1-CNS Flashcards
1
Q
Describe Foster Kennedy Syndrome
A
Anosmia
IL Optic Atrophy
CL Papilledema
Lesion in anterior skull base or frontal lobe
2
Q
What is a Marcus Gunn Pupil?
A
Afferent pupil defect (AFD)
- inturruption of optic pathway prior to chiasm (nerve or retinal disease)
- causes perception of dimming light and consequential pupil dilation
3
Q
What is an Adie Pupil?
A
Tonic UL/BL pupil caused by lesion to the ciliary ganglion.
Poor constriction in response to light.
4
Q
What disease is the Adie pupil associated with?
A
Holmes-Adie syndrome - benign (often familial seen in women)
- Adie pupil with depressed DTRs (often legs), anhidrosis, orthostatic hypotension, cardio autonomic instability
5
Q
What is an argyll robertson pupil?
A
small, irregular pupils, only constrict for accommodation, but not in response to light
Caused by: neurosyphilis, lesion to CNIII descending fibers, EGW nucleus (MS)
6
Q
What should be included in a differential for ptosis?
A
- Autonomics lesion: superior tarsal muscle(partial ptosis)
- CNIII Lesion: levator palpebrae
- NMJ: mysthenia gravis
- Muscular Dystrophy
Could also be a pseudoptosis: redundant skin folds associated with aging.
7
Q
Describe the different manifestations of facial paralysis and their root causes?
A
Full hemi-facial paralysis: LMN symptoms (Bell’s Palsy), peripheral nerve lesion or brainstem below pons
Lower Facial Paralysis: UMN manifestation, forehead spared, lesion above pons
8
Q
Describe the various primitive reflexes?
A
Grasp: stroking palm elicits grasp
Root: stroking cheek elicits nursing response
Snout: strike nose results in suckling response
Suck: touch lips elicits suck response
Palmomental: twitch of chin in response to stroking of palm
Glabellar sign (Myerson): tapping forehead elicits blinking
9
Q
Which primitive reflex is always abnormal/pathologic when seen in adults?
A
grasp
10
Q
What are the most worrisome abnormal physical findings in the elderly?
A
Grasp (alzheimers)
Babinski (UMN)
Tingling/Burning (positive findings are always bad)
Significant negative findings- e.g. weakness
Clumsiness
11
Q
Describe some normal deficits found in the elderly
A
decreased vib sensation
depressed reflexes
some primitive reflexes
12
Q
Describe presbycusis.
Is it a serious worry?
A
Elevated auditory threshold seen in most aging adults due to degeneration of hair cells in the organ of corti.
Not worrisome unless it greatly affects ADLs
13
Q
Word for decreased sensation?
A
Hypoesthesia
14
Q
Word for increased sensation?
A
Hyperesthesia
15
Q
Word for unpleasant, abnormal sensation produced by normal stimulus?
A
Dysesthesia
16
Q
Word for abnormal sensation (burning, prickling, crawling).
A
Paresthesia
17
Q
Describe Guillain-Barre Syndrome
A
acute, idiopathic inflammatory polyneuropathy (primarily demyelinating motor polyneuropathy
ascending paralysis begins in feet. sometimes starts cranially
18
Q
List some clinical features of Guillain-Barre syndrome
A
- Paresthesias (ill-defined back pain, tingling feet)
- Weakness
- Areflexia
- Facial diplegia
- Autonomic instability
19
Q
What is uremic polyneuropathy?
A
“restless legs” - burning, cramping, itching crawling, creeping) –
commonly seen in people with renal failure due to build-up of MW toxins despite dialysis
20
Q
Describe symmetric sensorimotor polyneuropathy.
A
Starts as “Stocking-Glove” neuropathy and then progresses from small fiber to large fiber (diabetic pseudotabes - loss of position sense)
21
Q
What is amyotrophy?
A
Gradually progressive proximal leg weakness. Painful, no sensory loss
22
Q
Describe some of the different possible toxic neuropathies.
A
Arsenic: sensorimotor peripheral polyneuropathy
Lead: wrist drop
Mercury: blindness, peripheral neuropathy
Thallium: alopecia, sensory and autonomic findings
Chemotherapeutics: vincristine, cisplatin, adriamycin.
23
Q
What is the significance of Isoniazid?
A
anti-TB drug
B6 deficiency?
24
Q
Describe Charcot Marie Tooth Disease
A
Inherited muscular atrophy
Type I: Demyelinating, stork leg deformity, foot drop, steppage gait, palpably enlarged nerves, peripheral polyneuropathy.
