Neuro Flashcards
BM neonates
listeria, group b strep, EColi
BM elderly
pneumococcal >listeria
BM children
HI
BM 10-21
meningococcal
BM 21>
pneumococcal >meningococcal
meningococcus meningitis treatment
IV ceftriaxone 2g bd (chloramphenicol IV 25mg/kg qds) for 5-7 days and stop dexa
pneumococcal meningitis
ceftriaxone 10 days or 14 if not responding
4 days of dexa
penicillin/cephalasporin resistant meningitis
ceftriaxone 14 days and vancomycin and 4 days of dexa
listeria meningitis
21 days amoxacillin IV 2g 4 hourly (PA co tramox IV 120mg/kg qds)
stop dexa
meningitis post op
IV ceft 2g 8 hourly and IV flucoxacillin and IV vancomycin
Early in patient management of meningitis bacterial
IV ceftriaxone 2g bd and IV amox 2g qds if listeria suspected or >55yo
vancomycin +/- rifampicin if pneumococcal penicillin resistance suspected
steroid (dexa) 10mg IV 15-20 mins before or with first AB dose and then every 6 hourly for 4 days
who is dexa contra indicated in
post surgical meningits
severe immunocompromised
meningococcal/septic shock
hypersensitivity to steroids
viral meningitis cells
colour
protein
glucose
lymphocytes
gin clear
normal/slightly high
normal
bacterial meningitis cells
colour
protein
glucose
polymorphs / neutrophils
cloudy
high
<70% of BG
normal glucose
2.3-4.5
normal protein
0.1-0.4
TB cells
colour
protein
glucose
lymphocytes
cloudy/yellow
high/very high
<60%
close contacts of people with meningitis have a increased risk for how long
6 months
prophylaxis regimes for bacteria mengingitis
600mg rifampicin PO 12 hourly 4 doses for adults and >12
10mg/kg PO 12 hourly 4 doses for 3-11m
500mg ciprofloxacin PO single dose in adults and over 12 yo
250 mg IM ceftriaxone single dose in adults
125mg IV single dose in under 12s
adverse effects of rifampicin
decreased efficacy of oral contraception, red discolouration of urine, contact lenses are stained
Hib
pneumococcal vaccine and conjugate
travel vaccine, group c conjugate
HI
strep pneumonia
nesisseira meningits
viral menignis who
when
cause
infants, young, elderly
late summer/autumn
enterovirsuses
ix for viral
viral stool culture, throat swab and CSF PCR
aseptic meningitis CSF
which kind of patients can it occur
low WBC, minimally elevated protein, normal glucose
HIV px
causes of viral encephalitis
herpes simplex varicella zoster CMV HIV measles west nile Jab b encephalitis tick borne encephalitis rabies
extreme lethargy
west nile
delay in ix for encephalitis
start high dose IV aciclovir anyways
aciclovir in encephalitis dose
neonates -3m 20mg/kg
3m-12yo 500mg/m2
>12 - 10mg/kg
adjust for renal failure
how long is aciclovir given for
given for 14 days
21 if immunocompromised or 3m-12yrs
fungal opening pressure colour cells CSF/glucose protein
high/very high clear/cloudy lymphocytes normal/low 0.2-5
normal opening pressure of CSF
10-20cm
cerebral abscess spread from brain
mastoiditis, otitis media, sinusitis
cerberal abscess blood borne
cyanotic heart disease, dental abscess, lung infection, pelvic infection, skin infection, abd infection
organisms in cerebral abscess immunocomp
fungal, toxoplasmic gondii
ix for cerebral abscess
contrast enhanced CT/MRI - ring enhancing lesion
if dx in doubt do stereotaxic biopsy
treatment for cerebral abscess normal
if staph infection suspected
if PA or MRSA infec suspected/proven
how long
IV ceftriaxone 2g qds and IV metro 500mg 8 hourly
IV flucox 2g qds
IV vancomycin
4w
what is the highest cause of deaths in under 40s
glioblastomas
tumour headache
worse in mornings and increases with coughing, leaning forward
increased ICP symptoms
headache
vom - pressure on medula
mental changes - pressure on frontal lobe
seizures
meningiomas are typically what
benign
having what increases the chance of getting meningiomas
NF2
meningiomas 1 type
who
symp
arachnoid cap cells, extraxial
F>M
asymp
meningiomas 2 symp
headache, CN neuropathies, regional anatomical disturbances
meningiomas 3
benign
slow growing
can have mets
meningiomas aggressors who are these most common in and where
childhood leukaemia in midline
treatment for meningiomas
pre op embolisation
surgery
radio
astrocytic tumours grade 1
truly benign
slow growing
children and young adults
astrocytic tumours grade 1 symp
ix
rx
child - blind in 1 eye, extreme hunger
enhance on contrast
surgery curative
grade 2 (low grade) astrocytic tumour symp
seizures, temp lobe in adults, post frontal, ant parietal
what happens to grade 2
eventually becomes grade 3/4
poor prognostic factors of astrocytoma 2
> 50, seizures, short duration of symp, increased ICP, altered consciousness, enhancement on contrast studies
grade 3 astrocytic tumours
can arise de novo
av survival 2y
grade 4 astrocytic tumours
is what
mean survival
spread
glioblastoma multiforme
most common primary tumour
12-14m
white matter tract, CSF pathways
poor prognostic factors of muktiforme
> 45
crossing midline
6cm
incomplete resection
treatment of grades 3 and 4
surgery
post op radio
temozolomide
better prognosis if what
MGMT methylated tumour
oligodendrogal tumours grade 1
who
symp
24-45s and 6-12yo
seizures
oligo type 2
difficult to extinguish from astrocytomas
treatment of oligo
chemo-sensitive. surgery
radio contraversion but reduces incidence of seizures
gamma knife for treatment of schwannoma
hearing decreases over time
pineal tumours in who
symp
children
hydrocephalus. symp of increased ICP
GCT who
<20s esp 10-12yo
most common CNS GCT
germinomous
radiosensitive
non germatus CNS GCT
teratoma, yolk sac, choriocarcinoma, embryonic carcinoma
