Exam 2- CNS Bringman

Question 1

meningitis is

Answer 1

Inflammation of the meningitis (Layers over the CNS)

Question 2

Causes of meningitis

Answer 2

Infection- viral, bacterial, fungus (other bugs- worms)

Question 3

How can we treat meningitis?

Answer 3

Antivirals, antibiotics, antifungal

Question 4

Viral meningitis

Answer 4

~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)

Question 5

What is something that is given to people with viral meningitis that shouldn’t be?

Answer 5

~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

Question 6

Bacterial meningitis

Answer 6

~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

Question 7

which is worse: bacterial or viral meningitis?

Answer 7

Bacterial is worse than viral

Question 8

Fungal meningitis

Answer 8

~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)

Question 9

s/s of meningitis

Answer 9

~Headache
~Fever
~Malaise 
~Fatigue
~Nausea (that means that the pressure is really high
~Neck flexion can replicate the symptoms

Question 10

What is a test to provoke meningitis?

Answer 10

the slump test

Question 11

inflammation in meningitis

Answer 11

~5 cardinal signs of inflammation
~can occasionally cause scarring
~will need to put in a shunt to decompress

Question 12

inflammation of the meningitis- scarring

Answer 12

~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

Question 13

encephalitis

Answer 13

~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)

Question 14

which can cause more of a problem: encephalitis or meningitis?

Answer 14

encephalitis

Question 15

s/s of encephalitis

Answer 15

~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

Question 16

Encephalitis- do you have to be in the hospital?

Answer 16

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

Question 17

Encephalitis- uncal herniation

Answer 17

~Brain stem comes through the foreman magnum

~Probably won’t recover; this will kill you

Question 18

how does encephalitis start?

Answer 18

~Usually will not start with encephalitis

~Usually have an infection in a different part of the body

Question 19

Encephalomyelitis

Answer 19

~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

Question 20

myelitis

Answer 20

inflammation of the spinal cord

Question 21

transverse myelitis

Answer 21

~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)

Question 22

transverse myelitis- causes

Answer 22

~We don’t know what causes this; probably autoimmune
~They come on very rapidly
~Presentation can be scattered

Question 23

Details on Bringmans aunt

Answer 23

~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

Question 24

what does CIDP stand for?

Answer 24

chronic inflammatory demyelination polyneuropathy

Question 25

what does CIP stand for?

Answer 25

chronic illness polyneuropathy

Question 26

what is CIDP?

Answer 26

~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

Question 27

What is CIP also called?

Answer 27

SIRS- systematic inflammatory response syndrome

Question 28

What is CIP?

Answer 28

~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

Question 29

What is VAP

Answer 29

vent acquired pneumonia
~This is like a wound for the skin
~They get pneumonia from the vent, we failed them

Question 30

Myasthenia gravis

Answer 30

~grave muscle disease
~takes on average 2 years to diagnosis
~autoimmune- don’t know the cause
~problem at the NM junction

Question 31

Myasthenia gravis s/s

Answer 31

~ptosis (droopy eyelids)

~get really tired really fast

Question 32

myasthenia gravis- NM junction

Answer 32

~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

Question 33

do we work with pts with myasthenia gravis?

Answer 33

~We will not work with this pt

~We can have this type of pt referred and we would referred them to the doc