Risk Factors: The two greatest risk factors for stroke are age and hypertension. TIA is basically a stroke that lasts for less than 24 hours, and symptoms resolve within 24 hours. TIA is reversible because there is no actual infarction of the brain cells. A clot resolves, or there's collateral circulation that perfuses the brain enough to save it in time. A key sign for TIA on board exams is amaurosis fugax, which is transient curtain-like blindness from a cholesterol plaque embolizing to the ophthalmic artery. To work up a stroke, the first step is a head CT without contrast. You do a CT without contrast to rule out hemorrhage because contrast is white, and blood in the brain is also white. This helps avoid camouflaging blood with the contrast. The main treatment for an ischemic stroke is TPA, which dissolves the clot but increases the risk of bleeding. A head CT without contrast is done to determine if the stroke is hemorrhagic, which would contraindicate TPA. 85% of strokes are ischemic, and the other 15% are hemorrhagic. The most common place for a stroke is the MCA. TIA- SHOWN BY AMAUROSIS FUGAX NCCT- STROKE(R/O HMG- IF NOT HMG- GIVE TPA), KIDNEY STONE Remember the homunculus: middle parts of the brain along the sagittal suture control the lower extremities, and outer parts control the upper extremities. If there's ischemia in the outer parts of the brain, there will be upper limb paralysis and sensory loss. The left MCA also supplies the language areas of the brain, including Broca's and Wernicke's areas. Broca's area is in the left inferior frontal lobe. Wernicke's area is in the temporal lobe. Left MCA strokes can cause language deficits: Broca's aphasia (expressive aphasia) or Wernicke's aphasia (receptive aphasia). A classic left MCA stroke will present with language deficits and right arm weakness and sensory loss, hyerreflex. Hemorrhagic strokes are often caused by trauma, ruptured berry aneurysm, or arteriovenous malformation. Subarachnoid hemorrhage is associated with the worst headache of someone's life and symptoms of increased intracranial pressure (ICP) like papilledema, nausea, and projectile vomiting. Berry aneurysms -autosomal dominant polycystic kidney disease- surgical clipping. If a subarachnoid hemorrhage is unclear on CT, the next best step is a lumbar puncture, which will show red blood cells (xanthochromia). After diagnosing a stroke, you should work up the source with a carotid Doppler, echo, and EKG. Carotid stenosis can lead to thrombosis, and an echo can reveal wall motion abnormalities predisposing to thrombus formation. An EKG can reveal atrial fibrillation, which increases the risk of thrombus formation and stroke. For atrial fibrillation, the CHADS2 score is used to determine the need for anticoagulation. If chadvas 0 or 1= aspirin, if >=2- warfarin Lacunar strokes affect deep subcortical parts of the brain (basal ganglia, internal capsule, thalamus) and are often caused by hypertension.Lacunar strokes can cause pure motor strokes (internal capsule) or pure sensory strokes (thalamus- VPL). Pure motor strokes cause complete hemiparesis, indicating a lacunar stroke in the internal capsule. The left hemisphere controls language (aphasia), and the right parietal hemisphere controls spatial awareness (hemineglect) Increased ICP can be lowered with hyperventilation(METABOLITES GET WASHED OUT- ARTERIES VASOCONSTRICT- REDUCED ICP), mannitol, and elevating the head of the bed. For ischemic strokes within three hours, TPA is administered. Outside the three-hour window, aspirin is used. For symptomatic carotid stenosis with >70% occlusion, carotid endarterectomy is performed. For
Great Brown Sequard explanation, just remember, the contralateral disfunction( pain and temperature) is 2 to 3 levels below the injured site, the ipsilateral part is exactly at the same level.
Using this video to help cram for my shelf exam today. Your videos are awesome. One thing - IIRC, the "Best you can do" for stroke after 3h (or 4.5 if they don't have a certain laundry list of risk factors including T2DM for tPA) is thrombectomy within 24h for large vessel occlusion and NIHSS > 6
23:50 CPT Brown Sequard (so like contralateral pain and temp, everything else is ipsilateral.) Absolutely love your videos, helped me with my clinical years and exams.
