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Neuro Flashcards

1
Q

What condition is characterized by an acute onset of neurological deficits that gradually improve over time?

A
  • Transient Ischemic Attack
  • Bell’s Palsy (face only)
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2
Q

Which conditions can mimic stroke like symtoms? (9)

A
  • BG < 60mg/dl
  • Bells Palsy
  • Todd’s paralysis
  • migraines
  • psych disorders
  • infections
  • seizures
  • metabolic/toxic disorders
  • structural brain lesions
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3
Q

How long do TIA symptoms usually last?

A

< 1hr

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4
Q

What is the gold standard test for both TIA’s and stroke?

A

rapid assessment

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5
Q

What imaging studies are done when a stroke is suspected?

A
  • CT head w/out contrast
  • CT angiography brain and neck
  • MRI brain (see changes w/in 30min)
  • TEE (aortic arch, LA, PFO)
  • CXR (evaluate cardiomyopath)
  • ekg
  • Echo
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6
Q

When should an MRA brain and neck be done on a suspected stroke patient?

A

when CTA is contraindicated, MRA does not need contrast

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7
Q

When should a carotid US de done for a patient with a suspected stroke?

A

if MRA and CTA are contraindicated

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8
Q

What labs should be drawn on a suspected stroke patient?

A
  • BG
  • troponin
  • E-lytes (to see if Na, K are low)
  • CBC (anemia, polycythemia)
  • PT/INR (hypercoagulopathy)
  • BUN/Creatinine (renal sufficiency)
  • lipid panel
  • toxicology screen
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9
Q

What are the 2 main types of strokes?

A
  • Ischemic
  • Hemorrhagic
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10
Q

What are the types of the ischemic strokes?

A
  • thrombotic
  • embolic
  • cryptogenic
  • lacuner
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11
Q

What are the types/causes of hemorrhagic strokes?

A
  • intracranial hemorrhage (ICH)
  • subarachnoid hemorrhage (SAH)
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12
Q

Which type of stroke is associated with “a severe HA that radiates down the neck?
- worst headache of a patients life

A

subarachnoid hemorrhage

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13
Q

What is the most commonly occluded vessel and cause of ischemic stroke?

A

middle cerebral artery (MCA)

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14
Q

What should the BP in a patient prior to and during administration of tPA thrombolytic?

A

1) Prior:
- SBP < 185 and DBP < 110
2) During:
- SBP <180 and DBP < 105

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15
Q

Which medications are recommended for BP control prior to and during administration of tPA?

A
  • labetolol 10-20mg IV push
  • nicardipine gtt 2.5-15 mg/hr
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16
Q

What timeframe after symptom onset should alteplase be started in a stroke patient?

A

< 4.5 hrs

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17
Q

What are contraindications for thrombolytic therapy in stroke patients?

A
  • current ICH/SAH
  • active bleeding
  • head trauma/surgery < 3 months
  • uncontrolled Systolic BP >180 mmHg
  • uncontrolled diastolic BP > 110 mmHg
  • aortic dissection
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18
Q

What is the dosing for Alteplase?

A

-0.9mg/kg (max 90mg) admin over 1hr
- 10% given as bolus with other 90% given over an hr

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19
Q

Why are nitroprusside or nitrogylcerin not given to a patient with a hemorrhagic stroke?

A
  • both cause vasodilation, which can increase the intracranial pressure
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20
Q

What is the reversal agent for heparin?

A

protamine

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21
Q

What are/is the reversal agent(s) for warfarin (coumadin)?

A
  • Vitamin K
  • 4- Factor Prothrombin Complex Concentrate (4FPCC)
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22
Q

What is Apixaban brand name?

A

Eliquis

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23
Q

What class of medication is apixaban (eliquis)?

A

Factor Xa inhibitor

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24
Q

What class of medication is rivaroxaban (xarelto)

A

Factor Xa inhibitor

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25
Q

What is the brand name for rivaroxaban?

A

Xarelto

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26
Q

What is hydrocephalus?

