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ICM Revision > NEURO > Flashcards

NEURO Flashcards

1
Q

WHat are the different CSF investigations?

A
  1. pressure - normal 10-18cmH20 on side or 20-30 if sitting up
  2. bichemistry
  3. microscopy
  4. Culture
  5. PCR
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2
Q

what are normal CSF findings?

A 
5-20cmH20 pressure 
normal/clear appearance
0.18-0.45 protein 
glucose 2.5-3.5 
normal gram stain 
WCC <3
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3
Q

Bacterial Meningitis on CSF?

A 
>30cmH20 (raised pressure)
turbid/cloudy appearance 
>1 protein 
<2.2 glucose 
60-80% +ve gram stain 
WCC >500
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4
Q

Viral meningitis on CSF?

A 
Normal or mildy increased pressure 
clear appeance 
<1 protein 
normal glucose 
normal gram stain 
<1000 WCC
- monocytes
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5
Q

Fungal/TB meningitis on CSF?

A 
fibrin web appearance
0.1-0.5 protein 
1.6-2.5 glucose
100-500 WCC 
- monocytes
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6
Q

Indications of a lumbar puncture?

A 
diagnosing meningitis/encephalitis 
diganosis of MS/GBS/Sarcoid 
diagnosis of SAH 
Measure pressure - intracranial HTN 
therapeutic removal of CSF
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7
Q

contraindications of Lumbar puncture?

A

suspicion of mass lesion in brain/spinal cord
raised ICP
local infection near site of LP
Congenital spinal problems - spina bifida
low platelets (<40), on anticoags or coagulopathy

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8
Q

SAH CSF/LP results …..

A

…..
blood-stained initially, then xanthochromia (yellowish) of LP >12hrs later,
elevated opening pressure, elevated WBC to RBC 1:1000, elevated RBC,
normal glucose,
elevated protein

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9
Q

GBS CSF/LP results ,…….

A 
......
clear or xanthochromia appearance, 
normal/elevated opening pressure,
WCC normal, 
Glucose normal, elevated protein
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10
Q

Multiple sclerosis results …..

A 
....
clear appearance, 
normal opening pressure,
WBC 0-20cells/uL (mainly lymphocytes),
glucose normal, 
protein mildly elevated
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11
Q

When are nerve conduction studies used?

A

carpel tunnel syndrome
GBS
peripheral sensory/motor problems

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12
Q

what are contraindications of nerve conduction tests?

A

anticoagulation

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13
Q

what are complications of nerve conduction tests?

A

risk of infection
bleeding
pain
damage to underlying structures of nerves

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14
Q

CT indications:

A 
tumours 
intracerebral haemorrhages
intracerebral infarction 
sub/epidural haematomas, sub-arachnoid bleed, lateral shift in structures 
ventricular dilatatin, atrophy 
bone
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15
Q

risks/contraindications of CT scans?

A

pregnancy, young and women - risk of radiation

contrast - allergy/renal impairment

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16
Q

what is an MRI?

A

a strong magnetic field that forces protons in the body to align with that field

when radiofrequency turned off - energy released as protons realign is detected by sensors

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17
Q

pros of MRI?

A 
pros = 
analyse brain soft tissue 
more detail
spinal cord 
nerve roots 
skill base 
resolution 
no radiation 
angiogram (MRA) - without contrast
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18
Q

cons of MRI?

A 
takes 30-80mins 
noisy 
claustrophobic 
expensive 
access to MRI scanner
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19
Q

risk and contraindications of MRI?

A

pacemaker/metal work/foreign bodies
non-compliant patients (younger patients/diabilities)
IV contrast is used

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20
Q

Investigations for suspected bacterial meningitis?

A

LP - CSF stain and cultures, bacterial antigen and PCR

Blood culture

Imaging - CT to r/o intracranial pathology

Bloods - FBC, CRP, Coag, Blood PCR, Glucose

Blood gas

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21
Q

Investigations for suspected viral meningitis?

A

LP - CSF

Viral PCR

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22
Q

Investigations for suspected whipple’s disease?

A

jejunal biopsy - usually has deposition of macrophages containing PAS granules

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23
Q

Investigations for suspected Lyme disease?

A

usually a clinical diagnosis if evidence of erythema migrans if present
ELISA assay - first line
Immunoblot is confirmatory Ix

24
Q

Investigations for suspected Encephalitis?

A

LF - CSF analysis
PCR HSV
CT - medial temporal and inferior frontal changes
EEG - lateral periodic changes

25
Q

Investigations for suspected Creutzfeldt-Jakob/Prion disease?

