p.13
Stroke: Types, Symptoms, and Management
What symptoms may result from lacunar infarcts?
Pure motor, pure sensory, mixed motor and sensory signs, or ataxia.
p.13
Stroke: Types, Symptoms, and Management
What is a key symptom that differentiates hemorrhagic from ischemic strokes?
Decrease in the level of consciousness, seen in up to 50% of hemorrhagic stroke patients.
p.21
Stroke: Types, Symptoms, and Management
What are common sites for lacunar strokes?
Basal ganglia, thalamus, and internal capsule.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What happens to the brain during a concussion?
The brain moves within the skull, interfering with electrical signals.
p.11
Stroke: Types, Symptoms, and Management
What classification system is used to categorize strokes based on initial symptoms?
The Oxford Stroke Classification (Bamford Classification).
p.36
Management Strategies for Dementia
What is a common management strategy for certain neurological conditions?
Ventriculoperitoneal shunting.
p.21
Stroke: Types, Symptoms, and Management
What is a pure sensory stroke?
A type of stroke that primarily affects sensory functions without motor impairment.
p.1
Definition and Overview of Dementia
What is dementia?
A syndrome involving impairment of multiple higher cortical functions, such as memory, thinking, orientation, comprehension, and language.
p.1
Types of Dementia: Alzheimer's, Vascular, Lewy Body, and Frontotemporal
What is the most common cause of dementia in the UK?
Alzheimer's disease, followed by vascular and Lewy body dementia.
p.30
Diagnosis and Assessment Tools for Dementia
What are signs of focal neurological deficit?
Problems with visual or speech disturbance, balance, muscle power, and paraesthesia.
p.17
Stroke: Types, Symptoms, and Management
What imaging techniques confirm occlusion of the proximal anterior circulation in ischaemic stroke?
Computed tomographic angiography (CTA) or magnetic resonance angiography (MRA).
p.3
Management Strategies for Dementia
What is the second-line treatment for Alzheimer's disease?
Memantine, an NMDA receptor antagonist.
p.20
Stroke: Types, Symptoms, and Management
What is the Oxford Stroke Classification used for?
To classify strokes based on initial symptoms.
p.20
Stroke: Types, Symptoms, and Management
What are the three criteria assessed in the Oxford Stroke Classification?
1. Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg; 2. Homonymous hemianopia; 3. Higher cognitive dysfunction (e.g., dysphasia).
p.22
Stroke: Types, Symptoms, and Management
What is a transient ischaemic attack (TIA)?
A brief period of neurological deficit due to a vascular cause, typically lasting less than an hour.
p.1
Diagnosis and Assessment Tools for Dementia
What MMSE score suggests dementia?
A score of 24 or less out of 30.
p.30
Diagnosis and Assessment Tools for Dementia
What indicates a possible basal skull fracture?
Clear fluid leaking from the ear or nose, periorbital haematoma, bleeding from ears, and Battle's sign.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What are some symptoms of concussion?
Headache, nausea, blurred vision, memory loss, cognitive impairment.
p.22
Stroke: Types, Symptoms, and Management
What is the new definition of a TIA?
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
p.23
Diagnosis and Assessment Tools for Dementia
What neuroimaging technique is preferred by NICE to assess ischaemia or detect haemorrhage?
MRI, including diffusion-weighted and blood-sensitive sequences.
p.17
Stroke: Types, Symptoms, and Management
What conditions must be met to consider thrombectomy for ischaemic stroke?
Confirmed occlusion of the proximal anterior circulation and potential to salvage brain tissue.
p.31
Management Strategies for Dementia
What should be assessed regarding the impact of symptoms?
The impact on daily activities, school, sports, work, driving, and relationships, as well as how carers are coping.
p.10
Diagnosis and Assessment Tools for Dementia
How do symptoms of this condition develop?
Symptoms develop rapidly.
p.15
Stroke: Types, Symptoms, and Management
What may show areas of low density in the brain?
Grey and white matter changes.
p.1
Diagnosis and Assessment Tools for Dementia
What are some assessment tools recommended for diagnosing dementia?
10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT), and the mini-mental state examination (MMSE).
p.34
Diagnosis and Assessment Tools for Dementia
Who is most commonly affected by idiopathic intracranial hypertension?
Young, overweight females.
p.3
Management Strategies for Dementia
What are the first-line pharmacological treatments for mild to moderate Alzheimer's disease?
Acetylcholinesterase inhibitors: donepezil, galantamine, and rivastigmine.
p.34
Diagnosis and Assessment Tools for Dementia
What are some risk factors for idiopathic intracranial hypertension?
Obesity, female sex, pregnancy, and certain drugs.
p.11
Stroke: Types, Symptoms, and Management
What are the three criteria assessed in the Oxford Stroke Classification?