Awesome video, thank you! Just one point I'd like to correct, medications aren't really used in management of BPPV. Rather, it is the particle repositioning maneuvers (e.g. Epley) that are the mainstay of treatment :)
I am a person that had an aneurysm rupture back in March 2022 when it happened I had no simtem whatsoever I just collapsed lucky for me my wife was near by it happened at the back of the head ,I have now fully recovered I find your video very interesting I'm trying to find out all I can to do with the brain. I have found since my medical problem occurred now the brain has become interesting to me
You are amazing. Just a quick correction, we no longer perform the Edrophonium test for MG because of its false positives and we just perform the Antibody tests
This is my favorite of all of your videos, because Goljan cuts off part of Neurology, Emma Holliday never gets to it, and Boards and Beyond requires a subscription/is much longer. Thanks a lot for this!!
Thanks for your video! To your point about doing an echo as part of the stroke work-up, my understanding is that a TTE is done to look for a PFO which would allow for a paroxysmal embolus and would therefore give us a potential etiology for the stroke.
Standardized testing now seems to prefer hypertonic saline for ICP instead of mannitol due to some emerging research showing improved safety and efficacy. Thanks for the great video!
Love that you included pictures. It makes it a lot easier to remember. I also love that you worded it in a question and answer format so on second viewing I played it like a quiz. Edit: one thing though, Graves is diagnosed by checking for serum antibodies against the acetylcholine receptors at the NMJ, not with the edrophonium(tensilon) test
Awesome video, thank you so much for this and all of your other videos! At 22:04, the caption says 'Arnold Chiari Malformation Type 2' and you mention that Syringomyelia is associated. I didn't know if you were talking about Chiari malformations in general or specifically type 2, but I just wanted to add that Syringomyelia is more commonly associated with Type 1 Chiari malformations as opposed to Type 2.
Great video!! Correct me if I’m wrong, but; Xanthochromia Is yellow fluid indicating there is bilirubin present. RBC in the CSF would indicate HSV meningitis.
Thank you for doing this! My CK is next week and if you can do all IM videos that would be sooooooo helpful, especially cardio, heme, ID, GI, resp. I appreciate it!
xanthochromia is not RBCs in the tap, it is yellow fluid in the CSF due to bilirubin breakdown from hemoglobin. This however is not always present so you may actually have high RBCs in the tap with normal other CSF values (normal glucose, protein, WBC)
The girl in the background with her mic ALWAYS on causing feedback, her side conversations, and constantly saying “YEAH” is driving me absolutely insane. EVERY. SINGLE. VIDEO.
Can you clarify MCA vs. ACA. You earlier said that MCA supplies lower extremity, but when you mention L MCA stroke, you stated that it affects the upper extremity. Thanks :)
Hi generally it should follow the homonculus distribution. ACA is medial and will be lower extremity predominant vs MCA which is lateral and will be more upper extremity predominant
I always wonder, why is the word "retardation" funny ? This reminds me of why certain words become politically incorrect for no reason. Pop culture (movies, music) cause medical terms to change for no reason and then (in medicine) we have to learn new terms when there's nothing wrong with the word. It's what in people's minds and how they react that should change.
For myasthenia gravis apart from edrophonium test latest UWorld also has this ice pack test…ptosis improves with placing ice over the eyelid. Can anyone please help me with differentiating between transient synovitis vs systemic juvenile arthritis…i know it isn’t topic from this video but somehow i always get it wrong…thanks in advance.
transient synovitis, likely history of recent viral illness (urti), usg can show joint effusion. systemic jia; rash, hepatosplenomegaly, lymphadenopathy, in addition to arthritis. hope this helps.
Risk Factors: The two greatest risk factors for stroke are age and hypertension.
TIA is basically a stroke that lasts for less than 24 hours, and symptoms resolve within 24 hours. TIA is reversible because there is no actual infarction of the brain cells.
A clot resolves, or there's collateral circulation that perfuses the brain enough to save it in time.
