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Neurological System > 1-CNS > Flashcards

1-CNS Flashcards

1
Q

Describe Foster Kennedy Syndrome

A

Anosmia
IL Optic Atrophy
CL Papilledema
Lesion in anterior skull base or frontal lobe

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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
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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.

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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
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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)

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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.

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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

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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

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9
Q

Which primitive reflex is always abnormal/pathologic when seen in adults?

A

grasp

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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

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11
Q

Describe some normal deficits found in the elderly

A

decreased vib sensation
depressed reflexes
some primitive reflexes

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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

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13
Q

Word for decreased sensation?

A

Hypoesthesia

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14
Q

Word for increased sensation?

A

Hyperesthesia

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15
Q

Word for unpleasant, abnormal sensation produced by normal stimulus?

A

Dysesthesia

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16
Q

Word for abnormal sensation (burning, prickling, crawling).

A

Paresthesia

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17
Q

Describe Guillain-Barre Syndrome

A

acute, idiopathic inflammatory polyneuropathy (primarily demyelinating motor polyneuropathy

ascending paralysis begins in feet. sometimes starts cranially

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18
Q

List some clinical features of Guillain-Barre syndrome

A
  • Paresthesias (ill-defined back pain, tingling feet)
  • Weakness
  • Areflexia
  • Facial diplegia
  • Autonomic instability
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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

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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)

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21
Q

What is amyotrophy?

A

Gradually progressive proximal leg weakness. Painful, no sensory loss

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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.

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23
Q

What is the significance of Isoniazid?

A

anti-TB drug

B6 deficiency?

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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

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25
Q

What is porphyria?

A

Recurrent episodes of seizures, psych disturbances, abdominal pain, and motor neuropathy due to abnormal heme metabolism tthat is precipitated by barbituate drugs.

Inherited

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26
Q

What is the DDx for recurrent facial mononeuorpathies?

A

MS
Lyme Disease
Sarcoidosis

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27
Q

What is the DDx for bilateral facial mononeuropathies?

A 
Giullain-Barre
Myasthenia Gravis 
Baal meningitis (TB)
Sarcoidosis
Lyme Disease
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28
Q

Describe Tic Douloureux and its etiology?

A

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

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29
Q

Define causalgia

A

trauma to nerve resulting in injury to sympathetic fibers

causes severe burning, dysesthetic pain, sudomotor, vasomotor, and atrophic changes

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30
Q

Describe the stages of Reflex Sympathetic Dystrophy.

A

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.

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31
Q

What is the best course of treatment for Guillain Barre?

A

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

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32
Q

What is the best course of treatment for uremic polyneuropathy?

A

Treat symptoms

Renal Transplant

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33
Q

Best course of treatment for alcoholic polyneuropathy?

A

stop drinking

improve nutrition

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34
Q

What is the best course of treatment for Trigeminal neuralgia?

A

Meds: phenytoin, carbamazepine, clonazepam, baclofen, lamotrigine

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35
Q

Describe the proper course of treatment for reflex sympathetic dystrophy

A
  • sympathetic block (surgical or chemical)
  • regional IV meds
  • TENs
  • NSAIDs, propanolol, nifedipine,reserpine, guanethidine, prednisone, antidepressants, antiarrythmics, anticonvulsants, phenothiazines, gabapentin WTFFFFFFFFFF
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36
Q

Guillain Barre syndrome pathology?

A

Lymphocytic infiltration
Segmental demyelination
Axonal Degeneration

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37
Q

List the major motor (muscle disorder) peripheral neuropathies to note?

A

Guillain Barre
Motor Neuron Disease
Porphyria
Tick Paralysis

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38
Q

List the two major Cranial caused peripheral neuropathies

A

Guillain Barre

Diptheria

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39
Q

Describe Spinal Muscular Atrophy.

A

Degeneration of anterior horn cells as a result of a deletion gene

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40
Q

What are the two common types of spinal muscular atrophy?

A

Werdinger-Hoffman

Kugelberg-Welander

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41
Q

Describe Werdnig-Hoffman disease?

A

Floppy baby, evident in 1st weeks of life, death within a few years.