1. Unilateral hemiparesis and/or hemisensory loss of the face, arm & leg; 2. Homonymous hemianopia; 3. Higher cognitive dysfunction (e.g., dysphasia).
p.34
Diagnosis and Assessment Tools for Dementia
What visual disturbances are associated with idiopathic intracranial hypertension?
Blurred vision and enlarged blind spot.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What is a subdural haematoma?
A collection of blood deep between the Dura mater and arachnoid matter of the brain.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What are the three recognized types of FTLD?
Frontotemporal dementia (Pick's disease), Progressive non-fluent aphasia, and Semantic dementia.
p.20
Stroke: Types, Symptoms, and Management
What areas are affected by Lacunar Infarcts (LACI)?
Perforating arteries around the internal capsule, thalamus, and basal ganglia.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
Where is the blood located in a subdural haematoma?
The blood is not within the substance of the brain.
p.34
Management Strategies for Dementia
What role does topiramate play in the management of idiopathic intracranial hypertension?
It inhibits carbonic anhydrase and may cause weight loss.
p.21
Stroke: Types, Symptoms, and Management
What are the common symptoms of a stroke?
Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all three.
p.14
Diagnosis and Assessment Tools for Dementia
What does the FAST screening tool stand for?
Face, Arms, Speech, Time.
p.30
Diagnosis and Assessment Tools for Dementia
What should be assessed regarding cranial nerves in a head injury?
Pupil size and reactivity.
p.24
Management Strategies for Dementia
What should be done if a patient is already taking low-dose aspirin regularly?
Continue the current dose of aspirin until reviewed by a specialist.
p.22
Stroke: Types, Symptoms, and Management
What was the original definition of a TIA?
A sudden onset of a focal neurologic symptom lasting less than 24 hours due to a transient decrease in blood flow.
p.4
Diagnosis and Assessment Tools for Dementia
What criteria does NICE recommend for diagnosing probable vascular dementia?
The NINDS - AIREN criteria.
p.20
Stroke: Types, Symptoms, and Management
What characterizes Partial Anterior Circulation Infarcts (PACI)?
Involves smaller arteries of anterior circulation with 2 of the 3 criteria present.
p.30
Management Strategies for Dementia
What protocols should be followed for trauma management?
Basic and advanced adult or paediatric trauma life support protocols.
p.9
Stroke: Types, Symptoms, and Management
What is a stroke?
A sudden interruption in the vascular supply of the brain.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What microscopic damage may occur in some concussion cases?
Damage to the smallest blood vessels in the brain.
p.3
Management Strategies for Dementia
What does NICE recommend regarding antidepressants for patients with dementia?
NICE does not recommend antidepressants for mild to moderate depression in dementia patients.
p.33
Diagnosis and Assessment Tools for Dementia
What is the most common cause of foot drop?
Common peroneal nerve lesion.
p.4
Management Strategies for Dementia
What are some examples of non-pharmacological management for vascular dementia?
Cognitive stimulation programs, multisensory stimulation, music and art therapy, and animal-assisted therapy.
p.3
Management Strategies for Dementia
When should antipsychotics be used in dementia patients?
Only for patients at risk of harming themselves or others, or when severe distress is caused by agitation, hallucinations, or delusions.
p.13
Stroke: Types, Symptoms, and Management
What are lacunar infarcts?
Small infarcts around the basal ganglia, internal capsule, thalamus, and pons.
p.21
Stroke: Types, Symptoms, and Management
What are lacunar strokes?
Strokes that present with isolated hemiparesis, hemisensory loss, or hemiparesis with limb ataxia.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What are some other causes of concussion?
Road traffic accidents and sports-related accidents.
p.4
Vascular Dementia: Causes, Symptoms, and Diagnosis
What are some symptoms of vascular dementia?
Focal neurological abnormalities, gait disturbance, difficulty with attention and concentration, seizures, memory disturbance, speech disturbance, and emotional disturbance.
p.14
Diagnosis and Assessment Tools for Dementia
What is the purpose of the ROSIER score?
To assess stroke risk in medical professionals.
p.15
Stroke: Types, Symptoms, and Management
What do acute hemorrhagic strokes typically show?
Areas of hyperdense material (blood) surrounded by low density (oedema).
p.4
Diagnosis and Assessment Tools for Dementia
How is vascular dementia diagnosed?
Through a comprehensive history and physical examination, formal screening for cognitive impairment, medical review to exclude medication causes, and MRI scans.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What is frontotemporal lobar degeneration (FTLD)?
The third most common type of cortical dementia after Alzheimer's and Lewy body dementia.
p.24
Management Strategies for Dementia
What should be discussed urgently if aspirin is contraindicated?
Management with the specialist team.
p.15
Stroke: Types, Symptoms, and Management
What may take time to develop in the brain?
Changes in grey and white matter density.
p.17
Stroke: Types, Symptoms, and Management
What is the recommended time frame for offering thrombectomy for ischaemic stroke?
As soon as possible for people last known to be well between 6 hours and 24 hours previously.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What behavioral change may indicate a concussion?
