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MSc Clinical neurology > Cerebrovascular and diseases of consciousness > Flashcards

Cerebrovascular and diseases of consciousness Flashcards

1
Q

What does a proto-oncogene mutation result in?

A

Results in promotion of cell division

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2
Q

What does a tumour suppressor gene mutation result in?

A

Results in loss of inhibition of cell division

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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

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4
Q

Description of grade I brain tumour

A

Slow growing
Least malignant
E.g. astrocytoma, craniopharyngioma

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5
Q

Description of grade II brain tumour

A

Slowly growing
Slightly abnormal appearance
May spread to nearby tissue

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6
Q

Description of grade III brain tumour

A

Malignant
Grow into nearby structures
Tend to recur

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7
Q

Description of grade IV brain tumour

A

Most malignant
Rapidly reproduce
Necrotic core
E.g. glioblastoma

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8
Q

Describe a glioblastoma

A

Type of astrocytoma
Grade IV
Occur in cerebral hemispheres
Prognosis <1yr

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9
Q

Describe a meningioma

A

Benign
Form under the dura mater
Grade I-III

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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

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11
Q

Describe a craniopharyngioma

A

Form in the sellar region from remnants of Rathke’s pouch
Grade 1
Benign

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12
Q

Symptoms of raised ICP

A 
Headache
Drowsiness
Nausea, vomiting
Papilloedema
3rd, 4th, 6th nerve palsies
Dilated pupils
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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

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14
Q

Symptoms with a tumour on the cerebellum

A

DASHING

Dysdiadochokinesis
Ataxia
Slurred speech
Hypotonia
Intention tremor
Nystagmus
Gait abnormality
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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

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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

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17
Q

What is the primary use of EEG?

A

To diagnose epilepsy using inter-ictal and ictal recordings

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18
Q

What does a spike and wave on an EEG show?

A

Epileptiform discharge

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19
Q

Describe the Theta wave on EEG

A

4-7Hz
Normal physiological rhythm – seen frontally/frontocentral
Increases in drowsiness, focussed concentrations, hyperventilation

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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
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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

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22
Q

Describe the Beta wave on EEG

A

Fast, 13Hz –20 Hz
Seen in drugs, esp. benzos / diazepam
Frontally

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23
Q

What is the hyperventilation technique in an EEG used to induce?

A

Childhood absence epilepsy

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24
Q

5 variables that can affect an EEG

A 
Age of px
Artifacts 
Conscious levels
Drugs
Co-existent cerebral pathology
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25
Q

Symptoms of West’s syndrome

A

3-12 months of age

Epileptic spasms, hypsarrhythmia, regression

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26
Q

Symptoms of Juvenile myoclonic epilepsy

A

5-34yrs
Myoclonic jerk <1sec
In mornings
Eye closure sensitivity – in 3 secs will see generalised spike and wave

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27
Q

What is epilepsy?

A

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

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28
Q

Pathophysiology of epilepsy?

A

Fast/long lasting activation of glutamate NMDA receptors
OR
Genetic mutations of GABA receptors so cannot inhibit signals

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29
Q

Causes of epilepsy

A 
2/3 are idiopathic
Cortical scarring
Space occupying lesion
Stroke
Alcohol withdrawal
Dementia
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30
Q

Symptoms of a prodrome

A

Lasting hours or days

Change of mood/behaviour

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31
Q

Symptoms of an aura

A

Patient is aware

Deja vu / strange smells / flashing lights / hallucinations / fear

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32
Q

Symptoms of the post-ictal period

A

Headache, confusion, myalgia, sore tongue
Todd’s paralysis
Dysphasia

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33
Q

Diagnostic test for epilepsy

A

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)

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34
Q

1st line drug for generalized seizures

A

Sodium valporate

If pregnant / woman of childbearing age then:
Lamotrigine
Carbamazepine
Levetiracetam

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35
Q

1st line drug for absence seziures

A

Ethosuximide

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36
Q

1st line drug for focal seizures

A

Carbamazepine

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37
Q

Criteria for medically intractable epilepsy

A

Reliable diagnosis
Need to be affecting quality of life – disabling seizures
2 drugs for 2 years need to be tried first

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38
Q

What is the driving guidelines for epilepsy?

A

Have to be free of seizures for 1 year

If coming off medications – no driving for 6 months after withdrawing from antiepileptics

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39
Q

What is status epilepticus?

