extra Flashcards
most comm0n cause of cerebral abascess in HIV pts
toxoplasmosis
best initial test for suspected brain abscess
Ct with contrast
initial antibiotic for brain abscess
ceftriaxone, metronidazole and vanc
congenital heart disease and recurrnet sinusitis are predisoping factors for brain abscess
lyme disease can be the first indication of bells palsy
ELISA - borrelia burgdorferi
mainstay for brain abscess
burr hole and if larger or recurrent = craniotomy
what differentiates brain abscess from tumour
biopsy
differential for a ring enhancing lesion on brain
glioblastoma multiforme
msot accurate investgation for brain abscess
biopsy
most common cause of death in alzheimers
penumonia becuase of reduced swallowing
early onset alzheimers asscoiated with presenelin 1 and 2
late associated with apollipoporetin e4 allele
– is particularly sensitive to damage in alzheiemrs
hippocampus
shrinkage of the amygdala - memory ct scan may show starfish sign
alzheimers
vit e can be used for
alzheimers/ vascualr dementia
dementia is more common in
females
all pts with cognitive impairment must be evaualted for
hypothyroidism and depression
pseudodemntia is cognitive impairment secondary to
major depressive disorder
elderly with acute symptoms of major depression
pseudodementia - treat with SSRI
initial investigation of dementia to help exldue other cuases
blood screen
lewy body dementia is
fluctuating
typical antipsychotics can worsen
lewy body dementia
dat scan can be used for
lewy body dementia
encephalitis most commonly caused by
hsv1
if suspect encephalitis do not wait for cause before starting treatment - start Iv aciclovir
U&es and tfts to rule out
reversible causes of essential tremor
extradural haematoma causes
ipsilateral dilated pupil
middle meningeal arery rupture
extradural - pterion fracture
encephalitis want to do
virology PCR - from lumabr pucnture and csf analysis
most dangerous complciation of a subarachnoid haemorrhage
rebledding
normal ct if suspect sub arachnoid haemorrhage do
lumbar puncture
most common site for berry aneurysm
junction of anterior communicating and anterior cerebral
if positive ct for subarachnoid haemorrhage then do
Ct angiography
findings will be normal on CT for subarahnoid haemorrhage if do less than
6hrs
lumbar puncture should be done at least how long after symptoms for subarachnoid haemorrhage
12- xanthocrhomia
do start dementia drugs MMSE should be greater than
12 as if below side effects outweigh benefits
major cause of death 3-10 days after SAH
vasopasm causing an ishaemic infarct
anticoagulants such as warfarin increase risk of
subdural haemorrhage in elderly
which haemorrhage crosses suture line
subdural
new bleeding will appear
hyperdense
chronic subdural haemorrhage more likely in alcholics and the elderly due to
cerebral atrophy which stretches the bridging veins
blood test important in subdural haemorrhage
coagulation screen
initial antibiotics for meningococcal meningitis
benzylpenicillin or cefotaxime
kernigs sign
meningitis
initial antibiotics for pneumococcal menigntis
Iv cefotaxime
patient contact less than 7 days ago from memnigntococaal meningjtis should be given
ciprofloxacin
mx of bacterial meningitis in primary care
Im/IV benzylpenicillin at earliest opportunity
diagnostic investigation for bacterial meningitis
LP - CSF findings
non blanching rash indicates what
meningococcal sepsis
patients with bacterial meningitis may be given – to avoid hearing loss
dexamethasone
bacterial meningitis initial empiral antibiotics if 3months to 5 years
Iv cefotaxime
bacterial meningitis if less than 3 months or over 50
cefotaxime and amoxicillin so basically just add amox
kernigs sign
knee extension - meningitis
fungal meningitis
amphotericine B and fluocystosine
soap bubble in the white matter of the brain
cryptococcus
vaccination agaisnt pneumococcal 23 serotypes is given at
65y/o
halo appearance on india ink stain
cryptococcus
fungal meningitis has
lymophocyte predominance and then same as bacteria with increased protein and decreased glucose
most common type of meningitis
viral
most common cause of viral meningitis
enteroviruses eg cocksackie and echoviruses. followed by hepres simplex
mx for confirmed viral meningitis - suportive eg analgesia. use of aciclovir is unlear but if has signs of encephalitis then defos give aciclovir
how does viral meningitis differ from fungal
viral has normal glucose and fungal has decreased glucose
what HSv is more common to cause viral meningitis
2
for viral meningitis gold standard for identifying the underlying organisms
CSF PCR
nerve conduction studies in motor neuron are
normal
non invasive ventilaltion (usually BiPap) at night also given for
MND
ALS (MND) usually has spastic paralysis in lower limbs and what paralysis in upper
flaccid
riluzole is a
glutamate inhibitor- prolongs life by 3 months
treat suspected viral meningitis as bacterial until diagnosis exluded so give
empirical antibiotics
ALS usually begins at
cervical lesion of the spinal cord
progressive bulbar palsy affects what motor neruones
upper and lower
als typically begins in
hands and feet
what is unaffected in mnd
sensory, bladder and bowel and occular muscles
Primary lateral scleoriss affects
upper motor neurones
suspect myasthenia gravis and negative for anti AChR antibodies can then consdier testing for Anti MUSK antibodies
ice pack over eyelids will improve symptoms in
myasthenia gravis
edrophonium differentiates myasthenic crisis from cholinergic crissi
if symptoms improve then myasthenic
ALS - spastic paralyis in
lower limbs
myasthenia gravis is a
type 2 hypersensitivity reaction
drugs contraindicated in myasthenia gravis
aminoglycosides eg gentamicin
all pts with myasthenia gravis should have a
thymus CT or MRI
myasthenia gravis - antibodies against post synaptic
NICOTINC ach
only anti emetic that is safe in parkinsosn
domperidone
what triptan should be avoided in clsuter headaches
oral
verapamil affects heart so do ECG prior to use in
cluster headahces