Type II: not as severe, axonal type, atrophy and polyneuropathy seen
25
What is porphyria?
Recurrent episodes of seizures, psych disturbances, abdominal pain, and motor neuropathy due to abnormal heme metabolism tthat is precipitated by barbituate drugs.
Inherited
26
What is the DDx for recurrent facial mononeuorpathies?
MS
Lyme Disease
Sarcoidosis
27
What is the DDx for bilateral facial mononeuropathies?
```
Giullain-Barre
Myasthenia Gravis
Baal meningitis (TB)
Sarcoidosis
Lyme Disease
```
28
Describe Tic Douloureux and its etiology?
Trigeminal Neuralgia
Sudden onset severe facial pain seen in middle age or later life.
Causes: idiopathic, multiple sclerosis, vascular, tumor
Often mistaken for sinus issues or tooth abscess
29
Define causalgia
trauma to nerve resulting in injury to sympathetic fibers
causes severe burning, dysesthetic pain, sudomotor, vasomotor, and atrophic changes
30
Describe the stages of Reflex Sympathetic Dystrophy.
I (Acute): increased temp, increased hair and nail growth, increased blood flow, rubor, edema, decreased ROM, may last up to 3 months
II(Dystrophic): hyperesthesia, cold intolerance, decreased temp, decreased hair growth, brittle nails, pale limbs, cyanotic, demineralization of bone,
III (Atrophic): decreased pain, hyperesthesia, smooth and glossy skin, muscle wasting, contractures.
31
What is the best course of treatment for Guillain Barre?
supportive care: PT, prevent DVTs (heparin, lovanox), respiratory therapy.
Plasmapharesis, IV IgG (to tone down immune response by flooding the body with antibodies), DO NOT USE STEROIDS
32
What is the best course of treatment for uremic polyneuropathy?
Treat symptoms
Renal Transplant
33
Best course of treatment for alcoholic polyneuropathy?
stop drinking
| improve nutrition
34
What is the best course of treatment for Trigeminal neuralgia?
Meds: phenytoin, carbamazepine, clonazepam, baclofen, lamotrigine
35
Describe the proper course of treatment for reflex sympathetic dystrophy
- sympathetic block (surgical or chemical)
- regional IV meds
- TENs
- NSAIDs, propanolol, nifedipine,reserpine, guanethidine, prednisone, antidepressants, antiarrythmics, anticonvulsants, phenothiazines, gabapentin WTFFFFFFFFFF
36
Guillain Barre syndrome pathology?
Lymphocytic infiltration
Segmental demyelination
Axonal Degeneration
37
List the major motor (muscle disorder) peripheral neuropathies to note?
Guillain Barre
Motor Neuron Disease
Porphyria
Tick Paralysis
38
List the two major Cranial caused peripheral neuropathies
Guillain Barre
| Diptheria
39
Describe Spinal Muscular Atrophy.
Degeneration of anterior horn cells as a result of a deletion gene
40
What are the two common types of spinal muscular atrophy?
Werdinger-Hoffman
Kugelberg-Welander
41
Describe Werdnig-Hoffman disease?
Floppy baby, evident in 1st weeks of life, death within a few years.
Progressive weakness, weak cry, dysphagia, respiratory failure
42
Describe Kugelberg-Welander
onset later in childhood
43
Describe the proper ways to dx a spinal muscular atrophy disorder.
H&P, muscle biopsy, EMG
44
Describe ALS (amyotrophic lateral sclerosis)
Degeneration of CST and anterior horn cells.
45
Describe Syringomelia
chronic progressive tubular cavitation of spinal cord.
Shawl-like pain and temperature loss.
46
What ailment is commonly seeen along with syringomelia?
Arnold-Chiari Malformation - congenital anomaly,
downward elongation of hindbrain into cervical column
Also seen with spina bifida and hydrocephalus
47
List some common causes of Subacute combined degeneration
B12 deficiency, pernicious anemia, myelin loss in the posterior columns
48
Describe Friedriech's Ataxia
Hereditary disease resulting in deficiency in frataxin.
Degeneration of posterior funiculi, lateral CST, Spinocerebellar tracts, dorsal roots, and clarkes column.
49
Describe the clinical features of Friedreichs ataxia.