A

blockage of CSF flow resulting in dilation of the brain ventricles

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27
Q

How much CSF does the brain produce?

A

500ml/day

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28
Q

What are the s/s of hydrocephalus in an adult?

A
  • cognitive decline
  • HA (initially in am)
  • neck pain
  • vomitting (bad in the am)
  • blurred or double vision
  • upward gaze
  • drowsiness
  • unsteady gai
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29
Q

Why is a CT scan of the brain done in a suspected stroke patient?

A

to rule out structural causes
- Subdural Hematoma
- Intracranial Hemorrhage
- brain tumor

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29
Q

In a suspected stroke patient, whey is an brain MRI better than a CT scan?

A
  • MRI is more sensitive in detecting early pathological changes
  • MRI shows changes seen < 30min
  • CT shows changes 6-8hrs
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29
Q

An MRI is the preferred imaging study for which type of strokes?

A

lacunar stroke and TIA

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29
Q

What is a lacunar stroke?

A

a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked

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29
Q

What is the term for a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked?

A

Lacunar stroke

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29
Q

How long does it take for pathological changes following or during a stroke in the brain to appear on an CT scan?

A

6-8 hrs

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29
Q

In a stroke patient with A-Fib or Flutter lasting > 48hrs , which anticoagulant should be administered and for what timeframe when planning for a cardioversion?

A
  • Warfarin
  • factor Xa inhibitor
  • direct thrombin inhibitor
  • given for at least 3 weeks prior to and 4 weeks following a cardioversion
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29
Q

What is the other name for aspirin?

A

acetylsalicylic acid

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29
Q

What is the 1st line therapy medication to reduce the risk of stroke in patients with TIA?

A

aspirin (acetylsalicylic acid)

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29
Q

How long does it take for pathological changes following or during a stroke in the brain to appear on an MRI?

A

< 30 min

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30
Q

What is the dosing for aspirin when used to prevent strokes in patients with TIA?

A

180mg x 5 days then 81mg QD

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30
Q

What medication is recommended for patients with LDL > 100 and < 75 y/o for stroke prevention?

A
  • high intensity statin therapy
  • 80mg atorvastatin
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30
Q

Why is a non-contrast CT scan of the brain done on a suspected TIA patient?

A

to r/o structural causes for the symptoms such as subdural hematoma, intracranial hemorrhage or tumor

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30
Q

What imaging study is done to r/o structural causes in a suspected TIA patient?

A

Non-contrast CT scan

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30
Q

What imaging study is done to evaluate the vessels of the neck and brain for patency/occlusions?

A

CT angiography (CTA)
- requires contrast

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31
Q

An MRI is the preferred image study to detect which type of TIA?

A

lacuner or vertebrobasilar

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32
Q

What labs should be done for a patient with suspected TIA?

A
  • CBC to r/o:
    • anemia/polycythemia
  • BG
  • CMP to r/o e-lyte imbalances
  • coag panel to r/o:
    • hypercoagulopathy
  • lipid panel
    • hyperlipidemia/dyslipidemia
  • BUN/Creatine to r/o:
    • renal insufficiency
  • troponins to r/o:
    • MI
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33
Q

What is the difference between the NIHSS and ABCD2s score?

A
  • NIHSS is used to assess the initial severity of the symptoms r/t a TIA or stroke
  • ABCD2 tool predicts risk of future stroke
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34
Q

What vessel is the most commonly occluded and cause of ischemic stroke?

A

Middle Cerebral Artery (MCA)

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35
Q

Why should a repeat CT scan be completed 24 hrs following a suspected stroke?

A

infarct my not be visible for up to 24hrs

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36
Q

According to the AHA, the BP should initially lowered by how much in a suspected/confirmed stroke patient?

A

lower BP by 15%

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37
Q

Which medications are recommended for lowering BP in suspected stroke patient?

A
  • Labetolol 10-20mg IV push
    • may repeat once
  • Nicardipine 2.5-15 mg/hr gtt
    • titratable to goal
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38
Q

What is the dose of Labetalol used to treat HTN in a suspected stroke patient?

