Cerebrovascular and diseases of consciousness Flashcards
1
Q
What does a proto-oncogene mutation result in?
A
Results in promotion of cell division
2
Q
What does a tumour suppressor gene mutation result in?
A
Results in loss of inhibition of cell division
3
Q
What does a mutation of isocitrate dehydrogenase lead to?
A
Excessive build-up of 2-Hydroxyglutarate
Genetic instability in glial cells and subsequent inappropriate mitosis – leading to cancer
4
Q
Description of grade I brain tumour
A
Slow growing
Least malignant
E.g. astrocytoma, craniopharyngioma
5
Q
Description of grade II brain tumour
A
Slowly growing
Slightly abnormal appearance
May spread to nearby tissue
6
Q
Description of grade III brain tumour
A
Malignant
Grow into nearby structures
Tend to recur
7
Q
Description of grade IV brain tumour
A
Most malignant
Rapidly reproduce
Necrotic core
E.g. glioblastoma
8
Q
Describe a glioblastoma
A
Type of astrocytoma
Grade IV
Occur in cerebral hemispheres
Prognosis <1yr
9
Q
Describe a meningioma
A
Benign
Form under the dura mater
Grade I-III
10
Q
Describe a oligodendroglioma
A
Form in the frontal lobes of the cerebral cortex
Grade II-III
IDH-1 mutation positive
7-10 years prognosis
11
Q
Describe a craniopharyngioma
A
Form in the sellar region from remnants of Rathke’s pouch
Grade 1
Benign
12
Q
Symptoms of raised ICP
A
Headache Drowsiness Nausea, vomiting Papilloedema 3rd, 4th, 6th nerve palsies Dilated pupils
13
Q
Describe the headache that you would get with raised ICP
A
Worse on waking from sleep in the morning
Pain increases by coughing, straining, bending forwards
Relieved by vomiting
14
Q
Symptoms with a tumour on the cerebellum
A
DASHING
Dysdiadochokinesis Ataxia Slurred speech Hypotonia Intention tremor Nystagmus Gait abnormality
15
Q
Diagnosis of brain tumours
A
CT with contrast and MRI (high grade tumours have irregular edges)
Biopsy via skull burr hole to determine cancer grade
16
Q
Treatment of brain tumours
A
Surgery to remove mass
Chemotherapy (Temozolomide, PCV)
Radiotherapy for 6 weeks (for high grade)
Oral dexamethasone for oedema
17
Q
What is the primary use of EEG?
A
To diagnose epilepsy using inter-ictal and ictal recordings
18
Q
What does a spike and wave on an EEG show?
A
Epileptiform discharge
19
Q
Describe the Theta wave on EEG
A
4-7Hz
Normal physiological rhythm – seen frontally/frontocentral
Increases in drowsiness, focussed concentrations, hyperventilation
20
Q
Describe the Alpha wave on EEG
A
8-12Hz Occipital Blocked with mental activity, and anxiety Abnormal if seen in front Drowsiness can reduce alpha by 1hz Alpha can be slow up to 7 yrs of age
21
Q
Describe the Delta wave on EEG
A
< 4Hz
In a normal awake routine adult should only occupy <10% of the EEG
More in babies and elderly
22
Q
Describe the Beta wave on EEG
A
Fast, 13Hz –20 Hz
Seen in drugs, esp. benzos / diazepam
Frontally
23
Q
What is the hyperventilation technique in an EEG used to induce?
A
Childhood absence epilepsy
24
Q
5 variables that can affect an EEG
A
Age of px Artifacts Conscious levels Drugs Co-existent cerebral pathology
25
Symptoms of West's syndrome
3-12 months of age
| Epileptic spasms, hypsarrhythmia, regression
26
Symptoms of Juvenile myoclonic epilepsy
5-34yrs
Myoclonic jerk <1sec
In mornings
Eye closure sensitivity – in 3 secs will see generalised spike and wave
27
What is epilepsy?