```
Areflexia
Ataxia
Loss of position sense
Nystagmus
Scoliosis
Pes Cavus
Cardiomyopathy
```
50
Describe conus medullaris syndrome
often occurs with cauda equina syndrome
- paralysis in the saddle region,
51
Describe ASA syndrome
Anterior Spinal Artery Syndrome
Cause by artery disease
Resuting in paralysis and dissociative sensory loss
52
What is the most common CNS tumor in the age group of infancy to adolescence? (0-20)?
Supratentorial: Glioma of cerebral hemisphere (10-14%)
Infratentorial: Astrocytoma (15-20%)
Medulloblastoma (14-18%)
53
What is the most common CNS tumor in the middle aged population (20-60)?
Supratentorial: Glioblastoma (25%), Meningioma (14%), Astrocytoma (13%)
Infratentorial: Metastases (10% -- higher than that),
54
What is the most common CNS tumor in the old aged population (>60)?
Supratentorial: Glioblastoma (35%)
Meningioma (20%)
Metastases (10% -- higher though)
Infratentorial: Acoustic neuroma (20%)
55
What is the etiology of the majority of Extradural spinal cord tumors?
Usually a metastatic carcinoma (breast, prostate, lung, GI), or lymphoma, myeloma, neurofibroma.
56
What is the etiology of extramedullary spinal cord tumors?
Neurofibromas and Meningiomas
57
What is the etiology of the majority of intramedullary spinal cord tumors?
Ependymomas and Gliomas
58
What is the #1 Primary Brain Tumor (meaning it originates in the brain)?
Gliomas (~60%) (incl.---glioblastoma, astrocytomas, ependymomas, medulloblastomas, oligodendrocytomas)
Note: adamant that metastatic carcinomas are far underrepresented due to the research facilities only getting the complex cases
59
Discuss the features of Astrocytomas covered in lecture.
Type of glioma that comprises of nearly 60% of all primary intracranial tumors.
Low and High Grade
- High = glioblastoma multiforme (GBM)
Prognosis is best predicted by necrosis and rate of growth
60
Discuss the details of a brainstem glioma.
Seen MOSTLY in children and young adults.
> CN findings (VI, VII, VIII, IX, X)
> Increased ICP - caused by constricting 4th ventricle drainage
61
Discuss the details of an optic nerve glioma.
Mainly caused by patients with inherited neurofibromatosis causing the abberant growth of gliomas.
Mainly benign, but causes symptoms due to pressure and damage.
Clinical Features: visual, endocrine (pituitary), hydrocephalus (3rd ventricle plumbing)
62
Discuss the major treatment options for gliomas?
Resection, Chemo, Radiation
Genetic, Immune, Viral (depending on causative factors)
VEGF inhibitor
Irinotecan (topoisomerase I inhibitor
63
Discuss the details of oligodendromas
Low percentage of gliomas that affect the frontal lobes
Usually seen in young adults. Well circumscribed tumors easily seen w/ correct imaging
50% of patients have calcifications
64
Why do patients with brain tumors commonly vomit?
Increased Intracranial pressure causes severe papilledema, headaches, and nausea
Irritation to brain tissues can also cause seizures that may be mistaken for encephalitis
65
Discuss the details of medulloblastomas.
Glioma again - Rare Majority are seen in kids (75% of paitients are under 16)
Location: posterior fossa (20-40% of posterior fossa tumors in kids)
Etiology: Usually arises from the fetal external granular layer
66
What is a dangerous characteristic of medulloblastomas that make it unlike most brain tumors?
Leptomeningeal Spread: They commonly break off and spread through the CSF and metastasize to other areas such as the spine.
67
Describe the tricky course of treatment of medulloblastomas?
Must irradiate the entire CNS due to its unique *leptomeningeal spread*
Causes a grave prognosis
68
Discuss the details of ependymomas?
Rare childhood glioma (~10% of intracranial tumors)
Location: middle of brain (4th ventricle, spinal cord, cerebellopontine angle)
Clinical Features: presents with hydrocephalus, focal findings
69
Discuss the details of choroid plexus papillomas
Epithelial in origin, 75% are seen in children 0-10 yrs.
Majority seen in lateral ventricle
70
How do choroid plexus papillomas present?
Discuss Treatment.
Hydrocephalus
Homomynous visual field deficits
Shunting, Resection
71
Discuss the details of acoustic neuromas.
Genetic association? What other neoplasm is associated with this genetic condition?
Represents the majority of tumors in the cerebellopontine angle.
