MRCP revision battle 57.1: Stroke thrombolysis

Now we're at utterly last minute topics...

MRCP revision battle 57.1: Stroke thrombolysis
MRCP revision battle 57.2: Cardiac tamponade
MRCP revision battle 57.3: Systemic sclerosis
MRCP revision battle 57.4: Tapeworms
MRCP revision battle 57.5: Brown-Sequard Syndrome
MRCP revision battle 57.6: Trigeminal neuralgia



MRCP revision battle 57.1: Stroke thrombolysis

Contraindications to stroke thrombolysis:

• evidence of intracranial haemorrhage on CT/MRI
• minor neurological defect
• symptoms rapidly improving
• seizures at onset of stroke
• any prior history of stroke and diabetes
• stroke within 3 months
• systolic BP >185 or diastolic BP >110
• hyperglycaemia >25mmol
• weight >15 stones
• platelets <100
• 
  

MRCP revision battle 57.2: Cardiac tamponade

Cardiac tamponade occurs when pericardial fluid collects to a degree that prevents the heart pumping.

On echo you see RA+/- RV collapse during diastle.


The classic triad is Becks:

• falling BP
• rising JVP
• muffled heart sounds

Other possible signs include:

• Kussmauls = rising JVP on inspiration
• pulsus paradoxus
• JVP - loss of y descent, x descent prominant

ECG may show electrical alternanas


Treatment is ugern pericardiocentesis

MRCP revision battle 57.3: Systemic sclerosis

Systemic sclerosis is a connective tissue disease characterised by thickening and fibrosis of skin (scleroderma) and involvement of internal organs.


Female: male 4:1

Commonest in 5th/6th decades


Limited systemic sclerosis = skin involvement is limited to face, hands and feet.
Associated with anti-centromere antibodies in 70-80%

Diffuse systemic sclerosis = more skin involvement
Anti Scl 70 in 40%


Features of sclerosis:

• Raynaulds - 1st presentation in 70% of cases
• arthralgia
• renal failure
• scleroderma
• GI problems
• classical skin presentation:
• telangiectasia
• peri-oral puckering
• smooth shiny skin
• livedo reticularis
• pulmonary fibrosis/hypertension

ESR/CRP are raised


CREST is a type of limited systemic sclerosis:
- calcinosis, raynaulds, eosophageal dysmotility, sclerodalyl, telangectasia
- renal crsis is rare but pulmonary hypertension is common


Linear scleroderma = coup de sabre

Treatment:

• supportive
• d-penicillamine
• steroids if lung disease
• ACE-i to help kidneys

MRCP revision battle 57.4: Tapeworms

Cysticercosis:

• taenia solum - found in pork
• taenia saginata - found in beef
• treatment:albendazole

Hydatid disease
:

• caused by echinococcus
• treatment: albendazole

MRCP revision battle 57.5: Brown-Sequard Syndrome

Brown-Sequard Syndrome is caused by a lesion in one half of the cord.

Commonest cause = MS
Other causes:

• trauma
• tumour
• degenerative disease

Result is:

• ipsilateral UMN weakness below
• increased reflexes
• spastic paralysis
• ipsilateral dorsal column loss
• loss of proprioception and vibration
• contralateral spinothalmic loss
• loss of pain and temperature sensation

MRCP revision battle 57.6: Trigeminal neuralgia

Trigeminal neuralgia is intense stabbing pain in the trigeminal root distribution.

It is unilateral and tends to affect the mandibular or maxillary divisions

Most common in females over 50.


Over 1 in 10 cases will be secondary (to aneuysm, tumour) so ?MRI


Treatment is carbamazepine