A recurrent tendency to spontaneous, intermittent, abnormal electrical and neuronal activity in part of the brain manifesting as a transient occurrence of signs and symptoms
28
Pathophysiology of epilepsy?
Fast/long lasting activation of glutamate NMDA receptors
OR
Genetic mutations of GABA receptors so cannot inhibit signals
29
Causes of epilepsy
```
2/3 are idiopathic
Cortical scarring
Space occupying lesion
Stroke
Alcohol withdrawal
Dementia
```
30
Symptoms of a prodrome
Lasting hours or days
| Change of mood/behaviour
31
Symptoms of an aura
Patient is aware
| Deja vu / strange smells / flashing lights / hallucinations / fear
32
Symptoms of the post-ictal period
Headache, confusion, myalgia, sore tongue
Todd’s paralysis
Dysphasia
33
Diagnostic test for epilepsy
At least 2 or more unprovoked seizures occurring > 24hrs apart
OR
One seizure AND >60% chance that further seizures in the next 10 years (predisposition on MRI – stroke, tumour, encephalomalacia or EEG)
34
1st line drug for generalized seizures
Sodium valporate
If pregnant / woman of childbearing age then:
Lamotrigine
Carbamazepine
Levetiracetam
35
1st line drug for absence seziures
Ethosuximide
36
1st line drug for focal seizures
Carbamazepine
37
Criteria for medically intractable epilepsy
Reliable diagnosis
Need to be affecting quality of life – disabling seizures
2 drugs for 2 years need to be tried first
38
What is the driving guidelines for epilepsy?
Have to be free of seizures for 1 year
| If coming off medications – no driving for 6 months after withdrawing from antiepileptics
39
What is status epilepticus?
Convulsive seizures >30 mins or multiple seizures without recovery of consciousness
40
Acute causes of status epilepticus
```
Stroke
Metabolic abnormalities
Hypoxia
Infections
Drug overdoses
```
41
Chronic causes of status epilepticus
Low conc. of AED
Alcohol misuse
Tumour
42
Pathophysiology of continued status epilepticus
GABA inhibitory receptors start to internalise and are no longer available
Glutamate and NMDA receptors lead to continued excitement
43
Potency of benzodiazepines reduces by ___ in ____ minutes in status epilepticus
20x
| 30 mins
44
Symptoms of non-convulsive status epilepticus
Seizures activity on EEG without clinical findings of generalised convulsive status epilepticus
Wandering confused, automatisms
Acutely ill, obtunded +/- motor abnormalities
Anorexia, aphasia / mutism, amnesia, catatonia, coma, confusion, lethargy, and staring
Agitation / aggression
Automatisms, blinking, facial twitching
Delusions, echolalia, laughter, nausea/vomiting
Nystagmus/eye deviation
Psychosis
45
Complications of status epilepticus
```
Airway obstruction, hypoxia, injury
Increased CNS metabolic consumption
Rhabdomyolysis
Renal failure – acute tubular necrosis
Metabolic acidosis
Hyperthermia
Major organ failure
Cerebral oedema
```
46
In status epilepticus if the px is fitting for >5 min what do you give them?
Benzodiazepine (lorazepam / diazepam)
47
In status epilepticus if the px is fitting for >10 min what do you give them?
IV PHENYTOIN 18mg/kg (max rate 50kg /min)
OR
IV LEVETIRACETAM 30mg/kg (infuse over 10 mins)
OR
IV SODIUM VALPROATE 30mg/kg (infuse over 5 mins)
OR
IV PHENOBARBITAL 10mg/kg (max rate 100mg / min)
48
In status epilepticus if the px is fitting for >30 min what do you give them?
Anaesthesia with paralysing drug e.g. suxamethonium and ICU admission
49
What are the differential diagnosis for epilepsy?
Epileptic seizure
Syncope
Psychogenic nonepileptic seizure (NEAD)
50
What is syncope?