A key sign for TIA on board exams is amaurosis fugax, which is transient curtain-like blindness from a cholesterol plaque embolizing to the ophthalmic artery.
To work up a stroke, the first step is a head CT without contrast.
You do a CT without contrast to rule out hemorrhage because contrast is white, and blood in the brain is also white.
This helps avoid camouflaging blood with the contrast.
The main treatment for an ischemic stroke is TPA, which dissolves the clot but increases the risk of bleeding.
A head CT without contrast is done to determine if the stroke is hemorrhagic, which would contraindicate TPA.
85% of strokes are ischemic, and the other 15% are hemorrhagic.
The most common place for a stroke is the MCA.
TIA- SHOWN BY AMAUROSIS FUGAX
NCCT- STROKE(R/O HMG- IF NOT HMG- GIVE TPA), KIDNEY STONE
Remember the homunculus: middle parts of the brain along the sagittal suture control the lower extremities, and outer parts control the upper extremities. If there's ischemia in the outer parts of the brain, there will be upper limb paralysis and sensory loss.
The left MCA also supplies the language areas of the brain, including Broca's and Wernicke's areas. Broca's area is in the left inferior frontal lobe. Wernicke's area is in the temporal lobe.
Left MCA strokes can cause language deficits: Broca's aphasia (expressive aphasia) or Wernicke's aphasia (receptive aphasia).
A classic left MCA stroke will present with language deficits and right arm weakness and sensory loss, hyerreflex.
Hemorrhagic strokes are often caused by trauma, ruptured berry aneurysm, or arteriovenous malformation.
Subarachnoid hemorrhage is associated with the worst headache of someone's life and symptoms of increased intracranial pressure (ICP) like papilledema, nausea, and projectile vomiting.
Berry aneurysms -autosomal dominant polycystic kidney disease- surgical clipping.
If a subarachnoid hemorrhage is unclear on CT, the next best step is a lumbar puncture, which will show red blood cells (xanthochromia).
After diagnosing a stroke, you should work up the source with a carotid Doppler, echo, and EKG.
Carotid stenosis can lead to thrombosis, and an echo can reveal wall motion abnormalities predisposing to thrombus formation.
An EKG can reveal atrial fibrillation, which increases the risk of thrombus formation and stroke.
For atrial fibrillation, the CHADS2 score is used to determine the need for anticoagulation.
If chadvas 0 or 1= aspirin, if >=2- warfarin
Lacunar strokes affect deep subcortical parts of the brain (basal ganglia, internal capsule, thalamus) and are often caused by hypertension.Lacunar strokes can cause pure motor strokes (internal capsule) or pure sensory strokes (thalamus- VPL).
Pure motor strokes cause complete hemiparesis, indicating a lacunar stroke in the internal capsule.
The left hemisphere controls language (aphasia), and the right parietal hemisphere controls spatial awareness (hemineglect)
Increased ICP can be lowered with hyperventilation(METABOLITES GET WASHED OUT- ARTERIES VASOCONSTRICT- REDUCED ICP), mannitol, and elevating the head of the bed.
For ischemic strokes within three hours, TPA is administered.
Outside the three-hour window, aspirin is used.
For symptomatic carotid stenosis with >70% occlusion, carotid endarterectomy is performed.
For
Great Brown Sequard explanation, just remember, the contralateral disfunction( pain and temperature) is 2 to 3 levels below the injured site, the ipsilateral part is exactly at the same level.
Using this video to help cram for my shelf exam today. Your videos are awesome. One thing - IIRC, the "Best you can do" for stroke after 3h (or 4.5 if they don't have a certain laundry list of risk factors including T2DM for tPA) is thrombectomy within 24h for large vessel occlusion and NIHSS > 6
I wish whoever else was listening to this would mute their mic, the echo effect on it is killing me with headphones on :(
Lolol I think it was a tutoring session
23:50 CPT Brown Sequard (so like contralateral pain and temp, everything else is ipsilateral.)
Absolutely love your videos, helped me with my clinical years and exams.
Probably the best content for medical students and residents on TH-cam.