Progressive weakness, weak cry, dysphagia, respiratory failure

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42
Q

Describe Kugelberg-Welander

A

onset later in childhood

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43
Q

Describe the proper ways to dx a spinal muscular atrophy disorder.

A

H&P, muscle biopsy, EMG

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44
Q

Describe ALS (amyotrophic lateral sclerosis)

A

Degeneration of CST and anterior horn cells.

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45
Q

Describe Syringomelia

A

chronic progressive tubular cavitation of spinal cord.

Shawl-like pain and temperature loss.

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46
Q

What ailment is commonly seeen along with syringomelia?

A

Arnold-Chiari Malformation - congenital anomaly,

downward elongation of hindbrain into cervical column

Also seen with spina bifida and hydrocephalus

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47
Q

List some common causes of Subacute combined degeneration

A

B12 deficiency, pernicious anemia, myelin loss in the posterior columns

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48
Q

Describe Friedriech’s Ataxia

A

Hereditary disease resulting in deficiency in frataxin.

Degeneration of posterior funiculi, lateral CST, Spinocerebellar tracts, dorsal roots, and clarkes column.

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49
Q

Describe the clinical features of Friedreichs ataxia.

A 
Areflexia
Ataxia
Loss of position sense
Nystagmus
Scoliosis
Pes Cavus
Cardiomyopathy
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50
Q

Describe conus medullaris syndrome

A

often occurs with cauda equina syndrome

  • paralysis in the saddle region,
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51
Q

Describe ASA syndrome

A

Anterior Spinal Artery Syndrome

Cause by artery disease
Resuting in paralysis and dissociative sensory loss

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52
Q

What is the most common CNS tumor in the age group of infancy to adolescence? (0-20)?

A

Supratentorial: Glioma of cerebral hemisphere (10-14%)

Infratentorial: Astrocytoma (15-20%)
Medulloblastoma (14-18%)

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53
Q

What is the most common CNS tumor in the middle aged population (20-60)?

A

Supratentorial: Glioblastoma (25%), Meningioma (14%), Astrocytoma (13%)

Infratentorial: Metastases (10% – higher than that),

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54
Q

What is the most common CNS tumor in the old aged population (>60)?

A

Supratentorial: Glioblastoma (35%)
Meningioma (20%)
Metastases (10% – higher though)

Infratentorial: Acoustic neuroma (20%)

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55
Q

What is the etiology of the majority of Extradural spinal cord tumors?

A

Usually a metastatic carcinoma (breast, prostate, lung, GI), or lymphoma, myeloma, neurofibroma.

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56
Q

What is the etiology of extramedullary spinal cord tumors?

A

Neurofibromas and Meningiomas

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57
Q

What is the etiology of the majority of intramedullary spinal cord tumors?

A

Ependymomas and Gliomas

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58
Q

What is the #1 Primary Brain Tumor (meaning it originates in the brain)?

A

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

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59
Q

Discuss the features of Astrocytomas covered in lecture.

A

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

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60
Q

Discuss the details of a brainstem glioma.

A

Seen MOSTLY in children and young adults.

> CN findings (VI, VII, VIII, IX, X)

> Increased ICP - caused by constricting 4th ventricle drainage

61
Q

Discuss the details of an optic nerve glioma.

A

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
Q

Discuss the major treatment options for gliomas?

A

Resection, Chemo, Radiation

Genetic, Immune, Viral (depending on causative factors)

VEGF inhibitor

Irinotecan (topoisomerase I inhibitor

63
Q

Discuss the details of oligodendromas

A

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
Q

Why do patients with brain tumors commonly vomit?

A

Increased Intracranial pressure causes severe papilledema, headaches, and nausea

Irritation to brain tissues can also cause seizures that may be mistaken for encephalitis

65
Q

Discuss the details of medulloblastomas.

A

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
Q

What is a dangerous characteristic of medulloblastomas that make it unlike most brain tumors?

A

Leptomeningeal Spread: They commonly break off and spread through the CSF and metastasize to other areas such as the spine.

67
Q

Describe the tricky course of treatment of medulloblastomas?

