturbance alone +1
D1 = Duration >60mins +2 <60mins +1
D2 – Diabetes +1
0-3 points = low risk
4-5 points = moderate risk
6-7 points = high risk
Investigations for TIA
CUSS
Bloods:...
Buy the full version of these notes or essay plans and more in our Neurology Notes.
Clinically relevant notes covering a broad spectrum of Neurological conditions. Enough depth for the SAQ papers while still containing clinical information and tips for OSCE examinations. More complex conditions are simplified and every condition links back to the history and examination of the patient along with relevant investigations and management. Ideal for both the written and practical exams.
Each subject is colour coded and contains presenting features, aetiology and management....
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