Reversible loss of consciousness due to short-term inadequate blood flow to the brain - transient global cerebral hypoperfusion
51
Symptoms of vasovagal syncope
Pallor, sweating, nausea
They know they are going to pass out
Lack of post-ictal confusion, hearing people around you before you can respond
52
Causes of orthostatic hypotension
Volume depletion - haemorrhage, vomiting, diarrhoea
| Autonomic failure - parkinson's, old age
53
Drop in what blood pressure suggests postural hypotension?
20mmHg systolic / 10mmHg diastolic
54
Symptoms of NEAD
Wax/wane, pelvic thrusting, crying / screaming, thrashing, sometimes responsive, self-harm
Resemble epileptic seizures, but without ictal cerebral discharges; asynchronous movements
Unaware and unresponsive
Emotionally labile
Minimal confusion
55
Investigations for transient loss of consciousness
12 lead ECG
| Neuroimaging
56
What is a stroke?
Rapid onset of neurological deficit caused by infarction. Characterised by rapidly developing signs of global disturbance lasting >24hrs or death
57
Risk factors for stroke?
```
Male
Black or Asian
Hypertension
Past TIA
Smoking
Diabetes mellitus
Increasing age
Heart disease
Alcohol
Polycythaemia, thrombophilia
AF
Hypercholesterolaemia
Combined oral contraceptive pill
Vasculitis
Infective endocarditis
```
58
Ischaemic causes for stroke
Thrombosis - large artery disease
Cardiac emboli
Lacunar infarct - small artery disease
Hypoperfusion - sudden drop in BP by more than 40mmHg
59
Causes of haemorrhagic stroke
```
Cerebral amyloid angiopathy (main)
Trauma
Aneurysm rupture
Carotid artery dissection
Anticoagulation
```
60
Causes for strokes in young people
```
Vasculitis
Thrombophilia
Subarachnoid haemorrhage
Carotid / vertebral artery dissection
Venous sinus thrombosis
Recreational drugs
```
61
What is the TOAST classification for stroke?
1. Large-artery atherosclerosis
2. Cardioembolism
3. Small-vessel occlusion
4. Stroke of other determined aetiology
5. Stroke of undetermined aetiology
62
Symptoms of a ACA stroke
```
Leg weakness
Truncal ataxia
Incontinence
Akinetic mutism
Drowsiness
```
63
Symptoms of a MCA stroke
```
Contralateral arm and leg weakness
Hemianopia
Aphasia
Dysphasia
Facial droop
```
64
Symptoms of a PCA stroke
Contralateral homonymous hemianopia
Unilateral headache
Visual agnosia
Colour naming and discriminate problems
65
Symptoms of a brainstem / cerebellum infarct
```
Locked in syndrome
Hemiparesis
Facial paralysis
Dysarthria and speech impairment
Vertigo, nausea and vomiting
Visual disturbance
Altered consciousness
```
66
Symptoms of a lacunar stroke
Unilateral weakness
Pure sensory loss – thalamus
Ataxic hemiparesis – pontine lesion
Dysarthria / clumsy hand - pons, internal capsule
67
First line investigation for stroke
Urgent CT head / MRI (diffusion weighted imaging)
68
When are carotid dopplers done in stroke?
The px is relatively well after stroke
If surgery is needed
If anterior circulation affected
69
Describe the thrombolysis treatment for stroke
Given upto 4.5hrs post onsent of symptoms
1. Tissue plasminogen activator - IV ALTERPLASE 0.9mg/kg
2. Then antiplatelet therapy - CLOPIDOGREL / ASPIRIN 24hrs after thrombolysis
3. Repeat CT scan after 24hrs
70
Contraindications for thrombolysis
```
Recent surgery last 3 months
History of active malignancy
INR >1.7
Severe liver disease
Head trauma <3 months
Recent MI <6 weeks
NHISS score <4
Large hypodense area on MRI (>1/3 of MCA territory)
```
71
How do you treat stroke if time of onset is unknown?
ASPIRIN 300 mg daily for 2 weeks then lifelong CLOPIDOGREL 75mg
72
How do you reverse warfarin in haemorrhagic stroke?
