Part 8



Focal neurodeficit of vascular origin lasting longer than 24 hours 

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Focal neurological deficit of vascular origin lasting less than 24 hours 

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Ischaemia (85%) haemorrhagic (15%)

Two types of stroke 

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Amyloid angiopathy

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 

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Risk factors for stroke

Hypertension (RR 5-10x)

Smoking (2x)

Diabetes (2x) 

Hyperlipidaemia (1.5x) 

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Most commonly affected artery in strokes 

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Broca's area

Left fronto-temporal region 

Involved in speech 

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Wernicke's area

Left parietal temporal region 

Involved in comprehension of speech 

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ACA territory

Contralateral hemiparesis (leg more than arm / face)

Cortical signs - emotional changes, dysphasia (left) 

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MCA territory

Contralateral hemiparesis - arm/face more than leg 

Cortical signs - Contralateral hemi-neglect and contralateral hemianopia 

Contralateral hemi-sensory loss 

Dysphasia (left)

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PCA territory

Contralateral hemianopia 

Contralateral hemi-neglect 

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Vertebro basilar territory

Nausea, vomitting 

Diplopia, vertigo and nystagmus 

Ataxia, hemi/quadriplegia 

Visual field defect 


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

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Lacunar stroke (small vessel)

No cortical features 

Pure hemiparesis 

Pure hemi-sensory loss 

Sensorimotor stroke 

Ataxic hemiparesis 

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ischaemic core

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

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Area at risk of infarction but hasn't died yet, ca

What is the penumbra

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Diffuse weighted imaging

Imaging used to show a ischaemic stroke immediately 

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Best within 3 hours. After 6 no benefit

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

After what hour is there no benefit 

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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 

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Basal ganglia nuclei


Putamen (lateral) 

Globus pallidus: externa and interna (medial) 

Subthalamic nucleus 

Substantia nigra (compacta and reticulata nuclei) 

(Caudate + putamen = striatum) 

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Basal ganglia

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 

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

Not enough blood supply 

Low BP 

Low blood volume 

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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 

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

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

Autoimmune disease attacking filtering units 

Interstitium nephritis 

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Functions of the kidneys

Excretion of metabolites 

Clearance of waste products 

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


Regulation of acid-base state 

Control of water balance 

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

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Low BP


Peaked T wave

Wide QRS 

Sine wave

ST-segment elevation 

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Metabolic acidosis

pH <7.3 

pCO2 low 

pO2 normal to high 

HCO3 low 


Breathlessness / tachypnoeic 


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

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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 

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V - 10-15%, osmolality - 1-2%

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

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Normal range of Na 

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Natriuretic peptide

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 

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Mild - asymptomatic 

Moderate - Cramps, weakness, nausea

Severe - Lethargy, headache, confusion 

Severe and rapidy evolving - seizures, coma, resp arrest 

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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 

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