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Neurology > Stroke + TIA + Facial Nerve palsy > Flashcards

Stroke + TIA + Facial Nerve palsy Flashcards

1
Q

What is a TIA

A

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

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2
Q

When is Aspirin in a stroke contraindicated

A
  1. Patient has a bleeding disorder
  2. Patient is on an anti-coagulant
  3. Patient is already taking a low dose aspirin (cont until specialist review)
  4. Aspirin is contraindicated
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3
Q

What do you do if TIA has occurred in the last 7 days

A
  1. Aspirin 300mg
  2. Urgent assessment from a stroke physician in 24 hours
  3. safety net
  4. Don’t drive
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4
Q

What do you do if TIA has occurred 7 days ago

A
  1. Assessment from a stroke physician within 7 days
  2. Safety net
  3. Don’t drive
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5
Q

Anti-thrombotic therapy used in Ischaemic stroke

A
  1. clopidogrel

2. second line aspirin + dipyridamole

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6
Q

When is carotid endartectomy indicated

A
  1. stroke or TIA in the carotid territory and are not severely disabled
  2. carotid stenosis > 70% according ECST* criteria or > 50% according to NASCET** criteria
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7
Q

What is Bells Palsy

A

acute, unilateral, idiopathic, facial nerve paralysis

20-40 years old, more common in pregnant women

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8
Q

Key features of Bells Palsy

A
  • lower motor neuron facial nerve palsy - forehead affected
  • post-auricular pain (may precede paralysis)
  • altered taste
  • dry eyes
  • hyperacusis
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9
Q

Management of Bells Palsy

A
  • prednisolone 1mg/kg for 10 days within 72 hours of onset

- artificial tears and lubricants

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10
Q

Symptoms of a stroke

A 
Symptoms usually asymmetrical 
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss
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11
Q

Risk factors for stroke

A 
Cardiovascular disease: angina, MI and PVD
Previous stroke or TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
Combined contraceptive pill
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12
Q

What tool is used to identify stroke

A

F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)

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13
Q

What is the ABCD2 Score

A

The ABCD2 score is used for assessing patients with a suspected TIA to estimate their risk of subsequently having a stoke. A higher score suggests a higher risk of stroke within the following 48 hours.

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14
Q

What does the ABCD2 score assess

A

A – Age (> 60 = 1)
B – Blood pressure (> 140/90 = 1)
C – Clinical features (unilateral weakness = 2, dysphasia without weakness = 1)
D – Duration (> 60 = 2, 10 – 60 = 1, < 10 = 0)
D – Diabetes = 1

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15
Q

What is the acute management of stroke

A
  • Admit patients to a specialist stroke centre
  • Exclude hypoglycaemia
  • Immediate CT brain to exclude primary intracerebral haemorrhage
  • Aspirin 300mg stat (after the CT) and continued for 2 weeks
  • Thrombolyse: alteplase
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16
Q

What is alteplase

A
  • tissue plasminogen activator that rapidly breaks down clots and can reverse the effects of a stroke if given in time
  • Needs to be given within 4.5 hours of onset
  • Patients need monitoring for post thrombolysis complications such as intracranial or systemic haemorrhage
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17
Q

What is the Management of a TIA

A
  • aspirin 300mg daily
  • Atorvostatin 80mg
  • Seen by stroke physician within 24 hours, esp. if crescendo
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18
Q

What further investigations may a specialist stroke doctor conduct

A
  • Diffusion weighted MRI

- Carotid Ultrasound

19
Q

What does a carotid ultrasound look at

A

Looks at the amount of carotid stenosis to see whet

20
Q

What is the secondary prevention of stroke

A
  • Clopidogrel 75mg OD
  • Atorvastatin 80mg ( not immediately)
  • Carotid endarterectomy or stenting in patients
  • Treat modifiable RF: HTN and DM
21
Q

Who is included in an MDT for a stroke patient

A 
Nurses
Speech and language (SALT)
Nutrition and dietetics
Physiotherapy
Occupational therapy
Social services
Optometry and ophthalmology
Psychology
Orthotics
22
Q

What is a facial nerve palsy

A
  • Facial nerve palsy refer to isolated dysfunction of the facial nerve
  • typically presents with a unilateral facial weakness
23
Q

What are the 5 terminal branches of the facial nerve

A 
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
24
Q

What is the motor function of the facial nerve

A

Supplies the muscles:

  • Facial expression
  • stapedius in the inner ear
  • posterior digastric
  • stylohyoid
  • platysma muscles
25
Q

What is the sensory function of the facial nerve

A

carries taste from the anterior 2/3 of the tongue.

26
Q

What is the parasympathetic function of the facial nerve

A
  • submandibular & sublingual salivary glands

- lacrimal gland (stimulating tear production).

27
Q

In facial palsy would you expect the forehead to be spared

A

no

28
Q

In stroke, would you expect the forehead to be spared

A

yes

29
Q

What is the prognosis Bells Palsy

A
  • Majority of patients recover fully in a few weeks but can take up to a year
  • 10-15% left with residual symptoms
30
Q

What is the management of Bells Palsy

A
  • Prednisilone within 72 hours on onset
  • lubrication of eyes
  • Tape eye closed over night
31
Q

If patients with Bells Palsy develop eye pain what should you do

A

ophthalmology review for exposure keratopathy.

32
Q

What is Ramsay Hunt syndrome

A
  • unilateral lower motor neurone facial nerve palsy
  • painful and tender vesicular rash in the ear canal and pinna
  • Rash can extend to anterior 2/3 of the tongue and hard palate
33
Q

What is the treatment of Ramsay hunt Syndrome

A
  • Prednisolone
  • Aciclovir
  • lubricating eye drops
    Within 72 hours of onset of pain
34
Q

What infections can cause Lower Motor Neurone Facial Nerve Palsy

A

Otitis media
Malignant otitis externa
HIV
Lyme’s disease

35
Q

What Systemic diseases can cause Lower Motor Neurone Facial Nerve Palsy

A 
Diabetes
Sarcoidosis
Leukaemia
Multiple sclerosis
Guillain–Barré syndrome
36
Q

Which tumours can causeLower Motor Neurone Facial Nerve Palsy

A

Acoustic neuroma
Parotid tumours
Cholesteatomas

37
Q

What trauma can cause Lower Motor Neurone Facial Nerve Palsy

A

Direct nerve trauma
Damage during surgery
Base of skull fractures

38
Q

When should a thrombectomy be performed on a patient with an ischaemic stroke

A

Within 6 hours following onsets of symptoms.

39
Q

Which criteria should be assessed according the oxford stroke classification

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
40
Q

What consists a total anterior stroke (TACI, c. 15%)

A

involves middle and anterior cerebral arteries

all 3 criteria are present

41
Q

Partial anterior circulation infarcts (PACI, c. 25%)

A

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 criteria are present

42
Q

Lacunar infarcts (LACI, c. 25%)

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

43
Q

Posterior circulation infarcts (POCI, c. 25%)

A 
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

Neurology (9 decks)

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