NEURO Flashcards by Majayda Islam

WHat are the different CSF investigations?

pressure - normal 10-18cmH20 on side or 20-30 if sitting up
bichemistry
microscopy
Culture
PCR

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what are normal CSF findings?

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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Bacterial Meningitis on CSF?

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

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Viral meningitis on CSF?

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

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Fungal/TB meningitis on CSF?

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

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Indications of a lumbar puncture?

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

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contraindications of Lumbar puncture?

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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SAH CSF/LP results …..

…..
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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GBS CSF/LP results ,…….

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

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Multiple sclerosis results …..

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

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When are nerve conduction studies used?

carpel tunnel syndrome
GBS
peripheral sensory/motor problems

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what are contraindications of nerve conduction tests?

anticoagulation

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what are complications of nerve conduction tests?

risk of infection
bleeding
pain
damage to underlying structures of nerves

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CT indications:

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

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risks/contraindications of CT scans?

pregnancy, young and women - risk of radiation

contrast - allergy/renal impairment

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what is an MRI?

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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pros of MRI?

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

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cons of MRI?

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

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risk and contraindications of MRI?

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

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Investigations for suspected bacterial meningitis?

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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Investigations for suspected viral meningitis?

LP - CSF

Viral PCR

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Investigations for suspected whipple’s disease?

jejunal biopsy - usually has deposition of macrophages containing PAS granules

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Investigations for suspected Lyme disease?

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

Investigations for suspected Encephalitis?

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

Investigations for suspected Creutzfeldt-Jakob/Prion disease?

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

Investigations for suspected Migraine headaches?

usually a clinical diagnosis

Investigations for suspected Cluster Headache?

usually a clinical diagnosis if presents with Horner's syndrome or pulsatile tinnitus = needs a angiogram to r/o carotid dissection

Investigations for suspected tension headache?

usually a clinical diagnosis

Investigations for suspected Cerebral venous sinus thrombosis

CTH | CT cerebral venography or MRV

Investigations for suspected Temporal Arteritis?

bloods - ESR | Gold standard - USS and temporal biopsy

Investigations for suspected Sub Arachnoid Haemorrhage?

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

Investigations for suspected Epidural Haemorrhage?

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

Investigations for suspected Subdural Haemorrhage?

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

Investigations for suspected Essential tremor?

usually a clinical diagnosis

Investigations for suspected Parkinson's disease?

also usually clinically diagnoses if difficult to differentiate from Essential tremor SPECT - loss of pigmentation in substantia nigra

Investigations for suspected Huntington's Disease?

genetic testing - trinucleotide repeat HTT gene

Investigations for suspected Epilepsy?

EEG - atypical pattern | MRI brain - ?structural abnormalities

Investigations for suspected Febrile seizures?

usually a clinical diagnosis

Investigations for suspected Status Epilepticus?

usually a clinical diagnosis

Investigations for suspected foot/wrist drop?

usually a clinical diagnosis

Investigations for suspected Brain tumour?

MRI - midline shift

Investigations for suspected Amyotrophic lateral sclerosis?

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

Investigations for suspected cerebral palsy?

usually a clinical diagnosis - MDT involvement

Investigations for syncope?

ECG or a 24HR tape | LSBP

Investigations for Bell's Palsy

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

Investigations for Diabetic/peripheral neuropathy?

Bloods = HbA1c, hepatitis serologies, autoimmune markers and VitB12 Nerve conduction studies -

Investigations for Guillain barre Syndrome?

LP = elevated protein, normal Glucose /WCC nerve conduction studies = decreased motor conduction Chronic IDP has similar investigations

Investigations for Stroke?

non-contrast CT = check for hemorrhagic stroke MRI

Investigations in TIA?

usually MRI preferred over CT = allows detection of ischaemic area urgent carotid doppler

Investigations for Raised ICP?

CTH = rule out any space occupying lesions or bleeds LP = invasive LP monitoring - Drain >20mmHg at regular intervals

Investiagtions for Alzheimers DIsease?

bloods - rule out any reversible causes Structural imaging = MRI/CT

Investigations for Suspected multiple sclerosis?

MRI brain = multiple areas of focal demyelinations LP - CSF will have oligoclonal bands

Investigations in Suspected Cavernous Sinus Thrombosis?

CTH | CT Venography and MRV

Investigations for suspected myasthenia Gravis?

ACh antibodies Musk antibodies LRP4 Antibodies CT/MRI of thymus gland

Investigations in suspected sarcoid?

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