Exam 2- CNS Bringman Flashcards
meningitis is
Inflammation of the meningitis (Layers over the CNS)
Causes of meningitis
Infection- viral, bacterial, fungus (other bugs- worms)
How can we treat meningitis?
Antivirals, antibiotics, antifungal
Viral meningitis
~If it’s just alcohol, it will not make a superbug;
~you have to get to the doc within 24 hours to stop the virus; if you get there after, it will just suppress
~Let it runs its course in healthy inds
~Pools are great places to get meningitis (more on the viral- they like the warm)
What is something that is given to people with viral meningitis that shouldn’t be?
~Lot of pt will want an antibiotic
~There is no point if you taking them if you have a virus!
~Make super bugs- can’t get rid of them
Bacterial meningitis
~Antibiotics- have to take it for a long time
~Hard to get to the brain because of the BBB
~Massive antibiotics doses; will be in hospital for a while to get rid of it
which is worse: bacterial or viral meningitis?
Bacterial is worse than viral
Fungal meningitis
~Where to get it- a dirty env
~Not easy to get
~A steroid has become tainted with the fungus- BAD (500 got it, 40 died)
s/s of meningitis
~Headache ~Fever ~Malaise ~Fatigue ~Nausea (that means that the pressure is really high ~Neck flexion can replicate the symptoms
What is a test to provoke meningitis?
the slump test
inflammation in meningitis
~5 cardinal signs of inflammation
~can occasionally cause scarring
~will need to put in a shunt to decompress
inflammation of the meningitis- scarring
~There is CSF in the area, so it if there is too much scaring, may have a block of the CSF
~Hypercyphale
~ s/s: Headache, confusion, vomiting, loss of cons, loss of function
encephalitis
~Inflammation of the brain
~Viral or bacterial (Want viral)
~Can have a rapid onset
~If there is inflammation, there fluid will not have anywhere to do
~Can start to can micro damage on the outside of the brain (lots of boney parts that can cause problems)
which can cause more of a problem: encephalitis or meningitis?
encephalitis
s/s of encephalitis
~headaches: sensitivity to sound and light
~Fever (temperature regulation ma get out of control)
~Loss of function
~Visual problems/ no visual
~Loss of ability to follow commands/ loss ability to move
~Vomiting
~Seizure
~Stopper to coma
Encephalitis- do you have to be in the hospital?
YES
~If we get to them soon enough, we may need to drain some CSF
~CSF tap
~reduce Intracranial pressure (ICP)
~normal values range from 1-15/20
~Can do a bolt: It is a short term VCP shunt; Used in very bad cases; Need to be at level of the head
Encephalitis- uncal herniation
~Brain stem comes through the foreman magnum
~Probably won’t recover; this will kill you
how does encephalitis start?
~Usually will not start with encephalitis
~Usually have an infection in a different part of the body
Encephalomyelitis
~Inflammation of brain and spinal cord
~Everything is inflamed
~Flexion will cause an extreme about of pain (SLR too)
~Pt will usually be put in a coma
~This is all very similar to the other two, but all put together
myelitis
inflammation of the spinal cord
transverse myelitis
~The majority of pts will have full or some return
~It usually does not show up again
~Age between 10-40
~Btw 1500-2000 new cases each year
~Harder to diagnosis that a normal SC pt
~Have to rule out other diagnoses: GBS, atraumatic SC injury, SC stroke, MS
~Usually people start to get better btw 2-12 weeks (How much scaring, etc)
transverse myelitis- causes
~We don’t know what causes this; probably autoimmune
~They come on very rapidly
~Presentation can be scattered
Details on Bringmans aunt
~Took a nap, woke up and couldn’t move legs
~we are worried about pressure, clots (thin blood)
~Abdominal Bleed out- colon resection
~did a spinal tap and remove blood for testing
~Spinal taps don’t always heal- leaking out CSF
~Get s CSF headache due to the loss of CSF- brain will sit on bottom of cranium
~Positional headaches- standing, sitting
~Test to see if there a CSF leak if there are positional headaches
~To fix the CSF leak- will do a blood patch (will put the blood in the whole and hope it will clot)
~Have recurrent pain
~Did not regain B/B
~Cath for rest of life
~Can walk again, but uses a cane
~On blood thinners, has ted hose
what does CIDP stand for?
chronic inflammatory demyelination polyneuropathy
what does CIP stand for?
chronic illness polyneuropathy
what is CIDP?
~Different form GBS because GBS is acute; this is the recurrent form of GBS
~Will have a more spontaneous healing process than GBS
~Will treat all these type of pts the same
What is CIP also called?
SIRS- systematic inflammatory response syndrome
What is CIP?
~They are weak, on bed rest for a long time; they can develop CIP
~We used to just say that these pts were weak; now we are finding out why they weak
~½ will get full recovery; ½ will get most back
~Huge risk for bed sores (skin); pneumonia
~Exercise them (if 3/5 or better); they have so much that they need to work on, want to make sure they are getting better, not getting worse
What is VAP
vent acquired pneumonia
~This is like a wound for the skin
~They get pneumonia from the vent, we failed them
Myasthenia gravis
~grave muscle disease
~takes on average 2 years to diagnosis
~autoimmune- don’t know the cause
~problem at the NM junction
Myasthenia gravis s/s
~ptosis (droopy eyelids)
~get really tired really fast
myasthenia gravis- NM junction
~ACh crosses
~Our body will make antibodies against his one site- Will block the ACh receptor site
~This is not a strength issue- we cant make them better
~They are weak bc there is no ACh to make the muscle fire
~Cholinesterase inhibitor: Mestinon; Helps to increase the amount of ACh in the cleft
~If you remove the thymus, it can somehow help
do we work with pts with myasthenia gravis?
~We will not work with this pt
~We can have this type of pt referred and we would referred them to the doc