A

10-20mg IV push, may repeat once

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39
Q

What is the dose of Nicardipine used to treat HTN in a suspected stroke patient?

A

1.5-15 mg/hr, titratable to goal

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40
Q

What are the contraindications to thrombolytic therapy with altepase?

A
  • Intracranial Hemorrhage
  • Sub-Arachnoid Hemorrage
  • any active internal bleeding
  • head/spinal trauma in last 3 months
  • severe uncontrolled HTN
  • arterial-venous malformations in brain
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41
Q

What is the maximum dose of Alteplase that can be given?

A

90 mg

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42
Q

What is the dose of alteplase dose and how is it administered?

A
  • 0.9mg/kg
  • 10% given as bolus over 1 min
  • 90% given over 1 hr
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43
Q

Why is succinylcholine contraindicated in patients with an ICH/SAH?

A

it causes transient increase in intracranial pressure (ICP)

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44
Q

What is the systolic BP goal in a patient with an ICP/SAH?

A

less than 140 mmHg

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45
Q

What medications are recommended in the treatment of HTN in a patient with an ICH/SAH?

A
  • Nicardipine 5-15 mg/hr gtt
  • Labetolol 10 mg IV PRN
  • Hydralazine 10 mg IV PRN
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46
Q

What is the normal range for intracranial pressure (ICP)?

A

4-13 mmHg or 7-18 cm H2O

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47
Q

What is the normal Cerebral Perfusion Pressure?

A

60-80 mmHg

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48
Q

At a serum sodium of _____, there is an increased risk of seizures, renal failure, pulmonary edema and HF?

A

Na > 160 mEq/L

49
Q

Which electrolyte abnormality is common among patients with a Sub-Acute Hemorrhage?

A

hyponatremia
- cerebral vasospasm injures hypothalamus and stimulates ADH release from the anterior pituitary

50
Q

What is the treatment of choice and goal of therapy for when treating cerebral salt wasting r/t a SAH?

A
  • 3% Na soln 30-60 mL/hr
  • goal = 320 mOmol/L
51
Q

What are the types of aneurysms?

A
  • berry (aka saccular)
  • fusiform
  • mycotic
  • pseudo-aneurysm
52
Q

Type of aneurysm that balloons or bulges out on all sides of the artery and takes on bizarre shapes?

A

fusiform

53
Q

What class of medication is recommended for use in the e treatment of a vasospasm following an acute SAH?

A
  • Calcium Channel Blocker
  • Nimodipine PO 60 mg q4 x 21 days
54
Q

What are causes of hydrocephalus?

A
  • CSF over secretion/production
  • obstruction of CSF flow (lesion/tumor)
  • impaired absorption
55
Q

What is communicating hydrocephalus?

A
  • when the flow CSF is obstructed after it leaves the ventricles
  • CSF can still flow between the ventricles
56
Q

What is non-communicating/obstructive hydrocephalus?

A
  • obstruction occurs within or next to the ventricular system which prevents CSF from circulating normally
57
Q

Specific S/S of hydrocephalus in an infant?

A
  • poor feeding
  • irritability
  • reduced activity
  • vomitting
58
Q

What are the classic symptoms of hydrocephalus?

A
  • cognitive deterioration
  • neck pain
  • vomitting (more often in am)
  • blurred vision
  • double vision
  • drowsiness
  • papilledema
  • can’t look up
  • unsteady gait
  • larger head
  • uni or bilateral 6th nerve palsy
59
Q

What imaging study is done to assess for potential/suspected hydrocephalus?

A
  • CT scan of brain for size of ventricles
  • MRI to detect flow voids
  • Transcranial doppler
60
Q

Autoimmune disease characterized by rapid progression of ascending paralysis and areflexia that begins in the lower extremities and is preceded by an infection?

A

Guillain-Barre Syndrome (GBS)
- affects motor neurons more than sensory

61
Q

In patient with Guillain-Barre Syndrome (GBS), when can they expect the max deficit to occur from time of onset?