Also associated with neurofibromatosis (w/ optic nerve gliomas and schwannomas)
72
Discuss the clinical features of acoustic neuromas?
```
Hearing loss duh
Tinnitus
Unstady/Dysequilibrium
Headache
CN V and VII findings
```
73
List a good DDx for a tumor in the Cerebellopontine angle.
1. Neuroma (Acoustic (NF)
2. Meningioma (hyperstosis - increased thickness of overlying skull)
3. Papilloma (choroid)
4. Ependymoma (hydrocephalus;location)
5. Cholesteatoma
(Neurofibromatosis)
74
Discuss the details of meningiomas.
Represent 15% of all intracranial tumors
More common in women (60%) due to the fact that these tumors are known to have estrogen receptors in them.
Clinical features depend on location.
75
Describe the look of a intracranial meningioma?
Most common locations?
nodular, can be round or flat (en plaque), well circumscribed like oligodendromas
Parasagittal region and Falx cerebri, Convexity, Sphenoid Ridge, Olfactory Groove, Rarely INtraventricular like in the lecture slides.
76
Discuss the details of Primary CNS Lymphomas.
| Other names?
aka- microglioma, reticulum cell sarcoma
Usually in white matter near ventricle (frontal lobes, cerebellar vermis, corpus callosum, basal nuclei). Sometimes can spread to spinal cord through leptomeningeal spread.
Increased incidence w/ AIDS patients
Poor prognosis, esp. due to risk for opportunistic infections
77
Discuss the details of Pineal Region Tumors.
Not usually primary tumors (originate somewhere else)
Clinical: hydrocephalus, lethargy(compression of reticular formation), vomiting, papilledma.
78
What are some common sources of pineal region tumors?
```
Germ Cell Tumors -- teratoma, germinoma
Metastases
Glioma
Pineocytoma
Pineoblastoma
Meningioma
```
79
Discuss perinaud syndrome and its common causes.
aka dorsal midbrain syndrome: Paralysis of upgaze, convergence/ retraction nystagmus, light-near dissociation.
Caused by: pineal region tumors, MS, Upper brainstem stroke
80
What is light-near dissociation???
Lack of miosis response to bright light (direct or consensual)
With presence of miosis response with accommodation for near vision.
81
Describe the most common diagnostic technique for pituitary tumors
Classified via immunohistochemical staining
They commonly cause endocrine issues by secreting prolactin, HGH, ACTH, TSH, LH, FSH
82
Discuss treatment options for a pituitary region tumor.
Usual tumor treatments
| Bromocriptine (dopamine agonist; shut of prolactin secretion)
83
Describe the DDx for tumors of the pineal/pituitary region.
Craniopharyngiomas
Meningiomas
Aneurysm
84
Discuss the details of craniopharyngiomas.
Derived from retained elements of Rathke's Pouch
~10% of CNS childhood tumors
85
Discuss the clinical features of craniopharyngiomas.
Visual Disturbances
Endocrinopathy
Headaches, Increased ICP, Papilledema
CN palsies
Dx/ via H&P, MRI/CT, Biopsy
86
Discuss the details of Colloid Cysts
An oval or round gelatinous tumor of the 3rd ventricle or the foramen of monroe (anterior)
Derived from fetal paraphysis gland
87
Briefly discuss Von Hippel-Lindau Disease
A hemangioblastoma of the cerebellum
| Associated with polycythemia, retinal angiomas, liver/pancreatic cysts.
88
Why do Von Hippel-Lindau patients have high RBC counts?
The tumor is a hemangioblastoma so it can sometimes secrete erythropoetin which stimulates RBC production.
89
Describe the tissues of origin, common locations, and signs of metastatic carcinomas.
#1 Tumor Found in the Head
25% of patients with cancer develop brain metastasis
Sources: lung, melanoma(50%, breast, renal, GI
90
Discuss the details of leptomeningeal carcinomatosis.
Hematogenous or Direct Extensive Spread of carcinomas.
Can be primary CNS neoplasms or come from distant sites.
Clinical Features: spinal root compression, CNs, Headache, Papilledema, NO FEVER!.
91
What are some things you should think immediately if you hear leptomeningeal carcinomatosis?
Medulloblastoma, glioma, Lymphoma, Lung/Melanoma/Breast metastasis.
92
Discuss the treatment of leptomeningeal carcinomatosis.
Radiation, Chemo Injections
93
What is a paraneoplastic syndrome?
| Discuss some of these conditions.