A

Must irradiate the entire CNS due to its unique leptomeningeal spread

Causes a grave prognosis

68
Q

Discuss the details of ependymomas?

A

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
Q

Discuss the details of choroid plexus papillomas

A

Epithelial in origin, 75% are seen in children 0-10 yrs.

Majority seen in lateral ventricle

70
Q

How do choroid plexus papillomas present?

Discuss Treatment.

A

Hydrocephalus
Homomynous visual field deficits

Shunting, Resection

71
Q

Discuss the details of acoustic neuromas.

Genetic association? What other neoplasm is associated with this genetic condition?

A

Represents the majority of tumors in the cerebellopontine angle.

Also associated with neurofibromatosis (w/ optic nerve gliomas and schwannomas)

72
Q

Discuss the clinical features of acoustic neuromas?

A 
Hearing loss duh
Tinnitus
Unstady/Dysequilibrium
Headache
CN V and VII findings
73
Q

List a good DDx for a tumor in the Cerebellopontine angle.

A
  1. Neuroma (Acoustic (NF)
  2. Meningioma (hyperstosis - increased thickness of overlying skull)
  3. Papilloma (choroid)
  4. Ependymoma (hydrocephalus;location)
  5. Cholesteatoma
    (Neurofibromatosis)
74
Q

Discuss the details of meningiomas.

A

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
Q

Describe the look of a intracranial meningioma?

Most common locations?

A

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
Q

Discuss the details of Primary CNS Lymphomas.

Other names?

A

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
Q

Discuss the details of Pineal Region Tumors.

A

Not usually primary tumors (originate somewhere else)

Clinical: hydrocephalus, lethargy(compression of reticular formation), vomiting, papilledma.

78
Q

What are some common sources of pineal region tumors?

A 
Germ Cell Tumors -- teratoma, germinoma
Metastases
Glioma
Pineocytoma
Pineoblastoma
Meningioma
79
Q

Discuss perinaud syndrome and its common causes.

A

aka dorsal midbrain syndrome: Paralysis of upgaze, convergence/ retraction nystagmus, light-near dissociation.

Caused by: pineal region tumors, MS, Upper brainstem stroke

80
Q

What is light-near dissociation???

A

Lack of miosis response to bright light (direct or consensual)

With presence of miosis response with accommodation for near vision.

81
Q

Describe the most common diagnostic technique for pituitary tumors

A

Classified via immunohistochemical staining

They commonly cause endocrine issues by secreting prolactin, HGH, ACTH, TSH, LH, FSH

82
Q

Discuss treatment options for a pituitary region tumor.

A

Usual tumor treatments

Bromocriptine (dopamine agonist; shut of prolactin secretion)

83
Q

Describe the DDx for tumors of the pineal/pituitary region.

A

Craniopharyngiomas
Meningiomas
Aneurysm

84
Q

Discuss the details of craniopharyngiomas.

A

Derived from retained elements of Rathke’s Pouch

~10% of CNS childhood tumors

85
Q

Discuss the clinical features of craniopharyngiomas.

A

Visual Disturbances
Endocrinopathy
Headaches, Increased ICP, Papilledema
CN palsies

Dx/ via H&P, MRI/CT, Biopsy

86
Q

Discuss the details of Colloid Cysts

A

An oval or round gelatinous tumor of the 3rd ventricle or the foramen of monroe (anterior)

Derived from fetal paraphysis gland

87
Q

Briefly discuss Von Hippel-Lindau Disease

A

A hemangioblastoma of the cerebellum

Associated with polycythemia, retinal angiomas, liver/pancreatic cysts.

88
Q

Why do Von Hippel-Lindau patients have high RBC counts?

A

The tumor is a hemangioblastoma so it can sometimes secrete erythropoetin which stimulates RBC production.

89
Q

Describe the tissues of origin, common locations, and signs of metastatic carcinomas.

A

1 Tumor Found in the Head

25% of patients with cancer develop brain metastasis
Sources: lung, melanoma(50%, breast, renal, GI

90
Q

Discuss the details of leptomeningeal carcinomatosis.