A

usually by week 4

62
Q

What is the cause of Guillain-Barre Syndrome?

A
  • autoimmune disease where the pts immune system attacks peripheral nerves causing ascending paralysis that begins in the lower extremeties
  • usually preceded by an infection
63
Q

Are symptoms of Guillain-Barre Syndrome permanent?

A
  • Not permanent
  • most fully recovery, but can take months or years
64
Q

What are the S/S of Guillain-Barre syndrome?

A
  • usually symmetric rapid progression of muscle weakness and paresthesia that begin in the legs and moves up body
  • reduced/absent deep tendon reflexes
  • can cause total motor paralysis leading to respiratory failure
65
Q

What tests are done to confirm Guillain-Barre Syndrome?

A
  • LP for CSF: will see
    • elevated CSF protein, esp IGG
    • > 1000 mg/dl
  • CBC:
    • leukocytosis with a shift to
      the left that resolves during
      the course of illness
  • Motor/Sensory nerve
    • conduction studies and
      needle electromyography
    • slow conduction r/t
      demyelination
66
Q

What is the treatment for Guillain Barre Syndrome?

A
  • there is no known cure
  • admit to ICU and monitor cardiovascular and respiratory status
  • Consult neurologist
  • IVIG or plasmapharesis/plasma exchange (PLEX) are 1st line therapies
67
Q

What is the term for the group of muscles that control swallowing, chewing, speaking, and keeping the jaw in place?

A

Bulbar Muscles

68
Q

Which receptor is affected in patients with Myasthenia Gravis?

A

Acetylcholine receptors (AChR) at the postsynaptic membrane of the neuromuscular junction are attacked by the patients immune system

69
Q

S/S of Myasthenia Gravis?

A
  • ptosis (eye droopage)
  • diplopia
  • facial weakness
  • dysphagia
  • dysarthria
  • dysphonia
  • respiratory weakness
  • no loss of deep tendon reflexes
70
Q

What are common precipitating factors that cause a Myasthenic Crisis?

A
  • infections
  • stress (trauma, surgery)
  • rapid start, stop, tapering of steroids
  • withdrawal of cholinesterase inhibitors
  • drugs
71
Q

What tests should be run on a patient with suspected Myasthenia Gravis?

A
  • Antibody testing
    • AChR: + in 80-85% of pts
    • MuSK: + in 50% of pts that
      test AChR AB +
    • antinuclear antibodies +
    • antithyroid AB +
    • rheumatoid arthritis factor
  • Repetitive nerve stimulation
  • single fiber electromyography
  • MRI/CT of anterior mediastinum may find thymoma
  • thyroid function test: MA pts have higher incidence of thyroid disease
  • B12: may be low
72
Q

How is Myasthenia Gravis managed?

A
  • consult neurologist
  • Cholinesterase inhibitors
    • pyridostigmine bromide
  • prednisone: if don’t respond well to cholinesterase inhibitors
  • Azathioprine: immunosuppressant
    • used to prevent organ rejection
      and to tux rheumatoid arthritis
73
Q

Why is hyperventilation (PaCO2 25-30%) used in the treatment of a patient with a TBI?

A
  • used when herniation symptoms are present
  • it causes cerebral vasoconstriction, which lowers ICP
  • careful not to cause cerebral ischemia
74
Q

What is the term meaning periorbital ecchymosis/bruising caused by an anterior skull base fracture?

A

Raccoon eyes

75
Q

What is the term for mastoid (behind the ear) ecchymosis related to a posterior skull fracture?

A

Battle sign

76
Q

An epidural hematoma is a bleed between which layers of the brain?

A

in the epidural space between the skull and dura mater

77
Q

A subdural hematoma is a bleed between which layers of the brain?

A

caused by tearing of bridging veins between the dura mater and arachnoid or pial layers

78
Q

A patient with a penetrating head wound should be started on which antibiotics?