A

Convulsive seizures >30 mins or multiple seizures without recovery of consciousness

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40
Q

Acute causes of status epilepticus

A 
Stroke
Metabolic abnormalities
Hypoxia
Infections
Drug overdoses
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41
Q

Chronic causes of status epilepticus

A

Low conc. of AED
Alcohol misuse
Tumour

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42
Q

Pathophysiology of continued status epilepticus

A

GABA inhibitory receptors start to internalise and are no longer available
Glutamate and NMDA receptors lead to continued excitement

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43
Q

Potency of benzodiazepines reduces by ___ in ____ minutes in status epilepticus

A

20x

30 mins

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44
Q

Symptoms of non-convulsive status epilepticus

A

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

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45
Q

Complications of status epilepticus

A 
Airway obstruction, hypoxia, injury
Increased CNS metabolic consumption 
Rhabdomyolysis
Renal failure – acute tubular necrosis
Metabolic acidosis
Hyperthermia 
Major organ failure
Cerebral oedema
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46
Q

In status epilepticus if the px is fitting for >5 min what do you give them?

A

Benzodiazepine (lorazepam / diazepam)

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47
Q

In status epilepticus if the px is fitting for >10 min what do you give them?

A

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)

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48
Q

In status epilepticus if the px is fitting for >30 min what do you give them?

A

Anaesthesia with paralysing drug e.g. suxamethonium and ICU admission

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49
Q

What are the differential diagnosis for epilepsy?

A

Epileptic seizure
Syncope
Psychogenic nonepileptic seizure (NEAD)

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50
Q

What is syncope?

A

Reversible loss of consciousness due to short-term inadequate blood flow to the brain - transient global cerebral hypoperfusion

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51
Q

Symptoms of vasovagal syncope

A

Pallor, sweating, nausea
They know they are going to pass out
Lack of post-ictal confusion, hearing people around you before you can respond

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52
Q

Causes of orthostatic hypotension

A

Volume depletion - haemorrhage, vomiting, diarrhoea

Autonomic failure - parkinson’s, old age

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53
Q

Drop in what blood pressure suggests postural hypotension?

A

20mmHg systolic / 10mmHg diastolic

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54
Q

Symptoms of NEAD

A

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

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55
Q

Investigations for transient loss of consciousness

A

12 lead ECG

Neuroimaging

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56
Q

What is a stroke?

A

Rapid onset of neurological deficit caused by infarction. Characterised by rapidly developing signs of global disturbance lasting >24hrs or death

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57
Q

Risk factors for stroke?

A 
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
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58
Q

Ischaemic causes for stroke

A

Thrombosis - large artery disease
Cardiac emboli
Lacunar infarct - small artery disease
Hypoperfusion - sudden drop in BP by more than 40mmHg

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59
Q

Causes of haemorrhagic stroke

A 
Cerebral amyloid angiopathy (main)
Trauma
Aneurysm rupture
Carotid artery dissection
Anticoagulation
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60
Q

Causes for strokes in young people

A 
Vasculitis
Thrombophilia
Subarachnoid haemorrhage
Carotid / vertebral artery dissection
Venous sinus thrombosis
Recreational drugs
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61
Q

What is the TOAST classification for stroke?

A
  1. Large-artery atherosclerosis
  2. Cardioembolism
  3. Small-vessel occlusion
  4. Stroke of other determined aetiology
  5. Stroke of undetermined aetiology
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62
Q

Symptoms of a ACA stroke

A 
Leg weakness
Truncal ataxia
Incontinence
Akinetic mutism
Drowsiness
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63
Q

Symptoms of a MCA stroke

A 
Contralateral arm and leg weakness
Hemianopia
Aphasia
Dysphasia
Facial droop
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64
Q

Symptoms of a PCA stroke

A

Contralateral homonymous hemianopia
Unilateral headache
Visual agnosia
Colour naming and discriminate problems

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65
Q

Symptoms of a brainstem / cerebellum infarct

A 
Locked in syndrome
Hemiparesis
Facial paralysis
Dysarthria and speech impairment
Vertigo, nausea and vomiting
Visual disturbance
Altered consciousness
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66
Q

Symptoms of a lacunar stroke

A

Unilateral weakness
Pure sensory loss – thalamus
Ataxic hemiparesis – pontine lesion
Dysarthria / clumsy hand - pons, internal capsule

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67
Q

First line investigation for stroke

A

Urgent CT head / MRI (diffusion weighted imaging)

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68
Q

When are carotid dopplers done in stroke?

A

The px is relatively well after stroke
If surgery is needed
If anterior circulation affected

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69
Q

Describe the thrombolysis treatment for stroke

A

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
Q

Contraindications for thrombolysis

A 
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
Q

How do you treat stroke if time of onset is unknown?

