Deck 2b - neuro Flashcards
Q. Describe the CSF results associated a) acute bacterial infections b) viral c)TB
meningitis d) fungal e) subarachnoid hemorrhage
A. Acute bacterial: raised OP, cloudy, high cell count, neutrophils, low glucose, high
protein
B: Viral: raised/normal OP, clear, normal/high cell count, lymphocytes, normal
glucose, normal/high protein
C: TB meningitis: raied OP, cloudy/yellow, slight increase in cell count, lymphocytes,
low glucose, high protein
D: Fungal: raised OP, cloudy, normal/high cell count, lymphocytes, normal/low
glucose, normal/high protein
E: SAH: raised OP, blood stained (axanthrochromia), slight increase in vells, normal
glucose, high protein
Q. Name three Txs for suspected bacterial meningitis
A. Cefotamine 2g QDS IV (or ceftriaxone)
B. ADD amoxicillin 2g QDS IV (covers listeria, >55, immunocompromised, history of
alcohol excess)
C. ADD steroids: dexamethasone
Family: Ciprofloxacin (all ages and pregnancy) – 500mg stat
Rifampicin (all ages, not pregnancy) – 600mg BD for 2 days
Q. What are most cases of meningococcal meningitis due to?
A. Men B 85% (Men C vaccine introduced in 1999), commonly carried in nasal
passage (vaccination at 1 yo and 15 yo)
Q. Name two differences between viral meningitis and bacterial meningitis
A. Viral: presents without rash, generally less severe disease
B. Most commonly due to enterovirus – mostly children, no specific tx, classicaly
presents with flu-like illness/sore throat, diarrhea
Q. Name 4 features of encephalitis presentation
A. Fever, headache, lethargy, behavioral change
B. Progression to focal signs, seizure, comas
C. usually an insidious onset, but may be abrupt. CSF: lymphocytosis usually, neuro-
radiological changes, EEG
D. Herpes virus – - treat 10mg/kg aciclovir IV tds
Q. Name 5 symptoms associated with Rabies
A. fever, anxiety, confusion, hydrophobia, hyper activity/uncontrable excitement,
hallucinations, violent movements
(RNA, spread by salvia, spreads to CNS, replications in brain then translocates to
salivary glands, 2 months incubation)
Q. Name 5 symptoms associated with Tetanus
A. Paraethesia of wound, trismus (lock jaw), sustained muscle contraction
(opisthotonus), involvement of facial muscles (risus sardonicus), paroxysmal
generalized spasms, severity may be mild/local or severe/systemic
- Q. What occurs in a lobar hemorrhage?.
A. Due to amyloid angiopathy – large and superficial
B. Seen in elderly patients, associated with dementia – brain imaging (protein
density MRI) may point to amyloid angiopathy but can only be diagnosed via post
mortem staining’’
C. Complication: intraventricular extension hydrocephalus
Q. Name three causes of intracerebral hemorrhage, describe the basic
management
A. HTN, amyloid, warfarin use
B. Management: resuscitation and specialist stroke unit care, check slotting and
reverse anticoagulant, lower BP if needed, ?neurosurgical referral (if GCS high,
infratentorial bleed/hydrocephalus), clipping or coiling approach to aneurysm/AVM
Q. Describe where each of the following arteries supplies – if an ischaemic stoke occurred what symptoms may occur? A) ACA B)MCA C) PCA
A) Anterior cerebral artery: supplies the frontal, prefrontal and supplementary motor cortex as well as some parts of the primary motor and primary sensory cortex
Symptoms: contralateral leg weakness and sensory loss, gait apraxia (truncal ataxia), incontinence, drowsiness, akinetic mutism – decreases in spontaneous speech
B) Middle cerebral artery: supplies virtually the whole of the lateral surface of the frontal, parietal and temporal lobes. This territory includes the primary motor and sensory cortices for the whole of the body – excluding the lower limb. It also serves the auditory cortex and the insula within the depths of the lateral fissure)
Symptoms: contralateral weakness and sensory loss, hemianopia (primary visual cortex), expressive aphasia, receptive dysphasia, facial droop
C) Posterior cerebral artery: supplies midbrain, sub thalamic nucleus, basal nucleus, thalamus, mesial inferior temporal lobe, and occipital and occipito-parietal cortices
May result in: cranial nerve palsy and contralateral motor/sensory defect, bilateral motor or sensory defect, eye movement problems (e.g. nystagmus), cerebellar dysfunction, isolated homonymous hemianopia
• Motor deficits such as hemiparesis or tetraparesis and facial paresis - 40-67%
of cases
- Dysarthria and speech impairment - 30-63% of cases
- Vertigo, nausea, and vomiting - 54-73% of cases
- Visual disturbances - 21-33% of cases
- Altered consciousness - 17-33% of cases
Q. How should ischemic strokes be treated?
A. Thrombolysis up to 4.5 hrs after onset of symptoms IV
B. Risk management:
I. Platelet Treatments:
a. Aspirin and dipyridamole of Clopidogrel
II. Cholesterol Treatments:
a. Statins
III. Atrial Fibrillation Treatments:
a. Warfarin
b. NOAC’s
IV. Blood Pressure Treatments:
a. Antihypertensives
V. Possible future treatment: clot retrieval, interarterial thrombolysis,
decompressive craniectomy