A

CSF - typically normal
EEG - biphasic, high amplitude sharp waves seen in biphase CJD
MRI - hyperintense signals in the basal ganglia and thalamus

26
Q

Investigations for suspected Migraine headaches?

A

usually a clinical diagnosis

27
Q

Investigations for suspected Cluster Headache?

A

usually a clinical diagnosis

if presents with Horner’s syndrome or pulsatile tinnitus = needs a angiogram to r/o carotid dissection

28
Q

Investigations for suspected tension headache?

A

usually a clinical diagnosis

29
Q

Investigations for suspected Cerebral venous sinus thrombosis

A

CTH

CT cerebral venography or MRV

30
Q

Investigations for suspected Temporal Arteritis?

A

bloods - ESR

Gold standard - USS and temporal biopsy

31
Q

Investigations for suspected Sub Arachnoid Haemorrhage?

A

CTH - exclude haemorrhage
If CTH NAD - do an LP - xanthachromia and opening pressure
if confirmed SAH - CT intracranial angio

32
Q

Investigations for suspected Epidural Haemorrhage?

A

CTH

findings:
usually can see a convex/oval appearance of bleed
mass shift of midline

33
Q

Investigations for suspected Subdural Haemorrhage?

A

CTH

Findings:
crescent shaped feathered fluid
often mass effect of midline shift

34
Q

Investigations for suspected Essential tremor?

A

usually a clinical diagnosis

35
Q

Investigations for suspected Parkinson’s disease?

A

also usually clinically diagnoses

if difficult to differentiate from Essential tremor
SPECT - loss of pigmentation in substantia nigra

36
Q

Investigations for suspected Huntington’s Disease?

A

genetic testing - trinucleotide repeat HTT gene

37
Q

Investigations for suspected Epilepsy?

A

EEG - atypical pattern

MRI brain - ?structural abnormalities

38
Q

Investigations for suspected Febrile seizures?

A

usually a clinical diagnosis

39
Q

Investigations for suspected Status Epilepticus?

A

usually a clinical diagnosis

40
Q

Investigations for suspected foot/wrist drop?

A

usually a clinical diagnosis

41
Q

Investigations for suspected Brain tumour?

A

MRI - midline shift

42
Q

Investigations for suspected Amyotrophic lateral sclerosis?

A

usually a clinical diagnosis

nerve conduction studies - usually normal
electromyography - reduced action potentials with higher amplitudes
MRI - usually done to r/o cervical cord compression and myelopathy

43
Q

Investigations for suspected cerebral palsy?

A

usually a clinical diagnosis - MDT involvement

44
Q

Investigations for syncope?

A

ECG or a 24HR tape

LSBP

45
Q

Investigations for Bell’s Palsy

A

usually a clinical diagnosis - unilateral facial droop where forehead IS affected

46
Q

Investigations for Diabetic/peripheral neuropathy?

A

Bloods = HbA1c, hepatitis serologies, autoimmune markers and VitB12

Nerve conduction studies -

47
Q

Investigations for Guillain barre Syndrome?

A

LP = elevated protein, normal Glucose /WCC

nerve conduction studies = decreased motor conduction

Chronic IDP has similar investigations

48
Q

Investigations for Stroke?

A

non-contrast CT = check for hemorrhagic stroke

MRI

49
Q

Investigations in TIA?

A

usually MRI preferred over CT = allows detection of ischaemic area

urgent carotid doppler

50
Q

Investigations for Raised ICP?

A

CTH = rule out any space occupying lesions or bleeds

LP = invasive LP monitoring - Drain >20mmHg at regular intervals

51
Q

Investiagtions for Alzheimers DIsease?

A

bloods - rule out any reversible causes

Structural imaging = MRI/CT

52
Q

Investigations for Suspected multiple sclerosis?

A

MRI brain = multiple areas of focal demyelinations

LP - CSF will have oligoclonal bands

53
Q

Investigations in Suspected Cavernous Sinus Thrombosis?

A

CTH

CT Venography and MRV

54
Q

Investigations for suspected myasthenia Gravis?

A

ACh antibodies
Musk antibodies
LRP4 Antibodies

CT/MRI of thymus gland

55
Q

Investigations in suspected sarcoid?

A

Largely clinical

CXR (can do CT scans)
ACE levels - not hugely sensitive or specific
Spirometry = restrictive picture
Tissue biopsy = caseating granulomas

ICM Revision (19 decks)

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