A

ASPIRIN 300 mg daily for 2 weeks then lifelong CLOPIDOGREL 75mg

72
Q

How do you reverse warfarin in haemorrhagic stroke?

A

Beriplex and vitamin K

73
Q

When would you do a thromboectomy?

A

Needs to be a large vessel occulsion

6hrs for ACA, 2hrs for basilar

74
Q

What is malignant MCA syndrome and how do you treat it?

A

Occurs when cell death causes swelling, pushing on brain and reducing GCS. Treated with decompressive hemicraniectomy

75
Q

In ischaemic stroke when would you give statins? What statins would you give?

A

If cholesterol is >3.8

Simvastatin 40mg or storvastatin 80mg

76
Q

What platelet treatment would you give to prevent further strokes?

A

ASPIRIN 300mg 14 days/discharge then switch to CLOPIDOGREL 75mg (long-term prophylaxis)

77
Q

What should INR be when on warfarin?

A

2-3

78
Q

What does the CHADS2VaSc score measure? List what it stands for

A

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
Q

At what score on the CHADS2VaSc risk scale would you give warfarin?

A

2

80
Q

What does the HASBLED score measure and what does it stand for?

A

Risk of bleeding with anticoagulation

Hypertension
Abnormal renal or liver function
Stroke
Bleeding
Labile INRs
Elderly (>65yrs)
Drugs or alcohol
81
Q

List three factors important in the mechanism of stroke recovery

A

Adaptation
Regeneration
Neuroplasticity

82
Q

What is the difference between primary and secondary headache?

A

Primary - no underlying cause relevant to the headache

Secondary - there is an underlying cause

83
Q

Clinical presentation of tension headache?

A 
Episodic
Bilateral temporal pain
Pressing / tight
Mild / moderate intensity
Scalp muscle tenderness
Not aggravated by activity
No nausea / vomiting
84
Q

Treatment of tension headache?

A

Pain medication
Tricyclic antidepressants
Stress relief; avoid triggers

85
Q

Triggers of migraine?

A 
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult (loud noise)
Exercise
86
Q

Clinical presentation of migraine?

A

Unilateral pounding/pulsating pain lasting 4-72hrs
Visual / somatosensory aura
Nausea / vomiting
Photophobia / phonophobia

87
Q

Treatment of migraine

A

Sumatriptan
NSAIDs
Propranolol

88
Q

Clinical presentation of cluster headaches?

A

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
Q

Clinical presentation of Horner’s syndrome?

A

Miosis
Ptosis
Anhidrosis

90
Q

Treatment of cluster headaches?

A

Acute attack - sumatriptan

Verapamil as first line prophylaxis

91
Q

Clinical presentation of trigeminal neuraglia headaches?

A 
Unilateral
Paroxysmal attacks 1sec-2mins
Severe intensity
Electric shock like
Precipitated by innocuous (non-harmful) stimuli
92
Q

Treatment of trigeminal neuraglia headaches?

A

Oral carbamazepine

Surgery (microvascular decompression; gamma knife surgery)

93
Q

Clinical presentation of drug overdose headache

A

Headache present on ≥ 15 days / month

Regular use for >3 months of 1+ drugs

94
Q

What organism is most likely to cause meningitis in 1-23month old children?

A

Neisseria meningtides

95
Q

What organism is most likely to cause meningitis in those >50years?

A

Strep. pneumoniae

96
Q

Clinical presentation of meningitis

A 
Sudden onset HEADACHES
FEVER
NUCAL RIGIDITY
Confusion
Vomiting
Papilloedema
BRUDZINSKI’S SIGN
KERNIG’S SIGN
Petechial rash + signs of sepsis
97
Q

WBC count of 500-10,000 neutrophils would be seen in the CSF of which type of meningitis?

A

Bacterial meningitis

98
Q

Which type of meningitis would you see normal glucose in the CSF?

A

Viral meningitis

99
Q

How do you treat bacterial meningitis?

A

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
Q

How do you treat TB meningitis?

A

12 months of rifampicin, isoniazid, pyrazinamide, ethambutol

101
Q

What do you add to treatment of meningitis if underlying HIV infection or cryptococcal meningitis?

A

Liposomal amphotericin b (AmBisome) + flucytosine for 2 weeks

102
Q

What is the most common organism to cause encephalitis?

A

Herpes simplex virus 1 & 2

103
Q

Which lobes does HSV encephalitis mainly affect?