Awesome video, thank you! Just one point I'd like to correct, medications aren't really used in management of BPPV. Rather, it is the particle repositioning maneuvers (e.g. Epley) that are the mainstay of treatment :)
Agreed. The meclizine is for symptomatic control, which can help patients tolerate Epley maneuver / vestibular PT.
I am a person that had an aneurysm rupture back in March 2022 when it happened I had no simtem whatsoever I just collapsed lucky for me my wife was near by it happened at the back of the head ,I have now fully recovered I find your video very interesting I'm trying to find out all I can to do with the brain. I have found since my medical problem occurred now the brain has become interesting to me
You are amazing.
Just a quick correction, we no longer perform the Edrophonium test for MG because of its false positives and we just perform the Antibody tests
if only shelf and step exams were as up to date as you are
😊😊😊😊😊
It still is tested on step
This is my favorite of all of your videos, because Goljan cuts off part of Neurology, Emma Holliday never gets to it, and Boards and Beyond requires a subscription/is much longer. Thanks a lot for this!!
From the time this video was posted they changed the alteplas window to 3-4.5 hours
Thanks for your video! To your point about doing an echo as part of the stroke work-up, my understanding is that a TTE is done to look for a PFO which would allow for a paroxysmal embolus and would therefore give us a potential etiology for the stroke.
Watched all your vids multiple times on my commute. Great high yield review for shelf/CK. Subscribed & shared. Thanks for creating and sharing!
Elizabeth thanks so much for listening glad you have found it helpful! All the best
Standardized testing now seems to prefer hypertonic saline for ICP instead of mannitol due to some emerging research showing improved safety and efficacy. Thanks for the great video!
This guidance probably changed since this video was posted, so this comment is for my fellow struggle bus neuro studiers!
Hypertonic is also preferred to mannitol in cases of increased ICP AND hypotension, since the diuretic effects can lead to fluid shifts
For tourette, antidopaminergic drugs are first line after habit reversal not clonidine
Love that you included pictures. It makes it a lot easier to remember. I also love that you worded it in a question and answer format so on second viewing I played it like a quiz.
Edit: one thing though, Graves is diagnosed by checking for serum antibodies against the acetylcholine receptors at the NMJ, not with the edrophonium(tensilon) test
Were you meant to say myasthenia gravis?
Awesome video, thank you so much for this and all of your other videos! At 22:04, the caption says 'Arnold Chiari Malformation Type 2' and you mention that Syringomyelia is associated. I didn't know if you were talking about Chiari malformations in general or specifically type 2, but I just wanted to add that Syringomyelia is more commonly associated with Type 1 Chiari malformations as opposed to Type 2.
Jerrin Bawa yes that's correct syringomyelia is more associated with type 1
Nice job. Listened to this right before my neuro shelf, keep up in the good work.
Thanks for commenting and I'm glad it was helpful, all the best with your neuro shelf!
Love your videos. If I do decently on step 2 next week it's at least 25% because of your videos.
That intro was HEAT
Great video!!
Correct me if I’m wrong, but;
Xanthochromia Is yellow fluid indicating there is bilirubin present.
RBC in the CSF would indicate HSV meningitis.
freaking sweet man. take step 3 in 1 week. feel more confident with neuro now. thanks.
This was very helpful for my Neurology rotation exam tomorrow! Great revision :)
The highest of yields bruh. Thank you for your time and effort.
Ashu Agarwal thanks and no problem glad it was helpful
"L I can't remember" hahaha dude there's always one part in every video that makes me laugh out loud
😂
Love your stuff man! You and Emma Holliday.
What a wonderful vid, very quick revision looking forward for others topics plz lets see more videos from you. You Åre a true saviour
ABDULLAHI A. ABDIRASHID thank you for your comment and yes I hope to add more videos soon!
Dr. High Yield I love you man but please don't make another video where you're facetiming. The audio feedback is terrible
He made sure, "she saw this" lol Still Fire tho
Thank you very much for making this - really clear and helpful!
no problem!