Being slow to get up after hitting their head.
p.1
Management Strategies for Dementia
What tests does NICE recommend for assessing dementia?
FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12, and folate levels.
p.4
Management Strategies for Dementia
What is the main focus of management for vascular dementia?
Symptomatic treatment to address individual problems and provide support to patients and carers.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What chemical changes occur in the brain during a concussion?
Release of chemicals that interfere with normal brain function.
p.36
Management Strategies for Dementia
What are some significant complications associated with ventriculoperitoneal shunting?
Seizures, infection, and intracerebral hemorrhages.
p.21
Stroke: Types, Symptoms, and Management
What is ataxic hemiparesis?
A condition characterized by weakness on one side of the body accompanied by coordination problems.
p.28
Brain Trauma: Concussion and Intracranial Hemorrhages
What is a concussion?
An injury to the brain due to head trauma.
p.15
Stroke: Types, Symptoms, and Management
What does the 'hyperdense artery' sign indicate?
It corresponds with the responsible arterial clot.
p.15
Stroke: Types, Symptoms, and Management
When does the 'hyperdense artery' sign become visible?
It tends to be visible immediately.
p.20
Stroke: Types, Symptoms, and Management
Which arteries are involved in Total Anterior Circulation Infarcts (TACI)?
Middle and anterior cerebral arteries.
p.32
Definition and Overview of Dementia
What is Amyotrophic Lateral Sclerosis (ALS)?
A progressive neurodegenerative disease affecting motor neurons.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What are the main characteristics of FTLD?
Progressive atrophy of the frontal and/or temporal lobes, leading to impairments in behavior, personality, language, and motor functions.
p.22
Stroke: Types, Symptoms, and Management
What are common clinical features of a TIA?
Sudden onset focal neurological deficit that resolves, typically within 1 hour.
p.24
Management Strategies for Dementia
What is the aim of high-intensity statin therapy?
To reduce non-HDL cholesterol by more than 40%.
p.38
Diagnosis and Assessment Tools for Dementia
What anatomical areas should be localized when assessing lesions?
Hemispheres, brain stem, cerebellar, spinal cord, neuromuscular junction, and muscles.
p.30
Diagnosis and Assessment Tools for Dementia
What GCS score indicates a need for immediate hospital transfer?
Less than 15 on initial assessment.
p.24
Management Strategies for Dementia
When is carotid artery endarterectomy recommended?
If the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled.
p.2
Alzheimer's Disease: Pathophysiology and Features
What are some risk factors for Alzheimer's disease?
Increasing age, Caucasian ethnicity, Down's syndrome, family history of Alzheimer's, and 5% of cases inherited as an autosomal dominant trait.
p.34
Management Strategies for Dementia
What is a temporary measure that may be used in the management of idiopathic intracranial hypertension?
Repeated lumbar puncture.
p.19
Management Strategies for Dementia
What is a key aspect of secondary prevention after a stroke?
Addressing risk factors to prevent recurrent strokes.
p.2
Alzheimer's Disease: Pathophysiology and Features
What causes Alzheimer's disease at the cellular level?
A build-up of amyloid protein deposits around brain cells and tau protein tangles within brain cells.
p.16
Management Strategies for Dementia
What medication should be given as soon as possible after ruling out a haemorrhagic stroke?
Aspirin 300mg for 2 weeks.
p.3
Vascular Dementia: Causes, Symptoms, and Diagnosis
What are the main subtypes of vascular dementia?
Stroke-related VD, subcortical VD, and mixed dementia.
p.24
Management Strategies for Dementia
What is the urgent assessment timeframe for a suspected TIA in the last 7 days?
Arrange assessment within 24 hours by a specialist stroke physician.
p.37
Definition and Overview of Dementia
What causes Brown-Sequard syndrome?
Lateral hemisection of the spinal cord.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
How does Semantic Dementia differ from other types of dementia?
Patients have fluent but empty speech that conveys little meaning, with better memory for recent rather than remote events.
p.37
Definition and Overview of Dementia
What are the features of Brown-Sequard syndrome?
Ipsilateral weakness below the lesion, ipsilateral loss of proprioception and vibration sensation, and contralateral loss of pain and temperature sensation.
p.35
Management Strategies for Dementia
What surgical procedures may be needed to prevent damage to the optic nerve?
Optic nerve sheath decompression and fenestration.
p.30
Diagnosis and Assessment Tools for Dementia
What does an inability to rotate the neck 45 degrees suggest?
Possible cervical spine injury.
p.14
Diagnosis and Assessment Tools for Dementia
What is the first line radiological investigation for suspected stroke?
A non-contrast CT head scan.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the recommended treatment for concussion symptoms?
Physical rest, adequate sleep, and mental rest, avoiding reading or screens.
p.11
Stroke: Types, Symptoms, and Management
What arteries are involved in Total Anterior Circulation Infarcts (TACI)?