Beriplex and vitamin K
73
When would you do a thromboectomy?
Needs to be a large vessel occulsion
| 6hrs for ACA, 2hrs for basilar
74
What is malignant MCA syndrome and how do you treat it?
Occurs when cell death causes swelling, pushing on brain and reducing GCS. Treated with decompressive hemicraniectomy
75
In ischaemic stroke when would you give statins? What statins would you give?
If cholesterol is >3.8
| Simvastatin 40mg or storvastatin 80mg
76
What platelet treatment would you give to prevent further strokes?
ASPIRIN 300mg 14 days/discharge then switch to CLOPIDOGREL 75mg (long-term prophylaxis)
77
What should INR be when on warfarin?
2-3
78
What does the CHADS2VaSc score measure? List what it stands for
Measures stroke risk in patients with AF
```
Congestive heart failure
Hypertension
Age > 75yrs (2)
Diabetes
Prior stroke / TIA (2)
Vascular disease
Age 65-74
Female sex
```
79
At what score on the CHADS2VaSc risk scale would you give warfarin?
2
80
What does the HASBLED score measure and what does it stand for?
Risk of bleeding with anticoagulation
```
Hypertension
Abnormal renal or liver function
Stroke
Bleeding
Labile INRs
Elderly (>65yrs)
Drugs or alcohol
```
81
List three factors important in the mechanism of stroke recovery
Adaptation
Regeneration
Neuroplasticity
82
What is the difference between primary and secondary headache?
Primary - no underlying cause relevant to the headache
| Secondary - there is an underlying cause
83
Clinical presentation of tension headache?
```
Episodic
Bilateral temporal pain
Pressing / tight
Mild / moderate intensity
Scalp muscle tenderness
Not aggravated by activity
No nausea / vomiting
```
84
Treatment of tension headache?
Pain medication
Tricyclic antidepressants
Stress relief; avoid triggers
85
Triggers of migraine?
```
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult (loud noise)
Exercise
```
86
Clinical presentation of migraine?
Unilateral pounding/pulsating pain lasting 4-72hrs
Visual / somatosensory aura
Nausea / vomiting
Photophobia / phonophobia
87
Treatment of migraine
Sumatriptan
NSAIDs
Propranolol
88
Clinical presentation of cluster headaches?
Headache ‘clusters’ of 8-10x a day, lasts 15mins-3hrs
Shooting / stabbing around one eye / temple / forehead; can wake from sleep
Horner's syndrome
89
Clinical presentation of Horner's syndrome?
Miosis
Ptosis
Anhidrosis
90
Treatment of cluster headaches?
Acute attack - sumatriptan
| Verapamil as first line prophylaxis
91
Clinical presentation of trigeminal neuraglia headaches?
```
Unilateral
Paroxysmal attacks 1sec-2mins
Severe intensity
Electric shock like
Precipitated by innocuous (non-harmful) stimuli
```
92
Treatment of trigeminal neuraglia headaches?
Oral carbamazepine
| Surgery (microvascular decompression; gamma knife surgery)
93
Clinical presentation of drug overdose headache
Headache present on ≥ 15 days / month
| Regular use for >3 months of 1+ drugs
94
What organism is most likely to cause meningitis in 1-23month old children?
Neisseria meningtides
95
What organism is most likely to cause meningitis in those >50years?
Strep. pneumoniae
96
Clinical presentation of meningitis
```
Sudden onset HEADACHES
FEVER
NUCAL RIGIDITY
Confusion
Vomiting
Papilloedema
BRUDZINSKI’S SIGN
KERNIG’S SIGN
Petechial rash + signs of sepsis
```
97
WBC count of 500-10,000 neutrophils would be seen in the CSF of which type of meningitis?
Bacterial meningitis
98
Which type of meningitis would you see normal glucose in the CSF?
Viral meningitis
99
How do you treat bacterial meningitis?