A
  • ceftriaxone
  • metronidazole
  • vancomycin
  • for minimum of 6 weeks
79
Q

What are the components of Cushings Triad?

A

Signs of increased ICP:
- Systolic HTN with widening pulse pressure
- Irregular respiratory rate
- Bradycardia

80
Q

What are the treatment strategies to manage increased ICP?

A
  • elevated HOB >30 deg
    • promote venous drainage
  • sedation and opioids
    • reduces metabolic demand
      and relieves anxiety
  • Code Cool
    • reduces metabolic demand
  • Possibly paralysis
  • hyperosmolar therapy (mannitol, hypertonic Na- 2,3%)
    • pulls excess H2O across BBB
      from CNS to intravascular
      space
  • Surgery: decompressive craniotomy
  • anticonvulsants
  • DVT prophylaxis
  • BG control
81
Q

When should ICP monitoring be started in an patient with a TBI?

A
  • comatose (GCS 3-8) with abnormal CT scan
  • comatose with normal CT and 2 of:
    1) > 40 y/o
    2) uni/bilateral posturing
    3) hypotension
82
Q

Treatment to lower ICP should be initiated when the ICP is?

A

> 22 mmHg for > 5 min
- normal range is 5-15 mmHg

83
Q

Cerebral perfusion pressure (CPP) should maintained at what value in a patient with a TBI?

A
  • minimum of 60 mmHg
  • CPP = MAP - ICP
84
Q

What type of medication is Phenytoin?

A

Anticonvulsant
- aka: Dilantin

85
Q

Dilantin is the brandname for which medication?

A

Phenytoin

86
Q

What are the causes of both TIA and strokes?

A
  • atherosclerosis
  • cardiac emboli
  • vasculitis
  • anemia (low RBC)
  • polycythemia (high RBC)
  • thrombocytosis (high PLT)
  • thrombocytopenia (low PLT)
  • hypercoagulable states
  • orthostatic hypotension
87
Q

What are risk factors for TIA? (9)

A
  • HTN > 140/90
  • cardiac disease
  • smoking
  • obesity
  • HLD
  • high homocysteine levels
  • age > 60
  • DM
  • alcohol/drug abuse
88
Q

What diagnostic test should be done on a suspected TIA patient? (13)

A
  • NIHSS
  • ABCD2 score
  • continuous telemetry (afib)
  • BG
  • troponins
  • CBC w/ plt count
  • coag panel (pt, INR)
  • CMP
  • lipid panel
  • tox screen
  • Brain imaging (CT,MRI brain, CTA)
  • TEE
  • CXR (cardiomegaly)
89
Q

What coagulation studies should be drawn on a patient with a suspected TIA or stroke?

A
  • prothrombin time (PT)
  • INR
  • fibrinogen
  • D-dimer
  • anticardiolipin (aCL) AB, inc clotting
  • Factor VII
  • Von Willebrand Factor
90
Q

Which medication(s) should be considered for patient with the following:
- Afib/flutter lasting < 48hrs
- CHADS2VASC2:
- men > 2
- women > 3

A
  • anticoagulation with:
    • heparin
    • warfarin (factor Xa inhibitor)
    • Direct-acting Oral AntiCoag
91
Q

What is the first line medication and dose when starting antiplatelet therapy in a TIA patient to reduce risk of stroker?

A
  • Aspirin (acetylsalicyclic acid)
  • 160 mg x 5 days, then 81mg QD
92
Q

What is the difference between a TIA and stroke?

A
  • TIA is a transient neurological condition with no infarct
  • stroke involves destruction of a portion of brain parenchyma due to an infarct
93
Q

Low cholesterol increases the risk for which type of stroke?

A

hemorrhagic stroke

94
Q

A CT scan of the head w/out contrast should be done within what timeframe of arrival to the hospital in a suspected stroke patient?

A

within 20 min
- done to r/o cerebral hemorrhage

95
Q

What is the treatment for orolingual angioedema associated with IV alteplase administration?