Middle and anterior cerebral arteries.
p.1
Management Strategies for Dementia
When should antipsychotics be used in dementia patients?
Only for patients at risk of harming themselves or others, or when agitation, hallucinations, or delusions cause severe distress.
p.14
Diagnosis and Assessment Tools for Dementia
What is a key question to determine in stroke investigations?
Whether it is an ischaemic stroke or a haemorrhagic stroke.
p.19
Management Strategies for Dementia
What types of rehabilitation are vital for regaining function post-stroke?
Physical, occupational, and speech therapy.
p.17
Stroke: Types, Symptoms, and Management
What is the NICE recommendation for secondary prevention after ischaemic stroke?
Clopidogrel is recommended ahead of aspirin plus modified-release dipyridamole.
p.31
Management Strategies for Dementia
What symptoms should be managed if they persist for more than 3 months?
Symptoms of anxiety, low mood, flashbacks, and nightmares.
p.38
Diagnosis and Assessment Tools for Dementia
What are some stroke syndromes associated with the brain stem?
Intranuclear ophthalmoplegia.
p.30
Management Strategies for Dementia
What reassurance can be given if no complications are present after a mild head injury?
Symptoms usually resolve within 4 weeks.
p.18
Management Strategies for Dementia
When should a patient with a bleeding disorder or on anticoagulants be admitted?
For imaging to exclude a haemorrhage.
p.33
Diagnosis and Assessment Tools for Dementia
What are some precipitating factors for common peroneal nerve lesions?
Prolonged confinement, recent weight loss, Baker's cysts, and plaster casts to the lower leg.
p.2
Alzheimer's Disease: Pathophysiology and Features
What are the microscopic features of Alzheimer's disease?
Cortical plaques due to type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by tau protein aggregation.
p.16
Management Strategies for Dementia
What should be done if cholesterol levels are greater than 3.5 mmol/l?
Patients should be commenced on a statin.
p.38
Diagnosis and Assessment Tools for Dementia
What is the difference between NCS and EMG?
NCS measures the electrical conduction in nerves, while EMG assesses the electrical activity of muscles.
p.12
Stroke: Types, Symptoms, and Management
What are the symptoms of Weber's syndrome?
Ipsilateral CN III palsy and contralateral weakness.
What are some causes of cerebellar syndrome?
Friedreich's ataxia, neoplastic conditions, multiple sclerosis, alcohol, stroke, hypothyroidism, and certain drugs.
p.12
Stroke: Types, Symptoms, and Management
What symptoms may occur with cerebral hemisphere infarcts?
Contralateral hemiplegia, contralateral sensory loss, homonymous hemianopia, dysphasia.
p.35
Types of Dementia: Alzheimer's, Vascular, Lewy Body, and Frontotemporal
What is Normal Pressure Hydrocephalus?
A reversible cause of dementia seen in elderly patients.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
How can small chronic subdural haematomas without neurological deficits be managed?
Conservatively, with the hope that they will dissolve with time.
p.18
Stroke: Types, Symptoms, and Management
Why is poor blood pressure control in the acute phase of a stroke concerning?
It is associated with worse long-term outcomes.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the management approach for patients with no neurological deficit due to an extradural haematoma?
Cautious clinical and radiological observation.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What are common symptoms of a concussion?
Unsteadiness, confusion, falling over, and ataxia.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What are some red flags indicating a serious condition after a head injury?
Drowsiness, worsening headache, weakness or tingling in limbs, vomiting, amnesia, and collapse/seizures.
p.3
Management Strategies for Dementia
When is memantine recommended for use in Alzheimer's patients?
For moderate Alzheimer's who are intolerant to acetylcholinesterase inhibitors, as an add-on for moderate or severe Alzheimer's, or as monotherapy in severe Alzheimer's.
p.2
Alzheimer's Disease: Pathophysiology and Features
What is Alzheimer's disease (AD)?
A progressive degenerative disease of the brain.
p.34
Management Strategies for Dementia
What management strategies are recommended for idiopathic intracranial hypertension?
Weight loss, carbonic anhydrase inhibitors, and medications like topiramate.
p.23
Diagnosis and Assessment Tools for Dementia
When should a non-contrast CT scan be performed if necessary?
On the same day as the specialist assessment, if possible.
What does the 'D' in the DANISH mnemonic stand for?
Dysdiadochokinesia and Dysmetria.
p.22
Stroke: Types, Symptoms, and Management
What are some possible features of a TIA?
Unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, loss of balance, and visual problems.
p.18
Diagnosis and Assessment Tools for Dementia
What is the typical outcome for patients with transient ischaemic attacks (TIAs) before seeing a doctor?
Most patients' symptoms will have resolved.
p.33
Diagnosis and Assessment Tools for Dementia
What are some possible causes of foot drop?