A

Frontal and temporal lobes

104
Q

What are the symptoms of HSV encephalitis?

A

Disorientation
Fever, chills, malaise
Speech disturbance
Hypo-mania, irritability

105
Q

Treatment of HSV encephalitis?

A

Acyclovir for 14-21 days

106
Q

Clinical presentation of shingles / herpes zoster?

A

Rash in the same dermatome

107
Q

Diagnosis of shingles / herpes zoster?

A

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
Q

Treatment of shingles / herpes zoster?

A

Acyclovir 5x daily

109
Q

What is Ramsey Hunt syndrome?

A

Bell’s palsy and loss of hearing and rash around ear

110
Q

What is amaurosis fugax?

A

Sudden transient loss of vision in one eye

Temporary reduction in the retinal ophthalmic or ciliary blood flow leading to temporary retinal hypoxia

111
Q

What is the main cause of TIA?

A

Atherothromboembolism from the carotid

112
Q

What imaging would you do in a TIA?

A

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
Q

What does the ABCD2 score measure and what are its features?

A

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
Q

Antiplatelet treatment for TIA?

A

Aspirin 300mg immediately

Continue clopidogrel 75mg 1x daily

115
Q

Definition of traumatic brain injury

A

Alteration in brain function; evidence of brain pathology caused by external force

116
Q

What is a contusion injury?

A

Bruising of the brain (large contusion = hemorrhage)

117
Q

What is a contrecoup injury?

A

Diffusion of the force - more diffuse injury opposite to the side of the blow

118
Q

How would you define a mild traumatic brain injury?

A

LOC <30 min
No skull fracture
PTA <1 day

119
Q

How would you define a moderate traumatic brain injury?

A

LOC >30 mins and <24hrs
With/out skull fracture
PTA >1day <7days

120
Q

How would you define a severe traumatic brain injury?

A

LOC >24hrs
With contusion, haematoma, or skull fracture
PTA >7 days

121
Q

When do you do a CT scan with a traumatic brain injury?

A 
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
Q

Immediate management of traumatic brain injury

A 
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
Q

Risk factors for venous sinus thrombosis?

A

Virchow’s triad:
Stasis of blood flow
Endothelial injury
Hypercoagulability

124
Q

What sign does a CT scan show for venous sinus thrombosis?

A

Dense triangle sign

125
Q

Clinical presentation of venous sinus thrombosis?

A

Isolated intracranial hypertension

Raised ICP esp. worse lying flat, visual obscuration with postural change and pulsatile tinnitus

126
Q

Management of venous sinus thrombosis?

A

LMWH

127
Q

What are some unusual causes of stroke?

A 
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
Q

Name some stroke mimics

A 
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
Q

What system is involved in disorders of consciousness?

A

The ascending reticular activating system

130
Q

Symptoms of a coma?

A 
Unrousable
Unresponsive
>6 hours
Cannot be wakened
Lacks normal sleep-wake cycle
No voluntary actions
131
Q

How do you diagnose permanent vegetative state?

A

VS >6 months after nontraumatic brain damage OR

VS 12 months after traumatic brain injury

132
Q

How do you assess minimally conscious state?

A

Purposeful behaviour
Following simple commands
Verbal / gestured yes or no
Intelligible verbalisations

133
Q

How do you emerge from minimally conscious state?

A

Functional interactive communication on two consecutive evaluations
Functional use of two different objects on two consecutive evaluations

134
Q

What is brainstem death?

A

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
Q

What are the common arteries that cause intracerebral haemorrahge?

A

Lenticulostriate
Thalamoperforators
Paramedian branches of the Basilar Artery

136
Q

What is the main cause of lobar intracerebral haemorrahge?

A

Cerebral amyloid angiopathy

137
Q

What is the main surgical treatment for intracerebral haemorrhage?

A

External ventricular drainage / ventriculostomy

138
Q

Main cause of subarachnoid haemorrhage?

A

Berry aneurysm

139
Q

Presentation of subarachnoid haemorrhage?

A 
Thunderclap headache
Nuchal rigidity
Seizures
Symptoms of raised ICP
Kernig / Brudzinski's sign
Papilloedema
140
Q

What imaging would you use for a subarachnoid haemorrhage and what will it show?

A

CT scan

Star shaped lesion

141
Q

Treatment for subarachnoid haemorrhage?

A

Clip artery and endovascular coiling

Calcium channel blockers

142
Q

What is the main cause of a subdural haemorrhage?

A

Accumulation of blood in the subdural space following rupture of a bridging vein between the cortex and venous sinus

143
Q

Presentation of subdural haemorrhage?

