Neuro Flashcards
Meningitis clinical presentation
- Fever
- Meningism: N/V, photophobia, phonophobia, neck stiffness
- Neurological: focal neurological deficits, CN palsies, seizures
- AMS
- +/- purpuric rash (meningococcemia)
How to differentiate between bacterial and fungal / parasitic meningitis?
depends on onset:
acute (<4/52) - bacterial
chronic (>4/52) - fungal / parasitic
Difference between ischaemic and haemorrhagic stroke (from Hx)
Onset (acute)
- sudden: hemorrhagic
- gradual: ischemic
PMHx
- HTN, HLD, DM, AF, Prosthetic valve replacement: ischemic
- Brain aneurysm, head trauma : hemorrhagic
Investigation workup for ischaemic stroke
Biochemical
- Bloods: fasting glucose, HbA1c, Fasting lipids, FBC, GXM, PT/PTT, D-dimer (?), platelet count
- ECG -> note AF
Imaging
- CT cranial angiogram -> localise site of occlusion
- MRI brain -> localise stroke
- CXR -> note prosthetic valve replacement
- Duplex US carotid arteries -> note stenosis
Investigation workup for meningitis
Biochemical
- Lumbar puncture - FEME, cytology, PCR, gram stain, biochemistry
- Bloods: FBC, UECr, ABG, CRP, LFT, blood glucose, PT/INR
Imaging
- CT / MRI brain
Complications of untreated meningitis
- SIADH
- Hearing loss
- Long term: Epilepsy
Management of meningitis
Immediate
- secure ABCs
- monitor vitals + conscious level charting
- obtain blood investigations
- Lumbar puncture
Subsequent
- Empirical IV antibiotics
- bacterial meningitis: IV corticosteroids eg dexamethasone
- viral meningitis: IV antivirals eg acyclovir
how to differentiate between Parkinson’s disease and Secondary Parkinsonism ?
STORE
Parkinson’s Disease:
- aSymmetrical
- resting Tremor present
- gradual Onset
- good Response to L-dopa
Secondary Parkinsonism:
- Symmetrical
- resting Tremor absent
- acute Onset
- no / poor Response to L-dopa
diagnosis criteria for migraine
at least 5 attacks of (any 2):
- duration 4-72h
- pulsatile
- unilateral
- N/V
- visual disturbance
- triggered by routine physical activity
clinical features of cluster headache
- unilateral
- retro-orbital pain; relieved by moving head around; constant, aching, stabbing
- occurs in extreme times of day
- lasts 10min to 2h
- unilateral Horner’s syndrome
- red, watery eye
- nasal congestion
What are stroke mimics TRO
Metabolic: hypoglycemia
Neuropathy: Bell’s palsy
Radiculopathy
Seizure: Todd’s paralysis
Migraine
Cortical signs for MCA infarct
- Aphasia
- Hemi-neglect
- Gaze deviation
Specific signs of cerebellar stroke
- Ataxia
- Vertigo
- N/V
- Nystagmus
Specific signs for brain stem stroke
- Cranial nerve palsies
- Cross sign: ipsilateral CN issue + contralateral limb weakness
What is the difference between aphasia and dysarthria
Aphasia - unable to understand and/or produce speech -> only moaning sounds
Dysarthria - muscle unable to produce smooth speech eg slurred speech
Characteristic features of Myasthenia Gravis
- Muscle fatiguability e.g. ptosis, diplopia, dysarthria, chewing, proximal muscle weakness
- associated with autoimmune thyroid conditions e.g. Graves’ , Hashimoto’s
Investigation workup for Myasthenia Gravis
Biochemical
- AChR-Ab
- Muscle-specific Tyrosine Kinase Ab
- FBC -> note TW
- Nerve conduction study, single-fibre EMG
Imaging
- CXR -> note thymoma, aspiration pneumonia
Management of Myasthenia Gravis
- Anticholinesterase drugs - PO Pyridostigmine
- Corticosteroids
- Thymectomy
Clinical presentation of GBS
- Bilateral weakness ascending from LL
- LL hyporeflexia, flaccid paralysis
- Autonomic dysfunction: cardiac arrhythmia, urinary retention, GI dysfunction
- Cranial nerve involvement: facial diplegia, bulbar dysfunction
3 types of seizures
- acute symptomatic / provoked seizure
- reflex seizure
- unprovoked seizure
3 types of epilepsies
- reflex epilepsy
- drug-resistant epilepsy
- resolved epilepsy
Clinical features of encephalitis
Acute / Subacute (<3/12) onset of:
Prodromal
- fever, headache, nausea
Neurological
- AMS, memory loss
- Seizure
- Focal neurological deficit
- Dysautonomia
Psychiatric
- Hallucination, anxiety, psychosis
Investigation workup for encephalitis
Biochemical
- FBC, CRP, ESR, blood culture, LFT, RP, PT/INR, HIV test
- Lumbar puncture - PCR, gram stain, cultures
- Serologic studies - autoAb
Imaging
- MRI brain w/ contrast
- CT brain
- Electroencephalography: non-specific; used in suspected viral etiology
Brain Biopsy (last resort)
Conditions a/w autoimmune encephalitis
Malignancies:
- Small cell lung CA
- Breast CA
- Hodgkin Lymphoma
- Prostate CA
- Thymoma
Common microB causes of encephalitis
Viral
- Herpes Virus 1-5
- HIV
- Japanese encephalitis virus
- Enterovirus
- Rabies, Measles
Bacterial
- Listeria monocytogenes
- Rickettsia Rickettsia
- Treponema Pallidum