L5 radiculopathy, sciatic nerve lesion, superficial or deep peroneal nerve lesion, central nerve lesions (e.g., stroke).
p.22
Stroke: Types, Symptoms, and Management
What is amaurosis fugax?
Sudden transient loss of vision in one eye.
p.3
Vascular Dementia: Causes, Symptoms, and Diagnosis
What is vascular dementia (VD)?
The second most common form of dementia, caused by impaired blood flow to the brain due to vascular damage.
p.9
Stroke: Types, Symptoms, and Management
What happens in a haemorrhagic stroke?
A blood vessel 'bursts' leading to a reduction in blood flow.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What are Pick bodies?
Spherical aggregations of tau protein that are silver-staining.
p.17
Stroke: Types, Symptoms, and Management
What is the criteria for recommending carotid artery endarterectomy?
If the patient has suffered stroke or TIA in the carotid territory and has carotid stenosis > 70% according to ECST criteria or > 50% according to NASCET criteria.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What are potential complications of brain injury?
Death, intracranial lesions, skull fractures, seizures, hypopituitarism, depression, PTSD, and cognitive impairment.
p.18
Management Strategies for Dementia
What should be done if a patient has had more than one TIA?
Discuss the need for admission or observation urgently with a stroke specialist.
p.9
Stroke: Types, Symptoms, and Management
What is a thrombotic stroke?
A type of ischaemic stroke caused by thrombosis from large vessels, e.g., carotid.
p.3
Vascular Dementia: Causes, Symptoms, and Diagnosis
How do patients with vascular dementia typically present?
With several months or years of sudden or stepwise deterioration of cognitive function.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
Why is the temporal region particularly vulnerable to extradural haematomas?
The thin skull at the pterion overlies the middle meningeal artery, making it susceptible to injury.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
How do chronic subdural haematomas appear on CT imaging?
Crescentic in shape, not restricted by suture lines, and compress the brain ('mass effect').
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the classical presentation of a patient with an extradural haematoma?
Initially loses, briefly regains, and then loses consciousness after a low-impact head injury.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the density of chronic subdural haematomas compared to brain substance?
They are hypodense (dark) compared to the substance of the brain.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the 'lucid interval' in the context of an extradural haematoma?
The brief regain in consciousness that is lost due to the expanding haematoma.
p.31
Definition and Overview of Dementia
What are examples of conditions related to upper motor neurone lesions?
Ischaemic or haemorrhagic stroke (including brainstem strokes).
p.35
Diagnosis and Assessment Tools for Dementia
What are the classical triad features of Normal Pressure Hydrocephalus?
Urinary incontinence, dementia and bradyphrenia, and gait abnormality.
p.23
Diagnosis and Assessment Tools for Dementia
Under what conditions should non-contrast CT scans not be performed according to NICE?
If the patient is on anticoagulants, has a bleeding disorder, or unless there is clinical suspicion of an alternative diagnosis.
p.30
Management Strategies for Dementia
What is indicated for patients with a head injury and risk factors for cervical spine injury?
Full cervical spine immobilization.
p.19
Management Strategies for Dementia
What should be done with anticoagulants and antithrombotic medications after a stroke?
They should be stopped to minimize further bleeding.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What is post-concussion syndrome?
Symptoms lasting more than a couple of weeks after a concussion.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What are the classifications of subdural haematomas based on age?
Acute, Subacute, and Chronic.
p.38
Diagnosis and Assessment Tools for Dementia
What conditions are associated with lesions in the hemispheres?
Stroke, encephalitis, and temporal seizures.
p.30
Management Strategies for Dementia
What symptoms warrant immediate transfer to the hospital after a head injury?
Shock, loss of consciousness, post-traumatic seizure, amnesia, persistent headache, vomiting, and suspected fractures.
p.18
Management Strategies for Dementia
What immediate treatment does NICE recommend for TIAs?
Immediate antithrombotic therapy, specifically aspirin 300 mg.
p.12
Stroke: Types, Symptoms, and Management
What are the three possible presentations of posterior circulation infarcts?
1. Cerebellar or brainstem syndromes, 2. Loss of consciousness, 3. Isolated homonymous hemianopia.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
What is traumatic brain injury?
A disturbance of normal brain function due to head injury.
p.23
Management Strategies for Dementia
What conditions prevent the immediate administration of aspirin?
If the patient has a bleeding disorder or is taking an anticoagulant.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
What causes a chronic subdural haematoma?
Rupture of small bridging veins within the subdural space resulting in slow bleeding.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What is the chief factor in Progressive Non-Fluent Aphasia (CPA)?
Non-fluent speech with short, agrammatic utterances.
p.38
Diagnosis and Assessment Tools for Dementia
What imaging techniques are key investigations for neurological assessment?
MRI, CT scanning, Nerve conduction studies (NCS), and electromyography (EMG).
p.29
Diagnosis and Assessment Tools for Dementia
What is the Glasgow Coma Scale used for?