Thank you bro. I include you in my prayers at night. fr.
the info is great and everything but can you drop your skin care routine?
Do you believe that i have been listening to your videos more than 100 times
Thank you for doing this! My CK is next week and if you can do all IM videos that would be sooooooo helpful, especially cardio, heme, ID, GI, resp. I appreciate it!
Zero Zero hope it helped on your exam!
xanthochromia is not RBCs in the tap, it is yellow fluid in the CSF due to bilirubin breakdown from hemoglobin. This however is not always present so you may actually have high RBCs in the tap with normal other CSF values (normal glucose, protein, WBC)
The girl in the background with her mic ALWAYS on causing feedback, her side conversations, and constantly saying “YEAH” is driving me absolutely insane. EVERY. SINGLE. VIDEO.
I hate it as well
Hi Dr, can you do a video on very easy approach on CT scan and MRI brains always have hard time learning them and even antibiotics please
I don't know her, but am really starting to hate the lady saying "yeah" after every half sentence in the background.
Great vids! Have u thought about doing one for biostats and ethics?
No mention of cervical spondylosis or lumbar spinal stenosis? Bro I had like 6 questions just on these alone
Thank you very much, very helpful tips
Glad I could help!
12:54 i think this is incorrect. Next best thing would be thrombectomy, not aspirin
I don't get the hyperventilation part. Can someone explain why hyperventilation lowers the ICP? i don't get the logic stated in the video
Remember co2 is a cerebral vasodilator .
So hyperventilation = decreased co2 = vasoconstriction = decreased ICP (hope it helps)
Is the new recommended treatment for Tourette’s VMAT inhibitors?
Fantastic!! Your videos are sooo helpful!! Thanks very much
Can you clarify MCA vs. ACA. You earlier said that MCA supplies lower extremity, but when you mention L MCA stroke, you stated that it affects the upper extremity. Thanks :)
Hi generally it should follow the homonculus distribution. ACA is medial and will be lower extremity predominant vs MCA which is lateral and will be more upper extremity predominant
Amazing job!thank you SOOOO much!
elevated ICP Tx = mannitol or Hypertonic saline
“Yeah!” Someone really excited about what “yeah, yeah” he is saying “yeah”
Hey can you allow the download option for this video! Thanks
What are those parrot sounds in the background?
David Ash oh it might be feedback or my gf haha
Is neurofibromatosid high yield?
Ur RX lectures helped me so much in pre clinicals my dude
Incredible, thank you
love all your vids great stuff
Thank you for your videos Very Helpful
you're the best!
Great effort bro, thanks!
Thank you so much for this video!!
A. S. No problem haha
Thank you !
Which song is in beginning
You did a great job
you are amazing thank u so much
Absence doesn't have postictal state
Thanks again and thanks again
You are amazing, thanks
Thank you so much!
Sorry the Link does not work anymore
Thank you!!!
Excellent 👍🏻
thanks so much man!
great video as always, that viewer should have muted though - pretty distracting
really good!!!
Anna thank you!
Amazing
♥️♥️
21:50 lol its ok
I always wonder, why is the word "retardation" funny ? This reminds me of why certain words become politically incorrect for no reason. Pop culture (movies, music) cause medical terms to change for no reason and then (in medicine) we have to learn new terms when there's nothing wrong with the word. It's what in people's minds and how they react that should change.
Thx
For myasthenia gravis apart from edrophonium test latest UWorld also has this ice pack test…ptosis improves with placing ice over the eyelid. Can anyone please help me with differentiating between transient synovitis vs systemic juvenile arthritis…i know it isn’t topic from this video but somehow i always get it wrong…thanks in advance.
transient synovitis, likely history of recent viral illness (urti), usg can show joint effusion. systemic jia; rash, hepatosplenomegaly, lymphadenopathy, in addition to arthritis. hope this helps.
Does anyone else hear this girl talking randomly?
I’m thinking this is from a private tutoring group?
dopeness
The chick saying “yEaH” to everything is so annoying
Yeah
Not only you save my lufe but you are good looking
Thank you so much!!!!