A
  • discontinue infusion
  • airway management
  • IV methylprednisolone 125mg
  • IV benadryl 50 mg
  • ranitidine 50mg or famotidine 20 mg
96
Q

Aspirin administration is delayed for how long in patients treated with IV altepase following an acute ischemic stroke?

A

delayed for 24hrs

97
Q

If the left side of the brain is affected by stroke, what symptoms might the patient be expected to present with?

A
  • expressive and/or receptive aphasia
  • small percentage of left handed patients have right sided dominance and may present with left sided weakness and aphasia
98
Q

If the right side of the brain is affected by stroke, what symptoms might the patient be expected to present with?

A
  • unilateral/left sided neglect
99
Q

What are the common presenting symptoms of hemorrhagic stroke?

A
  • seizures
  • vomiting
  • headache
  • diminished LOC
100
Q

What antihypertensives are recommended to lower BP in a patient with an ICH or SAH?

A
  • CCB
    • nicardipine 5-15mg/hr
    • clevidipine
  • labetolol 10mg PRN
  • hydralazine 10mg PRN
101
Q

How do you calculated cerebral perfusion pressure (CPP)?

A

MAP - ICP

102
Q

What are the treatment options for the management of an aneurysm?

A
  • surgical clipping
  • endovascular coiling
103
Q

What are the general management steps for an ICH/SAH?

A
  • ABCs
  • BP control
  • anticoagulation reversal
  • external ventricular drain
  • strict bedrest
  • minimize stimuli
  • seizure prophylaxis
  • craniectomy for hematoma evacuation
104
Q

What is the cause of the hyponatremia associated with a SAH?

A
  • stroke causes cardiac dysfunction and release of B-Type Natiuretic peptide (BNP) from the myocardial ventricular cells causing excess secretion for sodium and water in the urine
  • BNP will be high following a stroke
105
Q

What is the most common cause of non-traumatic subarachnoid hemorrhages?

A

rupture of a berry/saccular aneurysm

106
Q

How big does an aneurysm need to be for treatment to be started?

A

5mm or bigger

107
Q

When should treatment be considered or started for a patient with an aneurysm?

A
  • size is 5mm or greater
  • prior hx of aneurysm rupture
  • changes in shape/size in between interval imaging
  • daughter domes present: odd, non-smooth morphology
108
Q

What are the cranial nerves?

A

I - olfactory nerve (smell)
II - optic nerve (sight)
III - oculomotor nerve (move/blink eyes)
IV - trochlear nerve
V - trigeminal nerve
VI - abducens nerve
VII - facial nerve
VIII - vestibulocochlear nerve
IX - glossopharyngeal
X - vagus
XI - accessory nerve
XII -hypoglossal

109
Q

When should intubation be considered in a patient with Guillain-Barre Syndrome (GBS)?

A
  • vital capacity < 12-15 mL/kg
  • PaO2 < 70
  • difficulty clearing secretions
  • concerns for aspiration
110
Q

What is the leading cause of death in a patient with Guillain Barre Syndrome (GBS)?

A

autonomic dysfunction
- brady/tachy arryhthmias
- hyper/hypotension

111
Q

What is/are considered first line therapies for the treatment of Guillain-Barre Syndrome?

A
  • PLEX (plasmapheresis)
  • IVIG (intravenous immunoglobulin)
112
Q

When is intubation and mechanical ventilation indicated for a patient with Guillain Barre Syndrome (GBS)?

A
  • vital capacity < 12-15 ml/kg
  • PaO2 < 70
  • difficulty clearing secretions
  • concerns with aspiration
113
Q

Patients with which antibody are most likely to experience a Myasthenic Crisis?

A

Muscle-specific kinase (MUSK) antibody

114
Q

Which antibiotics are risk factors for developing myasthenia gravis?

A
  • aminoglycosides
  • fluoroquinolones
  • macrolides
115
Q

Pyridostigmine bromide (Mestinon) is what class of medication?

A

Cholinesterase inhibitor
- used to tx myasthenia gravis
- reverse effects of nondepolarizing muscle relaxants

116
Q

What is the scoring range for the Glascow Coma Scale?