A

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
Q

What are some things you should think immediately if you hear leptomeningeal carcinomatosis?

A

Medulloblastoma, glioma, Lymphoma, Lung/Melanoma/Breast metastasis.

92
Q

Discuss the treatment of leptomeningeal carcinomatosis.

A

Radiation, Chemo Injections

93
Q

What is a paraneoplastic syndrome?

Discuss some of these conditions.

A

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
Q

What are some cancers associated with paraneoplastic disorders?

A 
Small cell lung
Lymphoma
Ovarian (anit-NMDA receptor)
GI
Testicular
95
Q

Describe the criteria for migraines without auras

A

Without: >5 attacks of headache lasting 4-72 hrs with the following : (photophobia, pulsating, unilateral, nausea, aggravated by physical activity)

96
Q

Describe what an aura is.

A

Aura is warning sign - caused by irritation of CNV, meninges, or blood vessels.

97
Q

Describe the criteria used to delineate a migraine with aura.

A

> 2 attacks of migraine criteria following a few minute long aura lasting no longer than 1 hour.

98
Q

Define prodrome

A

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
Q

What causes the pain associated with migraines?

A

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
Q

Discuss some treatment options for migraine headaches and their specifics.

A

d

101
Q

Discuss Tension headaches.

A

Steady pressure headache with tightening quality, bilateral location, not aggravated by exertion.

NO NAUSEA or VOMITING

102
Q

What is the criteria for episodic tension-headaches?

A

at least 10 previous headache episodes

<180 days/year

Headaches can last 30 mins to days

103
Q

Discuss treatment options for tension headaches.

A

Analgesics, NSIADS, Acetaminophen.

104
Q

Discuss Chronic Tension Headaches and their treatment.

A

Tension headaches for >15days/month for greater than 6 months.

Give Amitriptyline for chronic cases.

105
Q

What types of things should you be sure to consider before dx of tension headaches?

A 
Non-pulsating (r/o migraine)
Stress triggers (big sign of tension)
 Neck pain (also sign of tension)
106
Q

Most common trigger for migraines?

A

Stress

Menstruation

107
Q

Discuss cluster headaches.

A

> 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
Q

Discuss course of treatment for cluster headaches.

A

Inhaled Oxygen

Sumatriptan

109
Q

What are some contraindications for triptan medications?

A

Hypertension/coronary artery disease

110
Q

What are some contraindications for ergots medications?

A

Hypertension/Coronary Artery disease

111
Q

What are the contraindications for Topiramate?

A

Kidney Stones

112
Q

What are some symptomatic treatments for migraine headaches

A 
(with 1-2 events a week)
OTC analgesics
NSAIDS (naproxen0
Triptans
Ergots (side effects)
Opiods 
Neuroepileptics
113
Q

What are some prophylactic treatments for migraines?

A 
(with >2 events a week)
Propanolol
Verapamil
SSRIs, TCE (antidepressant)
Topiramate, Valproic Acid (aniconvulsant)
Botox
114
Q

What are some symptomatic treatments for cluster headaches

A 
Oxygen 
Dihydroergotamine
Sumatriptan
Sphenopalatine block 
Lidocaine/Capsaicin
Indomethacine
Opiods
115
Q

What are some preventative treatments for cluster headaches?

A 
Verapamil
Steroids
Lithium 
Methylsergide
Valproic Acid
Neuroepileptics
Clonidine
116
Q

Discuss treatment options for tension headaches.

A

Counseling, midrin, fioricet/phrenilin (not for long), antidepressants, PT, OMT

117
Q

Describe serotonin syndrome.

A

serious, drug related complication.

symptoms range from mild to cardiac arrest.

118
Q

Describe some drug combinations associated with serotonin syndrome.

A

MAOI + L-tryptophan, TCA, SSRI, Meperidine, Dextromethoprhan

Fluoxetine + L-tryptophan or pentazocine

SSRI + fenfluramine

Sumatriptan + Dexfenfluramine

Antidepressant + Sumatriptan

119
Q

Describe treatment for patients with serotonin syndrome.