Diseases or symptoms caused by cancer/tumors in the body. Not mediated via direct contact, rather through hormonal secretions or immune response to the foreign body.
- Limbic Encephalitis
- Subacute Cerebellar Degeneration
- Subacute Motor Neuropathy
- Lambert-Eaton Syndrome
- Dermatomyositis
94
What are some cancers associated with paraneoplastic disorders?
```
Small cell lung
Lymphoma
Ovarian (anit-NMDA receptor)
GI
Testicular
```
95
Describe the criteria for migraines without auras
Without: >5 attacks of headache lasting 4-72 hrs with the following : (photophobia, pulsating, unilateral, nausea, aggravated by physical activity)
96
Describe what an aura is.
Aura is warning sign - caused by irritation of CNV, meninges, or blood vessels.
97
Describe the criteria used to delineate a migraine with aura.
>2 attacks of migraine criteria following a few minute long aura lasting no longer than 1 hour.
98
Define prodrome
Phenomenon of symptoms that precede headache by hours or days.
- Mood Swings
- Stiff Neck
- Chilled Feeling
- Increased Urination
- Anorexia
- Bowel changes
- Food cravings
- Fluid Retention
99
What causes the pain associated with migraines?
Generated by a sterile neurogenic inflammation.
Spreading oligemia (depression of brain structures and vasculature) in the brain from an undetermined cause
CGRP is released upon activation of the 5HTD receptor by something.
CGRP binds vessels and causes the neurogenic inflammation due to vasodilation. Also affects the Trigeminal nucleus which explains referred pain to certain Trigeminal Dermatomes.
100
Discuss some treatment options for migraine headaches and their specifics.
d
101
Discuss Tension headaches.
Steady pressure headache with tightening quality, bilateral location, not aggravated by exertion.
NO NAUSEA or VOMITING
102
What is the criteria for episodic tension-headaches?
at least 10 previous headache episodes
<180 days/year
Headaches can last 30 mins to days
103
Discuss treatment options for tension headaches.
Analgesics, NSIADS, Acetaminophen.
104
Discuss Chronic Tension Headaches and their treatment.
Tension headaches for >15days/month for greater than 6 months.
Give Amitriptyline for chronic cases.
105
What types of things should you be sure to consider before dx of tension headaches?
```
Non-pulsating (r/o migraine)
Stress triggers (big sign of tension)
Neck pain (also sign of tension)
```
106
Most common trigger for migraines?
Stress
| Menstruation
107
Discuss cluster headaches.
>5 attacks of brief headaches (15-180 mins) with excruciating periorbital pain with lacrimation and Rhinorrhea. May induce a horner's.
Usually so bad that the patient paces or pounds fist to head with attack. Could possibly commit suicide.
108
Discuss course of treatment for cluster headaches.
Inhaled Oxygen
| Sumatriptan
109
What are some contraindications for triptan medications?
Hypertension/coronary artery disease
110
What are some contraindications for ergots medications?
Hypertension/Coronary Artery disease
111
What are the contraindications for Topiramate?
Kidney Stones
112
What are some symptomatic treatments for migraine headaches
```
(with 1-2 events a week)
OTC analgesics
NSAIDS (naproxen0
Triptans
Ergots (side effects)
Opiods
Neuroepileptics
```
113
What are some prophylactic treatments for migraines?
```
(with >2 events a week)
Propanolol
Verapamil
SSRIs, TCE (antidepressant)
Topiramate, Valproic Acid (aniconvulsant)
Botox
```
114
What are some symptomatic treatments for cluster headaches
```
Oxygen
Dihydroergotamine
Sumatriptan
Sphenopalatine block
Lidocaine/Capsaicin
Indomethacine
Opiods
```
115
What are some preventative treatments for cluster headaches?
```
Verapamil
Steroids
Lithium
Methylsergide
Valproic Acid
Neuroepileptics
Clonidine
```
116
Discuss treatment options for tension headaches.
Counseling, midrin, fioricet/phrenilin (not for long), antidepressants, PT, OMT
117
Describe serotonin syndrome.
serious, drug related complication.
symptoms range from mild to cardiac arrest.
118
Describe some drug combinations associated with serotonin syndrome.
MAOI + L-tryptophan, TCA, SSRI, Meperidine, Dextromethoprhan
Fluoxetine + L-tryptophan or pentazocine
SSRI + fenfluramine
Sumatriptan + Dexfenfluramine
Antidepressant + Sumatriptan
119
Describe treatment for patients with serotonin syndrome.