A 
Headache
Personality change
Unsteadiness
Seizures
Coma
Raised ICP symptoms
144
Q

What shape would you see on CT scan for a subdural haemorrhage?

A

Crescent shape

145
Q

Treatment for subdural haemorrhage?

A

IV mannitol

Drained fluid / craniotomy

146
Q

What is an extradural haemorrhage?

A

Collection of blood between the dura mater and the bone caused by head injury

147
Q

What artery is most likely to be damaged in an extradural haemorrhage?

A

Middle meningeal artery

148
Q

Presentation of extradural haemorrhage?

A 
Lucid interval
Severe headache
Nausea
Vomiting
Ipsilateral pupil dilates
Coma 
Bilateral limb weakness 
Breathing becomes deep and irregular
149
Q

What would you see on CT scan for a extradural haemorrhage?

A

Hyperdense mass that is biconvex shaped and adjacent to the skull

150
Q

Diagnosis of insomnia?

A

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
Q

Clinical presentation of narcoplexy?

A

CHESS

Cataplexy
Hallucinations
Excessive daytime sleepiness
Sleep paralysis
Sleep disruption
152
Q

Diagnostic test and diagnostic criteria for narcoplexy

A

Multiple sleep latency test

At least one of:
Episodes of cataplexy
Hypocretin deficiency
Reduced REM latency

153
Q

Clinical presentation of obstructive sleep apnea

A

At night: Breathing stopping and starting, gasping noises, loud snoring

At day: feeling very tired, headache on waking

154
Q

Treatment of obstructive sleep apnea

A

Continuous positive airway pressure

155
Q

How is HIV transmitted?

A 
Sexual intercourse
IV drug abuse
Mother to child
Accidental needle sticks
Blood products
156
Q

Which cells does HIV target?

A

CD4+ cells

157
Q

What happens after HIV enters the body?

A 
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
Q

At level do the CD4+ cells need to fall below to be classified as AIDS?

A

200cells/mm3

159
Q

Symptoms of seroconversion in HIV?

A 
Fever
Malaise
Myalgia (muscle pain)
Pharyngitis (sore throat)
Maculopapular rash
Significant weight loss
160
Q

Name some AIDS defining conditions

A 
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
Q

How do you diagnose HIV?

A

HIV viral load (RNA copies/ml) (from 2 weeks)

Detection of IgG antigen/antibody test (6 weeks)

162
Q

What is highly active antiretroviral therapy for HIV?

A

2 NRTI + 1 NNRTI OR
2 NRTI + 1PI

Nucleoside reverse transcriptase inhibitors (NRTI)
Non-nucleoside reverse transcriptase inhibitors (NNRTI)
Protease inhibitors (PI)

163
Q

Clinical presentation of toxoplasmosis encephalitis

A

Fever, headache, altered mental status, focal neurology, seizures

Extracerebral disease – lung, eye, muscle (calcified cysts in muscles)

164
Q

Clinical presentation of primary CNS lymphoma

A

Confusion, lethargy, memory loss, hemiparesis, aphasia, seizures
+/- Constitutional symptoms (fever/weight loss/night sweats)

165
Q

Clinical presentation of tuberculous meningitis

A

Fever, headache, meningism, weight loss, fluctuating GCS

166
Q

Clinical presentation of cryptococcal meningitis

A

Fever, headache, meningism, photophobia, vomiting

167
Q

What is progressive multifocal leukoencephalopathy?

A

Severe demyelinating disease of CNS

Reactivation of John-Cunningham virus (acquired asymptomatically in childhood, then latent)

168
Q

Treatment for toxoplasmosis encephalitis

A

Initial therapy (6 weeks) - sulfadiazine and pyrimethamine

Steroids

Maintenance therapy (prophylaxis)

Anti-retroviral therapy after 2 weeks

169
Q

Diagnosis and treatment of primary CNS lymphoma

A

Stereotactic biopsy (diagnosis)

High dose methotrexate (every 2 weeks 8-12 weeks)

170
Q

Diagnosis of cryptococcal meningitis

A

CSF cryptococcal antigen

171
Q

Treatment of cryptococcal meningitis

A

Acutely - Liposomal amphotericin B + flucytosine or fluconazole (antifungal) (2 weeks)

Consolidation - fluconazole 400mg, 8 weeks

172
Q

Clinical presentation of progressive multifocal leukoencephalopathy?

A

Altered mental state, motor deficit, ataxia, hemianopia

Subacute months – years

MSc Clinical neurology (1 decks)

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