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Pathology > Acute Neurological Issues > Flashcards

Acute Neurological Issues Flashcards

1
Q

What are some symptoms of meningitis?

A

-Headache
-Neck stiffness
-Photophobia
-Fever
-Altered consciousness
-Neurological signs
-Purpuric rash

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2
Q

What are some septicaemia symptoms?

A

-Cold hands
-Fever
-Mottled skin
-Confused
-Low BP
–> can have both or just 1 of meningitis & septicaemia

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3
Q

How is a purpuric rash tested for?

A

Press glass on - will not fade under glass

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4
Q

What is Kernig’s sign - meningitis?

A
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5
Q

What is Brudzinski’s sign - meningitis?

A
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6
Q

What is the emergency treatment plan for meningitis?

A

-Emergency transfer to hospital
-Stabilise A, B & C
-Monitor NEWS score & GCS
-Preadmission antibiotics – record if used e.g., benzylpenicillin (penicillin given IV or intramuscularly)
-Manage sepsis
-Antibiotic treatment – empiric then targeted e.g., ceftriaxone first (= broad spectrum - can then narrow down after gram stain & then culture results)

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7
Q

Why give a patient with possible meningitis a CT scan before lumbar puncture?

A

Do CT 1st if worried about raised intracranial pressure shown by:
-Confusion/drowsiness
-Focal neurological signs
-GCS 12 or less
-Uncontrolled seizures or septic shock
-Presence of papilledema (swelling in top of eyes)
–> but if can do CT 1st then try to!

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8
Q

When should lumbar puncture be performed for meningitis & why?

A

ASAP - to maximise pathogen detection

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9
Q

What other tests can be done other than lumbar puncture for meningitis?

A

-Blood culture/blood PCR meningococcus
-Swabs

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10
Q

What should WBC, RBC & glucose levels be like in lumbar puncture - CSF sample - normal?

A

-5 WBCs
-No RBCs really - can have a few
-Serum/blood vs glucose comparison - CSF glucose levels should be half of serum/blood glucose

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11
Q

What WBC - types of neutrophils, lymphocytes & glucose levels would be seen in lumbar puncture CSF sample - for someone with meningitis?

A

-White cell count (WCC) = over 100 per microlitre - bacterial
-Neutrophils = bacterial
-Lymphocytes = viral
-Relative low CSF glucose - could be bacterial/TB

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12
Q

How can causative pathogens be detected in meningitis?

A

-Gram stain = v. fast & high sensitivity (50-99%)
-Acid stain for TB

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13
Q

What is a problem associated with early broad spectrum treatment for meningitis before has detected the pathogen type?

A

Sensitivity of gram staining CSF decreases by 20% following antibiotic pre-treatment
(But PCR of CSF = v. helpful in pre-treated patients)

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14
Q

Risk factors of acute bacterial meningitis?

A

-Infants, TEENAGERS/YOUNG ADULTS, elderly, pregnant women
-Immunosuppressed
-Smoker, alcoholism, iv drug use, foreign travel
-CSF shunt
-Splenectomy increases risk of encapsulated organisms
-Crowding

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15
Q

Mortality in bacterial meningitis - comparing the types of meningitis & prognosis?

A

-Bacterialmeningitis = serious & notifiable disease
-Some die - can occur in few hours
–> BUT - most recover from bacterial meningitis
-Don’t forget contact tracing

-Complications affect outcome
-Meningococcal sepsis has a higher mortality rate
-Meningococcal meningitis has a lower mortality and morbidity than pneumococcal meningitis
-Tuberculous meningitis a significant risk of death even with treatment
-Viral meningitis much better prognosis

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16
Q

What is the name of meningitis caused by Herpes simplex (HSV1)?

A

Meningoencephalitis/encephalitis

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17
Q

Treatment of meningoencephalitis/encephalitis?

A

Aciclovir - ensure is given early enough so temporal lobe & so memory not affected (or not as much)

18
Q

What is meningoencephalitis/encephalitis?

A

-Inflammation of brain parenchyma associated with neurological dysfunction - e.g., altered state of consciousness, seizures, personality changes, cranial nerve palsies, speech problems, & motor & sensory deficits

-Both the meninges & brain are infected = meningoencephalitis

19
Q

2 types of status epilepticus?

A

-Convulsive
-Non-convulsive

20
Q

What is convulsive status epilepticus?

A

Life-threatening neurological = 5 or more minutes of continuous seizure activity OR repetitive seizures without regaining consciousness between episodes
–> complete loss of awareness with stiff rigid limbs +/- incontinence & tongue biting
-Period of recovery/confusion
-Often focal onset/aura

21
Q

What is non-convulsive status epilepticus?

A

-Loss of consciousness or confusion - BUT without additional involuntary movements
-BUT seizure activity is seen on EEG

22
Q

Causes of status epilepticus?

A

-Epilepsy - refractory fits/non-compliance/alcoholism
-Metabolic problem e.g., low sodium
-Infection
-Recreational drug abuse/drug overdose
-LOW BLOOD SUGAR
-Underlying tumour
-Stroke
-Trauma

23
Q

What are the guidelines for management of convulsive status epilepticus?