To assess the level of consciousness in individuals with head injuries.
p.29
Diagnosis and Assessment Tools for Dementia
What should be included in the assessment of a head injury?
Comprehensive history, examination of consciousness, vital signs, and signs of visible trauma.
p.18
Diagnosis and Assessment Tools for Dementia
What should be done for a suspected TIA that occurred more than a week ago?
Refer for specialist assessment as soon as possible within 7 days.
p.16
Management Strategies for Dementia
What are some criteria for offering thrombolysis for acute ischaemic stroke?
Stroke symptoms onset within 4.5 hours, haemorrhage excluded, and no previous intracranial haemorrhage.
p.38
Diagnosis and Assessment Tools for Dementia
What is the purpose of electroencephalography (EEG)?
To assess electrical activity in the brain, with specific indications and limitations.
p.16
Management Strategies for Dementia
What is mechanical thrombectomy and when should it be offered?
An exciting new treatment option for acute ischaemic stroke, offered as soon as possible within 6 hours of symptom onset.
p.18
Stroke: Types, Symptoms, and Management
What is the aim for blood pressure control in the acute phase of a haemorrhagic stroke?
Maintain blood pressure at <140/80 mm Hg.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What happens as the extradural haematoma expands?
The uncus of the temporal lobe herniates, leading to a fixed and dilated pupil due to compression of the third cranial nerve.
p.37
Definition and Overview of Dementia
What is the pathway of the lateral corticospinal tract?
Decussates in the medulla and travels down to the cord on the ipsilateral side.
p.33
Diagnosis and Assessment Tools for Dementia
What is foot drop a result of?
Weakness of the foot dorsiflexors.
p.4
Management Strategies for Dementia
Why is it important to address cardiovascular risk factors in vascular dementia?
To slow down the progression of the disease.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What are common features of frontotemporal lobar dementias?
Onset before 65, insidious onset, personality change, social conduct problems, and relatively preserved memory and visuospatial skills.
p.9
Stroke: Types, Symptoms, and Management
What are the two main types of strokes?
Ischaemic and Haemorrhagic.
p.16
Management Strategies for Dementia
When should blood pressure not be lowered in the acute phase of stroke management?
Unless there are complications such as hypertensive encephalopathy.
p.23
Diagnosis and Assessment Tools for Dementia
Why should all patients have an urgent carotid doppler?
To check for atherosclerosis in the carotid artery, which may be a source of emboli.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What is a characteristic macroscopic change seen in Pick's disease?
Atrophy of the frontal and temporal lobes.
p.17
Stroke: Types, Symptoms, and Management
When should aspirin plus modified-release dipyridamole be used after an ischaemic stroke?
Only if clopidogrel is contraindicated or not tolerated.
p.31
Management Strategies for Dementia
What should be assessed regarding substance use?
Any issues with alcohol and drug misuse, and offer support as needed.
p.24
Management Strategies for Dementia
What should be done if a patient has had more than 1 TIA ('crescendo TIA')?
Discuss the need for admission or observation urgently with a stroke specialist.
p.2
Alzheimer's Disease: Pathophysiology and Features
What are the macroscopic pathological changes in Alzheimer's disease?
Widespread cerebral atrophy, particularly involving the cortex and hippocampus.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is an extradural (epidural) haematoma?
A collection of blood between the skull's inner surface and the dura mater.
p.11
Stroke: Types, Symptoms, and Management
What are the possible presentations of Lacunar Infarcts (LACI)?
1. Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all three; 2. Pure sensory stroke; 3. Ataxic hemiparesis.
p.31
Definition and Overview of Dementia
Where are lower motor neurone lesions located?
In the anterior horn cell, motor nerve roots, and peripheral motor nerves.
p.19
Stroke: Types, Symptoms, and Management
What is a symptom of a posterior cerebral artery lesion?
Contralateral homonymous hemianopia with macular sparing and visual agnosia.
p.31
Definition and Overview of Dementia
What is the inspection finding for upper motor neurone lesions?
No fasciculations and no significant wasting (some disuse atrophy).
p.19
Stroke: Types, Symptoms, and Management
What syndrome is associated with the posterior inferior cerebellar artery?
Lateral medullary syndrome (Wallenberg syndrome).
p.31
Definition and Overview of Dementia
What is the tone characteristic of lower motor neurone lesions?
Decreased (hypotonia, flaccid) or normal.
p.18
Stroke: Types, Symptoms, and Management
What initial steps may be taken for patients with haemorrhagic strokes?
Neurosurgical evaluation, admission to neuro ICU or stroke unit, and blood pressure control.
p.9
Stroke: Types, Symptoms, and Management
What are common risk factors for strokes?
Age, smoking, hypertension, hyperlipidaemia, and diabetes mellitus.
p.2
Management Strategies for Dementia
What type of therapy does NICE recommend for patients with mild and moderate dementia?