Oral DEXAMETHASONE 0.15mg/kg qds for 4 days if unknown or S. pneumonia
IV CEFOTAXIME or IV CEFTRIAXONE (for N. meningitis)
If > 50/immunocompromised then add IV AMOXICILLIN 2g to cover Listeria
If presenting in GP then give IM BENZYLPENICILLIN
100
How do you treat TB meningitis?
12 months of rifampicin, isoniazid, pyrazinamide, ethambutol
101
What do you add to treatment of meningitis if underlying HIV infection or cryptococcal meningitis?
Liposomal amphotericin b (AmBisome) + flucytosine for 2 weeks
102
What is the most common organism to cause encephalitis?
Herpes simplex virus 1 & 2
103
Which lobes does HSV encephalitis mainly affect?
Frontal and temporal lobes
104
What are the symptoms of HSV encephalitis?
Disorientation
Fever, chills, malaise
Speech disturbance
Hypo-mania, irritability
105
Treatment of HSV encephalitis?
Acyclovir for 14-21 days
106
Clinical presentation of shingles / herpes zoster?
Rash in the same dermatome
107
Diagnosis of shingles / herpes zoster?
Tzanck test (multinucleated giant cells in the fluid of the vesicles)
CSF HSV-1 DNA PCR (48hrs-10days)
CSF HSV antivosy from 10 days
108
Treatment of shingles / herpes zoster?
Acyclovir 5x daily
109
What is Ramsey Hunt syndrome?
Bell’s palsy and loss of hearing and rash around ear
110
What is amaurosis fugax?
Sudden transient loss of vision in one eye
Temporary reduction in the retinal ophthalmic or ciliary blood flow leading to temporary retinal hypoxia
111
What is the main cause of TIA?
Atherothromboembolism from the carotid
112
What imaging would you do in a TIA?
Carotid artery doppler to look for stenosis
(If significant stenosis within then endarterectomy within 2 weeks)
MRI/CT angiography to determine extent of stenosis
113
What does the ABCD2 score measure and what are its features?
Risk of stroke after TIA
```
Age > 60 yrs = 1
Blood pressure > 140/90mmHg = 1
Clinical features (Unilateral weakness = 2; Speech disturbance without weakness = 1)
Duration of symptoms (symptoms lasting ≥ 1hr = 2; symptoms lasting 10-59min = 1)
Diabetes = 1
```
114
Antiplatelet treatment for TIA?
Aspirin 300mg immediately
| Continue clopidogrel 75mg 1x daily
115
Definition of traumatic brain injury
Alteration in brain function; evidence of brain pathology caused by external force
116
What is a contusion injury?
Bruising of the brain (large contusion = hemorrhage)
117
What is a contrecoup injury?
Diffusion of the force - more diffuse injury opposite to the side of the blow
118
How would you define a mild traumatic brain injury?
LOC <30 min
No skull fracture
PTA <1 day
119
How would you define a moderate traumatic brain injury?
LOC >30 mins and <24hrs
With/out skull fracture
PTA >1day <7days
120
How would you define a severe traumatic brain injury?
LOC >24hrs
With contusion, haematoma, or skull fracture
PTA >7 days
121
When do you do a CT scan with a traumatic brain injury?
```
GCS < 13 at any time
GCS < 15 at 2hrs post injury
Basal skull fracture
Seizures
> 1 episode of vomiting
Antegrade amnesia > 30 min
No improvement in 4 hours
Severe symptoms
```
122
Immediate management of traumatic brain injury
```
IV fluids
Glucose
Early CT scan
If seizures - Diazepam 10 mg PR/IV
If opiods - Nalaxone 0.4 mg IV
If alcohol - Thiamine 100 mg IV
If tricyclics - Physostigmine 1 mg IV
If Benzodiazepines - Flumazenil 0.2 mg IV over 30 sec
If ICP - Mannitol
```
123
Risk factors for venous sinus thrombosis?
Virchow’s triad:
Stasis of blood flow
Endothelial injury
Hypercoagulability
124
What sign does a CT scan show for venous sinus thrombosis?
