Part 8

Focal neurodeficit of vascular origin lasting longer than 24 hours 

Focal neurological deficit of vascular origin lasting less than 24 hours 

Two types of stroke 

Amyloid deposition in cortical artery muscle layers 

Typically cause lobar intracerebral haemorrhage and ICH at grey/white border 

Prone to recurrence 

Contraindication for anti-coagulant or platelet therapy as prone to bleeding 

Alzheimers can cause this disease 

Hypertension (RR 5-10x)

Smoking (2x)

Diabetes (2x) 

Hyperlipidaemia (1.5x) 

Most commonly affected artery in strokes 

Left fronto-temporal region 

Involved in speech 

Left parietal temporal region 

Involved in comprehension of speech 

Contralateral hemiparesis (leg more than arm / face)

Cortical signs - emotional changes, dysphasia (left) 

Contralateral hemiparesis - arm/face more than leg 

Cortical signs - Contralateral hemi-neglect and contralateral hemianopia 

Contralateral hemi-sensory loss 

Dysphasia (left)

Contralateral hemianopia 

Contralateral hemi-neglect 

Nausea, vomitting 

Diplopia, vertigo and nystagmus 

Ataxia, hemi/quadriplegia 

Visual field defect 

Coma 

Supplies the cerebellum, brain stem as well as the occipital lobe 

No cortical features 

Pure hemiparesis 

Pure hemi-sensory loss 

Sensorimotor stroke 

Ataxic hemiparesis 

Area recieving little to known blood comprised of rapidly dying cells is known as the... 

What is the penumbra

Imaging used to show a ischaemic stroke immediately 

Greatest benefit of thrombolytic treatment is seen if given within the first how many hours? 

After what hour is there no benefit 

What do we check in a stroke patient given thrombolytic treatment ever 

15mins first 2 hours

30 mins for 6 hours

1hr for 18 hours 

Caudate 

Putamen (lateral) 

Globus pallidus: externa and interna (medial) 

Subthalamic nucleus 

Substantia nigra (compacta and reticulata nuclei) 

(Caudate + putamen = striatum) 

Programmes sequential pattern of movement 

Via timing of individual muscles, sizing at setting amplitude of movement 

Which muscles contract, when and by how much 

Controls body posture 

Complex unconscious and semi-voluntary movements e.g. walking and turning (PD patients have extreme difficulty with turning) 

Also some roles in thinking and executive functions 

Pre-renal, renal or post renal causes for AKI:

Not enough blood supply 

Low BP 

Low blood volume 

Pre-renal, renal or post renal causes for AKI:

Blocked (stone, tumour)

Anything that blocks the kidney below the pelvis will lead to kidney injury due to raised BP 

Pre-renal, renal or post renal causes for AKI:

Damaged glomeruli or tubular cells (voltarol, ibubrofen, Abx) 

Autoimmune disease attacking filtering units 

Interstitium nephritis 

Excretion of metabolites 

Clearance of waste products 

Receptor sites for hormones (ADH, aldosterone, ANP, PTH)

Gluconeogenesis 

Regulation of acid-base state 

Control of water balance 

Production of hormones (renin, vit d, erythropoietin, prostaglandins) 

Symptoms:

Dizzy 

Low BP

ECG: 

Peaked T wave

Wide QRS 

Sine wave

ST-segment elevation 

pH <7.3 

pCO2 low 

pO2 normal to high 

HCO3 low 

Symptoms

Breathlessness / tachypnoeic 

Nausea 

At pH <7.2 - very serious as the heart doesn't work properly 

Retention of metabolic waste (sulphate, urea, ammonia, creatinine, phosphate)

Lining of the organs becomes inflamed:

Pericarditis -> pericardial effusion 

Pleurisy -> pleural effusion 

Encephalopathy -> drowsy, confused to complete comatose 

Thirst is stimulated by osmoreceptors when plasma volume drops by what percentage and when plasma osmolality drops by what percentage?

Normal range of Na 

Promotes loss of Na+ in water and urine 

Dilation of afferent arteriole and constriction of efferent 

Reduce Na reabsorption in DCT 

Inhibit renin 

Inhibits renal sympathetic tone 

Symptoms 

Mild - asymptomatic 

Moderate - Cramps, weakness, nausea

Severe - Lethargy, headache, confusion 

Severe and rapidy evolving - seizures, coma, resp arrest 

Treatment of ? 

Hypovolaemia - correct fluid depletion with IV 0.9% saline 

Euvolaemia - correct underlying cause, fluid retention 

Hypervolemia - underlying cause, fluid restriction (vasopressin receptor antagonists) 

Raise serum levels by 4-6mmol/L over a few hours no more than 8mmol/L a day 

Rapid correction of low levels leads to central pontine myelinolysis 

Thirst 

Anorexia 

Weakness 

Stupor 

Seizures 

Coma