Group cognitive stimulation therapy.
p.35
Diagnosis and Assessment Tools for Dementia
What mnemonic is used to remember the triad of Normal Pressure Hydrocephalus?
Weird (dementia), Wet (urinary incontinence), and Wobbly (abnormal gait).
p.16
Management Strategies for Dementia
What should be maintained within normal limits in the management of acute stroke?
Blood glucose, hydration, oxygen saturation, and temperature.
p.17
Stroke: Types, Symptoms, and Management
What is the recommended treatment for acute ischaemic stroke within 4.5 hours?
Thrombectomy together with intravenous thrombolysis.
p.31
Management Strategies for Dementia
What is advised for a person recovering from symptoms?
To gradually return to normal activities and maintain a regular schedule of activity and sleep.
p.7
Frontotemporal Lobar Degeneration: Types and Symptoms
What characterizes Pick's disease?
Personality change, impaired social conduct, disinhibition, hyperorality, increased appetite, and perseveration behaviors.
p.12
Stroke: Types, Symptoms, and Management
Which arteries are involved in posterior circulation infarcts?
Vertebrobasilar arteries.
p.29
Brain Trauma: Concussion and Intracranial Hemorrhages
How is a head injury defined?
Any trauma to the head other than superficial injuries to the face.
p.4
Management Strategies for Dementia
What should be considered in pharmacological management for vascular dementia?
AChE inhibitors or memantine, but only if there is suspected comorbid Alzheimer's disease, Parkinson's disease dementia, or dementia with Lewy bodies.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
What is a chronic subdural haematoma?
A collection of blood within the subdural space that has been present for weeks to months.
p.22
Stroke: Types, Symptoms, and Management
What visual problems can occur during a TIA?
Diplopia and homonymous hemianopia.
p.11
Stroke: Types, Symptoms, and Management
What type of arteries are involved in Lacunar Infarcts (LACI)?
Perforating arteries around the internal capsule, thalamus, and basal ganglia.
p.19
Stroke: Types, Symptoms, and Management
What symptoms are associated with a middle cerebral artery lesion?
Contralateral hemiparesis and sensory loss, upper extremity > lower, contralateral homonymous hemianopia, and aphasia.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
Who is particularly at risk for chronic subdural haematomas?
Elderly and alcoholic patients due to brain atrophy and fragile bridging veins.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the most common cause of an extradural haematoma?
Almost always caused by trauma, typically low-impact trauma like a blow to the head or a fall.
p.2
Alzheimer's Disease: Pathophysiology and Features
What is the mnemonic to remember the features of Alzheimer's disease?
The '4As': Amnesia, Agnosia, Aphasia, and Apraxia.
p.16
Management Strategies for Dementia
What is thrombolysis and when should it be offered?
Thrombolysis with alteplase should be offered if the stroke is ischaemic and certain criteria are met.
p.38
Diagnosis and Assessment Tools for Dementia
What specialized imaging techniques are mentioned?
CTA, MRA, CTV, MRV, and angiography catheter studies.
p.9
Stroke: Types, Symptoms, and Management
What is a transient ischaemic attack (TIA)?
A subtype of ischaemic stroke with sudden onset of focal neurologic symptoms lasting less than an hour.
p.37
Definition and Overview of Dementia
Where does the spinothalamic tract decussate?
At the level of entry in the anterior commissure.
p.32
Diagnosis and Assessment Tools for Dementia
Which drugs are known to cause peripheral neuropathy?
Amiodarone, metronidazole, isoniazid, nitrofurantoin, and vincristine.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
What is required if a patient with a chronic subdural haematoma is confused or has severe imaging findings?
Surgical decompression with burr holes.
p.37
Definition and Overview of Dementia
What are the effects of a right-sided lateral hemisection of the spinal cord?
Right-sided weakness, right-sided loss of vibration/proprioception, and left-sided loss of pain and temperature.
p.9
Stroke: Types, Symptoms, and Management
What is the essential problem in an ischaemic stroke?
'Blockage' in the blood vessel stops blood flow.
p.16
Management Strategies for Dementia
What is the first step in managing ischaemic strokes?
Urgent neuroimaging to classify the stroke as ischaemic or haemorrhagic.
p.23
Management Strategies for Dementia
What is the immediate antithrombotic therapy recommended by NICE?
Give aspirin 300 mg immediately.
p.33
Diagnosis and Assessment Tools for Dementia
What can cause compression of the common peroneal nerve?
Certain positions such as leg crossing, squatting, or kneeling.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the typical presentation time for subacute and chronic subdural haematomas?
Subacute (within 3 days to 3 weeks) and chronic (>3 weeks).
p.31
Definition and Overview of Dementia
Where are upper motor neurone lesions located?
In the cerebral hemispheres, cerebellum, brainstem, and spinal cord.
p.3
Vascular Dementia: Causes, Symptoms, and Diagnosis
What are some risk factors for vascular dementia?