Dense triangle sign
125
Clinical presentation of venous sinus thrombosis?
Isolated intracranial hypertension
| Raised ICP esp. worse lying flat, visual obscuration with postural change and pulsatile tinnitus
126
Management of venous sinus thrombosis?
LMWH
127
What are some unusual causes of stroke?
```
Vasculitis
Arterial dissection
Cerebral venous sinus thrombosis
Antiphospholipid antibody syndrome
Cocaine use
Degenerative amyloidosis (CAA)
Degenerative moya moya
MELAS syndrome
Fabry's disease
Myxoma
```
128
Name some stroke mimics
```
Brain tumour
CNS infection
Falls / trauma
Hypoglycaemia
Migraines
Multiple sclerosis
Seizure
Haemorrhage
Vertigo
Hyponatraemia /hypercalcaemia/Wernickee’s
Nonketotic hyperosmolar hyperglycaemia
Paroxysmal symptoms MS
Cervical Cord Neuropraxia
Transient global amnesia
```
129
What system is involved in disorders of consciousness?
The ascending reticular activating system
130
Symptoms of a coma?
```
Unrousable
Unresponsive
>6 hours
Cannot be wakened
Lacks normal sleep-wake cycle
No voluntary actions
```
131
How do you diagnose permanent vegetative state?
VS >6 months after nontraumatic brain damage OR
| VS 12 months after traumatic brain injury
132
How do you assess minimally conscious state?
Purposeful behaviour
Following simple commands
Verbal / gestured yes or no
Intelligible verbalisations
133
How do you emerge from minimally conscious state?
Functional interactive communication on two consecutive evaluations
Functional use of two different objects on two consecutive evaluations
134
What is brainstem death?
Declared when brainstem reflexes, motor responses and respiratory drive are absent in a normothermic, non-drugged comatose patient with an irreversible widespread brain lesion of known cause and no contributing metabolic derangements
135
What are the common arteries that cause intracerebral haemorrahge?
Lenticulostriate
Thalamoperforators
Paramedian branches of the Basilar Artery
136
What is the main cause of lobar intracerebral haemorrahge?
Cerebral amyloid angiopathy
137
What is the main surgical treatment for intracerebral haemorrhage?
External ventricular drainage / ventriculostomy
138
Main cause of subarachnoid haemorrhage?
Berry aneurysm
139
Presentation of subarachnoid haemorrhage?
```
Thunderclap headache
Nuchal rigidity
Seizures
Symptoms of raised ICP
Kernig / Brudzinski's sign
Papilloedema
```
140
What imaging would you use for a subarachnoid haemorrhage and what will it show?
CT scan
| Star shaped lesion
141
Treatment for subarachnoid haemorrhage?
Clip artery and endovascular coiling
| Calcium channel blockers
142
What is the main cause of a subdural haemorrhage?
Accumulation of blood in the subdural space following rupture of a bridging vein between the cortex and venous sinus
143
Presentation of subdural haemorrhage?
```
Headache
Personality change
Unsteadiness
Seizures
Coma
Raised ICP symptoms
```
144
What shape would you see on CT scan for a subdural haemorrhage?
Crescent shape
145
Treatment for subdural haemorrhage?
IV mannitol
| Drained fluid / craniotomy
146
What is an extradural haemorrhage?
Collection of blood between the dura mater and the bone caused by head injury
147
What artery is most likely to be damaged in an extradural haemorrhage?
Middle meningeal artery
148
Presentation of extradural haemorrhage?
```
Lucid interval
Severe headache
Nausea
Vomiting
Ipsilateral pupil dilates
Coma
Bilateral limb weakness
Breathing becomes deep and irregular
```
149
What would you see on CT scan for a extradural haemorrhage?
Hyperdense mass that is biconvex shaped and adjacent to the skull
150
Diagnosis of insomnia?
Difficulty falling asleep / waking up throughout the night / waking up in the early-morning and then struggling to fall asleep / hypnic phenomena
Must be present >3x a week for 3 months
151
Clinical presentation of narcoplexy?