A

-Emergency hospital admission, paramedic support
-Buccal midazolam in community if appropriate
-Usually benzodiazepines such as lorazepam in hospital
-Stop seizure if prolonged
-Prevent further seizures
-Identify cause of seizure
-Protocol for treatment (phenytoin, levetiracetam)
-Patient may need ventilation & ICCU care

24
Q

What is thunderclap headache?

A

A headache with a sudden onset of unusual severity reaching maximal intensity in under 1 minute

25
Q

Causes of sudden onset headaches?

A

-Pituitary bleed
-Subarachnoid/intracerebral haemorrhage
-Meningitis/infections
-Cerebral bleed +/- tumour
-Arterial dissection
-Spontaneous CSF leak
-Cerebral venous sinus thrombosis
-Phaeochromocytoma
-RCVS (reversible vasoconstriction)
-Idiopathic/other e.g., coital cephalgia

26
Q

Primary vs secondary headaches?

A

18% of headaches are due to a secondary cause
The rest are primary

27
Q

What are some ‘RED FLAG’ features of headaches

A

-Sudden onset
-Severe enough to wake at night
-Associated vomiting
-Worse in the morning/on coughing/when stooping
-Visual obscurations

28
Q

What is giant cell arteritis?

A

-Systemic inflammatory granulomatous large vessel vasculitis
-Disease of elderly
-More women affected
-Cause unknown

-Inflammation of lining of arteries - often in head - especially in temples
–> so sometimes called temporal arteritis

-Frequently causes headaches, scalp tenderness, jaw pain & vision problems
-Untreated - can lead to blindness!

29
Q

Clinical presentation of giant cell arteritis?

A

-Sudden or insidious
-Non specific : aching, malaise, weight loss, fever, loss appetite
-Headache in 2/3 temporal
-Proximal pain
-Jaw claudication
-Blurred vision then sudden visual loss
-ACHE not WEAKNESS
-Co-existent polymyalgia rheumatica

30
Q

What are some examination findings in giant cell arteritis?

A

-1/2 patients have tender swollen superficial temporal artery
-Check pulses
-Check optic nerve and vision for anterior ischaemic optic neuropathy or retinal vessel occlusion

31
Q

What investigations should be conducted to determine if patient has giant cell arteritis?

A

-ESR usually over 50mm/h (can be normal = 0-15 in men or 0-20 in women)
-CRP
-Temporal artery biopsy
-Colour duplex ultrasonography

32
Q

What are some risks of untreated giant cell arteritis?

A

-Blindness - irreversible
-Stroke/large vessel involvement
-Multi infarct dementia

33
Q

How to treat giant cell arteritis?

A

-TREAT WITH STEROIDS (corticosteroids) start at high dose
-Monitor ESR (erythrocyte sedimentation rate)
-Titrate dose
-Watch for relapses

34
Q

Side-effects of steriods?

A

-Weight gain/obesity
-Osteoporosis - fractures
-Mood changes
-Depression
-Anger

35
Q

How to manage giant cell arteritis?

A

-Goal of GCA treatment = pre­vent further visual loss & systemic sequelae of ischemia
-Steroids high dose (caveats & side effects)

Other treatments :
-Low dose aspirin (= NSAID)
-Methotrexate
-Toclizumab

36
Q

What influences the prognosis for giant cell arteritis?

A

-Fast recognition & treatment
–> should fully recover within days if treated early enough

37
Q

What is acute spinal cord compression?

A

-Caused by a condition that puts pressure on spinal cord
-Symptoms = pain, numbness, or weakness in arms, hands, legs, or feet can come on gradually or more suddenly, depending on cause

–> ANY PATHOLOGY THAT LEADS TO COMPRESSION OF SPINAL CORD

38
Q

What are some causes of acute spinal cord compression?

A

-Trauma/fracture/dislocation
-Tumour – metastatic: breast lung renal carcinoma, prostate thyroid & myeloma & lymphoma
-Epidural abscess and infection e.g., TB
-Disc/spinal stenosis
-Known arthropathy

39
Q

What are some ‘RED FLAGS’ for acute spinal cord compression?

A

-Elderly, major trauma
-Steroids
-Osteoporosis
-Infection – fever, chills, weight loss, recent bacterial infection, immunosuppression, IV drug use
-Pain keeping up at night, unremitting quality
-History of cancer
-Rheumatoid arthritis

40
Q

What is involved in the examination of possible acute spinal cord compression?

A

-Look for UMN pattern weakness
-Reflexes increased
-Sensory level
-Plantars upgoing
-Clonus at ankle
-Sphincter loss/urinary retention
-Nb spinal shock at onset if acute
–> this examination should guide you to site of lesion

41
Q

How is acute spinal cord compression managed?

A

-Urgent MRI (which part of spine to image)
-Contact neurosurgery or spinal team on call?
-High dose steroids/transfer
-Treatment depends on cause – Surgery - Antibiotics – Steroids – Radiotherapy
-Risk if delayed treatment

Pathology (7 decks)

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