History of stroke or TIA, atrial fibrillation, smoking, hypertension, hyperlipidaemia, diabetes mellitus, obesity, coronary heart disease, and family history of stroke or cardiovascular issues.
p.33
Diagnosis and Assessment Tools for Dementia
What examination findings suggest isolated peroneal neuropathy?
Weakness of foot dorsiflexion and eversion with normal reflexes.
p.26
Brain Trauma: Concussion and Intracranial Hemorrhages
What is a common presentation of chronic subdural haematoma?
Progressive history of increasing confusion, reduced consciousness, and worsening neurological deficit.
p.7
Management Strategies for Dementia
What does NICE recommend regarding the use of AChE inhibitors or memantine in frontotemporal dementia?
They do not recommend their use.
p.2
Alzheimer's Disease: Pathophysiology and Features
What is Amnesia in the context of Alzheimer's disease?
Recent memories are lost first.
p.19
Stroke: Types, Symptoms, and Management
What are the symptoms of the anterior inferior cerebellar artery lesion?
Ipsilateral facial paralysis and deafness, ataxia, and nystagmus.
p.33
Management Strategies for Dementia
What is the recommended management for peroneal neuropathy?
Conservative management, avoiding leg crossing, squatting, and kneeling.
p.38
Diagnosis and Assessment Tools for Dementia
What specialized blood tests are relevant for neurological conditions?
Acetylcholine receptor antibodies for myasthenia gravis, CK for myositis, and autoimmune antibodies screen for autoimmune encephalitis.
p.35
Types of Dementia: Alzheimer's, Vascular, Lewy Body, and Frontotemporal
What is thought to cause Normal Pressure Hydrocephalus?
Reduced CSF absorption at the arachnoid villi, possibly secondary to head injury, subarachnoid hemorrhage, or meningitis.
p.31
Definition and Overview of Dementia
What are examples of conditions related to lower motor neurone lesions?
Peripheral nerve trauma/compression, spinal muscular atrophy, and amyotrophic lateral sclerosis.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What are common clinical presentations of a subdural haematoma?
Headache, nausea or vomiting, confusion/reduced consciousness, focal neurological signs, and diminished eye, verbal, or motor response.
What does 'N' signify in the DANISH mnemonic?
Nystagmus (horizontal = ipsilateral hemisphere).
p.19
Stroke: Types, Symptoms, and Management
What are the effects of a lesion in the anterior cerebral artery?
Contralateral hemiparesis and sensory loss, with lower extremity > upper.
p.16
Management Strategies for Dementia
When should anticoagulants be started for patients with atrial fibrillation after an ischaemic stroke?
Not until brain imaging has excluded haemorrhage, usually not until 14 days have passed.
p.12
Stroke: Types, Symptoms, and Management
What are the ipsilateral symptoms of lateral medullary syndrome?
Ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy (e.g., Horner's syndrome).
What does 'S' stand for in the DANISH mnemonic?
Slurred staccato speech and scanning dysarthria.
p.18
Diagnosis and Assessment Tools for Dementia
What is the recommended action for a suspected TIA within the last 7 days?
Arrange urgent assessment by a specialist stroke physician within 24 hours.
p.9
Stroke: Types, Symptoms, and Management
What is an embolic stroke?
Usually caused by a blood clot, fat, air, or clumps of bacteria acting as an embolus.
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What does a large acute subdural haematoma cause in the brain?
Mass effect, midline shift, or herniation.
p.33
Diagnosis and Assessment Tools for Dementia
What are indications for specialist referral in foot drop cases?
Bilateral symptoms, fasciculations, or other abnormal neurological findings (e.g., hyperreflexia).
p.25
Brain Trauma: Concussion and Intracranial Hemorrhages
What is a potential management option for large acute subdural haematomas?
Decompressive craniectomy.
p.31
Definition and Overview of Dementia
What reflexes are associated with upper motor neurone lesions?
Exaggerated or brisk (hyperreflexia).
p.12
Stroke: Types, Symptoms, and Management
What severe symptoms can result from brainstem infarction?
Quadriplegia and lock-in syndrome.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
How does an extradural haematoma appear on a CT scan?
As a biconvex (or lentiform), hyperdense collection around the surface of the brain, limited by the suture lines of the skull.
p.35
Diagnosis and Assessment Tools for Dementia
What imaging findings are associated with Normal Pressure Hydrocephalus?
Hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement.
p.35
Management Strategies for Dementia
What types of shunts may be performed to reduce intracranial pressure?
Lumboperitoneal or ventriculoperitoneal shunt.
p.2
Management Strategies for Dementia
What does NICE recommend for non-pharmacological management of Alzheimer's?
Offering a range of activities to promote well-being tailored to the person's preference.
p.27
Brain Trauma: Concussion and Intracranial Hemorrhages
What is the definitive treatment for an extradural haematoma?
Craniotomy and evacuation of the haematoma.