Benzodiazepines
Cyproheptadine(kids)
Propanolol (control tachy and BP)
Possibly send to ICU
120
List the major causes of bacterial meningitis.
Neisseria Meningitidis
Haemophilus Influenza (usually immunized now)
Strep Pneumoniae
121
Describe signs and symptoms of meningitis (infants)
```
Bulging Fontanelle
Fever
Irritability
Poor Feeding
Vomiting
Drowsiness
```
122
Most common causes of bacterial meningitis in infants/newborns?
```
Strep B (agal)
E.Coli
```
123
What drug should be given to children with meningitis along with antibiotics?
Dexamethasone to prevent hearing damage
124
What is a key sign of Meningococcal meningitis?
Petechial or Hemorrhagic skin rash
125
What are the major viral infections seen in the CNS?
Meningitis
Encephalitis
Myelitis
Meningoencephalitis
126
What is a tell-tale sign of encephalitis
Seizures
127
What viruses are common causes of encephalitis?
West Nile
EEE, WEE
St. Louis Encephalitis
HSV-1
128
Clinical Presentation of viral encephalitis
Siezures, drowsiness, coma, headache,vomiting
High WBC count, increased CSF pressure on spinal tap
129
Discuss the details of Herpes (HSV1) encephalitis.
Enters brain via trigeminal ganglion or olfactory bulbs (Generally affects frontal or temporal lobe)
Presents with fever, headache, focal signs, agitation, hallucinations, meningeal signs.
130
What is the most common cause of bacterial meningitis in elderly adults?
Pneumococcal meningitis (due to infectious spread from lung, ear, sinus, or skull.)
Also associated with alcoholism, sickle cell, asplenia (important for opsonization)
131
How can staph cause meningitis?
Usually through surgery or endocarditis, can result in abscess or thrombosis of venous sinuses
132
Discuss the details involved with brain abscesses?
Cuased by staph, strep, anaerobes (T. gondii, fungal, M. TB [tuberculoma] in immunocomprimised)
Diagnosis: MRI***
Treat with antibiotics or resection if severe enough
133
How do you differentiate an epidural abscess in dx.?
Radicular symptoms, perforating wound, myelopathy
Lab: inc. sed rate, inc. WBC,
134
What types of patients are often associated with Listeria monocytogenes
Immunocomprimised (Renal, diabetic, transplant recipients, alcoholics)
135
Describe neurosarcoidosis.
Unknown cause
Generalized granulomatous inflammation.
Can affect meninges, CNs, periphery
136
Describe the Dx. of Neurosarcoidosis.
Increased angiotensin converting enzyme, increased serum calcium, negative cultures
137
How would you treat neurosarcoidosis?
Steriods
138
What is cysticercosis? Describe the presentation?
Presentation depends on location. It is caused by Taenia Solium (pork tapeworm)
Can present as prenchymal (focal symptoms), Meningitic (cyst ruptures into CSF), or hydrocephalus (intraventricular)
139
Describe the proper treatment for cysticercosis.
Antibiotics
| Steroids
140
Discuss the details of Toxoplasmosis.
Opportunistic protozoal infection.
Mono (EBV) symptoms
MRI: multiple masses with focal symptoms
141
How would you treat toxoplasmosis
Antibiotics
142
Discuss the details of Creutzfeld-Jakob disease.
RARE - human form of mad cow disease
Rapid dementia, parkinsonian sx, startle response exaggerated
Caused by a prion
EEG has periodic sharp waves,
Elevated 14-3-3 protein
143
Discuss the details of a cryptococcus infection?
Seen in immunocomprimised (HIV/AIDS), usually caught from bird feces
India Ink staining
Fatal if not treated with antifungals
144
What are the normal findings of a spinal tap.
WBC - 0-5
Glucose - 45-85mg/dl
Proteins - 15-45 md/dl
Appear Clear and Colorless
145
Review table on LO pg. 34
LO pg. 34
146
What are some contraindications of a spinal tap?
Focal Skin infection
Increased ICP with mass lesion (risk of herniation)
Platelets 1
147
What are some indications of traumatic tap? (3)
1. RBC/WBC ratio similar to peripheral blood ratio
2. CSF differential similar to blood
3. CSF clears when spun down.
148
What is another possibility along with traumatic tap if there is RBC evidence in the sample?
Subarachnoid Hemorrhage: CSF = yellow/reddish when spun down