CHESS
```
Cataplexy
Hallucinations
Excessive daytime sleepiness
Sleep paralysis
Sleep disruption
```
152
Diagnostic test and diagnostic criteria for narcoplexy
Multiple sleep latency test
At least one of:
Episodes of cataplexy
Hypocretin deficiency
Reduced REM latency
153
Clinical presentation of obstructive sleep apnea
At night: Breathing stopping and starting, gasping noises, loud snoring
At day: feeling very tired, headache on waking
154
Treatment of obstructive sleep apnea
Continuous positive airway pressure
155
How is HIV transmitted?
```
Sexual intercourse
IV drug abuse
Mother to child
Accidental needle sticks
Blood products
```
156
Which cells does HIV target?
CD4+ cells
157
What happens after HIV enters the body?
```
Acute infection - acute HIV syndrome
Large spike in HIV replication
Amount of virus in blood declines
Latent phase (2-10yrs) (no. of virus in blood slowly increases; no. of T cells in blood decreases)
AIDS
```
158
At level do the CD4+ cells need to fall below to be classified as AIDS?
200cells/mm3
159
Symptoms of seroconversion in HIV?
```
Fever
Malaise
Myalgia (muscle pain)
Pharyngitis (sore throat)
Maculopapular rash
Significant weight loss
```
160
Name some AIDS defining conditions
```
Candidiasis oesophageal/lung (fungal infection)
Extra-pulmonary cryptococcosis
Cryptosporidiosis >1 month
Mycobacterium TB
Persistent herpes simplex (cold sores)
Pneumocystis jiroveci (carinii) pneumonia
Recurrent bacterial pneumonia
Cytomegalovirus (CMV)
Recurrent salmonella septicaemia
```
Invasive cervical carcinoma
Kaposi’s carcinoma
Primary CNS lymphoma
Non-Hodgkin’s lymphoma
HIV dementia/encephalopathy
HIV associated wasting
161
How do you diagnose HIV?
HIV viral load (RNA copies/ml) (from 2 weeks)
| Detection of IgG antigen/antibody test (6 weeks)
162
What is highly active antiretroviral therapy for HIV?
2 NRTI + 1 NNRTI OR
2 NRTI + 1PI
Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors (PI)
163
Clinical presentation of toxoplasmosis encephalitis
Fever, headache, altered mental status, focal neurology, seizures
Extracerebral disease – lung, eye, muscle (calcified cysts in muscles)
164
Clinical presentation of primary CNS lymphoma
Confusion, lethargy, memory loss, hemiparesis, aphasia, seizures
+/- Constitutional symptoms (fever/weight loss/night sweats)
165
Clinical presentation of tuberculous meningitis
Fever, headache, meningism, weight loss, fluctuating GCS
166
Clinical presentation of cryptococcal meningitis
Fever, headache, meningism, photophobia, vomiting
167
What is progressive multifocal leukoencephalopathy?
Severe demyelinating disease of CNS
Reactivation of John-Cunningham virus (acquired asymptomatically in childhood, then latent)
168
Treatment for toxoplasmosis encephalitis
Initial therapy (6 weeks) - sulfadiazine and pyrimethamine
Steroids
Maintenance therapy (prophylaxis)
Anti-retroviral therapy after 2 weeks
169
Diagnosis and treatment of primary CNS lymphoma
Stereotactic biopsy (diagnosis)
High dose methotrexate (every 2 weeks 8-12 weeks)
170
Diagnosis of cryptococcal meningitis
CSF cryptococcal antigen
171
Treatment of cryptococcal meningitis
Acutely - Liposomal amphotericin B + flucytosine or fluconazole (antifungal) (2 weeks)
Consolidation - fluconazole 400mg, 8 weeks
172
Clinical presentation of progressive multifocal leukoencephalopathy?
Altered mental state, motor deficit, ataxia, hemianopia
Subacute months – years