A

Benzodiazepines
Cyproheptadine(kids)
Propanolol (control tachy and BP)

Possibly send to ICU

120
Q

List the major causes of bacterial meningitis.

A

Neisseria Meningitidis
Haemophilus Influenza (usually immunized now)
Strep Pneumoniae

121
Q

Describe signs and symptoms of meningitis (infants)

A 
Bulging Fontanelle
Fever
Irritability 
Poor Feeding
Vomiting
Drowsiness
122
Q

Most common causes of bacterial meningitis in infants/newborns?

A 
Strep B (agal)
E.Coli
123
Q

What drug should be given to children with meningitis along with antibiotics?

A

Dexamethasone to prevent hearing damage

124
Q

What is a key sign of Meningococcal meningitis?

A

Petechial or Hemorrhagic skin rash

125
Q

What are the major viral infections seen in the CNS?

A

Meningitis
Encephalitis
Myelitis
Meningoencephalitis

126
Q

What is a tell-tale sign of encephalitis

A

Seizures

127
Q

What viruses are common causes of encephalitis?

A

West Nile
EEE, WEE
St. Louis Encephalitis
HSV-1

128
Q

Clinical Presentation of viral encephalitis

A

Siezures, drowsiness, coma, headache,vomiting

High WBC count, increased CSF pressure on spinal tap

129
Q

Discuss the details of Herpes (HSV1) encephalitis.

A

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
Q

What is the most common cause of bacterial meningitis in elderly adults?

A

Pneumococcal meningitis (due to infectious spread from lung, ear, sinus, or skull.)

Also associated with alcoholism, sickle cell, asplenia (important for opsonization)

131
Q

How can staph cause meningitis?

A

Usually through surgery or endocarditis, can result in abscess or thrombosis of venous sinuses

132
Q

Discuss the details involved with brain abscesses?

A

Cuased by staph, strep, anaerobes (T. gondii, fungal, M. TB [tuberculoma] in immunocomprimised)

Diagnosis: MRI***

Treat with antibiotics or resection if severe enough

133
Q

How do you differentiate an epidural abscess in dx.?

A

Radicular symptoms, perforating wound, myelopathy

Lab: inc. sed rate, inc. WBC,

134
Q

What types of patients are often associated with Listeria monocytogenes

A

Immunocomprimised (Renal, diabetic, transplant recipients, alcoholics)

135
Q

Describe neurosarcoidosis.

A

Unknown cause
Generalized granulomatous inflammation.
Can affect meninges, CNs, periphery

136
Q

Describe the Dx. of Neurosarcoidosis.

A

Increased angiotensin converting enzyme, increased serum calcium, negative cultures

137
Q

How would you treat neurosarcoidosis?

A

Steriods

138
Q

What is cysticercosis? Describe the presentation?

A

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
Q

Describe the proper treatment for cysticercosis.

A

Antibiotics

Steroids

140
Q

Discuss the details of Toxoplasmosis.

A

Opportunistic protozoal infection.

Mono (EBV) symptoms

MRI: multiple masses with focal symptoms

141
Q

How would you treat toxoplasmosis

A

Antibiotics

142
Q

Discuss the details of Creutzfeld-Jakob disease.

A

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
Q

Discuss the details of a cryptococcus infection?

A

Seen in immunocomprimised (HIV/AIDS), usually caught from bird feces

India Ink staining

Fatal if not treated with antifungals

144
Q

What are the normal findings of a spinal tap.

A

WBC - 0-5
Glucose - 45-85mg/dl
Proteins - 15-45 md/dl
Appear Clear and Colorless

145
Q

Review table on LO pg. 34

A

LO pg. 34

146
Q

What are some contraindications of a spinal tap?

A

Focal Skin infection
Increased ICP with mass lesion (risk of herniation)
Platelets 1

147
Q

What are some indications of traumatic tap? (3)

A
  1. RBC/WBC ratio similar to peripheral blood ratio
  2. CSF differential similar to blood
  3. CSF clears when spun down.
148
Q

What is another possibility along with traumatic tap if there is RBC evidence in the sample?

A

Subarachnoid Hemorrhage: CSF = yellow/reddish when spun down

Neurological System (10 decks)

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