A

Range is 3-15:
- 3 = worst score
- 15 = best score

117
Q

A patient with a Glascow Coma Scale score of _?__ is considered to be in a coma?

A

8 or less

118
Q

A sluggish, unequal, or enlarged pupil w/o response or “blown pupil” is indicative of what?

A
  • increased ICP or brain herniation
119
Q

Layers of the head from bone to brain?

A
  • skull
  • epidural space
  • dura mater
  • subdural space
  • arachnoid mater
  • subarachnoid space (vessels in this layer)
  • pia mater
  • brain
120
Q

What are the meningeal layers (meninges)?

A
  • dura mater
  • arachnoid mater
  • pia mater
121
Q

What is the term for the inflammation of the meninges caused by a viral, bacterial, or fungal infection?

A

Meningititis

122
Q

What is the most common organism that causes bacterial meningitis?

A

Streptococcus Pneumonia called Pneumococcal meningitis

123
Q

What organism is the most common cause of viral meningitis?

A

Enterovirus

124
Q

What are the signs/symptoms of meningitis?

A

1) Classic Triad:
- stiff neck (nuchal rigidity)
- fever
- altered mental status
2) Other S/S:
- severe HA
- photophobia
- seizures
- chills
- N/V
- pos Brudzinski’s sign
- pos Kernig’s sign

125
Q

What are the classic signs of meningitis?

A
  • fever
  • nuchal rigidity
  • altered mental status
126
Q

What is considered a positive Brudzinski’s sign?

A

if the patient flexes/bends their hips and knees when the provider lifts their head

127
Q

What is considered a positive Kernig’s sign?

A

if the patient reports/experiences spasms/pain in the hamstring when the provider extends the leg towards the sky after flexing the patients knee, then hip to a 90 degree angle

128
Q

What is the gold standard test to diagnose meningitis?

A

Lumbar Puncture (LP)

129
Q

Compare the following LP CSF sample characteristics for bacterial vs viral meningitis?
1) Appearance
2) Cells
3) Total Protein
4) Glucose
5) Culture q

A

Bacterial:
1) Cloudy appearane
2) increased WBCs, most are polymorphonuclear
3) total protein: 100-500/mm
4) low glucose: 5-40 mg/dl
5) bacteria on gram stain

Viral:
1) clear (occasionally cloudy) appearance
2) increased WBC’s, most are mononuclear
3) total protein: < 200 mg/dl
4) normal glucose (> 45 mg/dl)
5) no bacteria on culture

130
Q

What is the term for fast, painful sensations that travels from the neck down the spine and can radiated to the arms and legs?

A

Lhermitte’s sign
- seen in MS and pts with cervical nerve damage
- aka barber chair phenomenon

131
Q

What is the term for an increased rigidity of the muscles due to brain or spinal cord injury?

A

Spasticity

132
Q

What are the diagnostic tests for multiple sclerosis?

A
  • full neuro exam
  • MRI of head/neck
  • cerebrospinal fluid analysis ‘
133
Q

What are white mater lesions in the brain?

A

areas of abnormal myelination in the brain that appear as bright spots on MRI

134
Q

What would be seen in the CSF of a patient with multiple sclerosis?

A
  • elevated IgG and oligoclonal bands in CSF, but not in serum
  • bands are indicative of MS
135
Q

What is the treatment of choice for a patient experiencing an relapse of symptoms related to multiple sclerosis?

A
  • high dose glucocorticoids
  • IV or oral
  • methylprednisolone 500-1000mg/day
136
Q

Prednisolone is what type of medication?

A

glucocorticoid

137
Q

Methylprednisolone is what type of medication?

A

glucocorticoid

138
Q

Dexamethasone is what type of medication?

A

glucocorticoid

139
Q

Glucocorticoids are used to treat what conditions?

A
  • allergies
  • asthma
  • autoimmune diseases
  • sepsis

NP School (19 decks)

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