Neuro Flashcards
Classic triad for bacterial meningitis
Fever
Headache – severe, generalized, constant
Nuchal rigidity
Classic Triad for viral meningitis
Headache - frontal or retro-orbital
Photophobia
Pain on moving the eyes
Meningitis investigation
Lumbar puncture - CSF analysis
CSF analysis of bacterial
Turbid Opening pressures: markedly elevated Protein >1.5 Neutrophils Glucose down
CSF analysis of viral
Clear
Opening pressures normal to slightly elevated
protein <1
Prevention of meningitis ?
*Immunization:
H. influenzae, S.pneumoniae, N. meningitidis
Prophylaxis:
N. meningitidis, H. influenzae
Complications of meningitis (4)
seizures, cerebral edema, SIADH, deafness
MCC of Encephalitis
Viral - Herpes* (EBV, Varicella)
Herpes encephalitis affects which lobes ?
Frontal (hemiparesis, aphasia) and temporal lobes (olfactory and gustatory hallucination)
Feats of parenchymal involvement in encephalitis?
Altered mental status: confusion, hallucination, agitation
Focal neurologic deficits: aphasia, ataxia
Rabies virus encephalitis
early brainstem involvement
Hypersalivation
Hydrophobia
Aerophobia
West Nile Virus/St. Louis encephalitis
Basal ganglia and thalamus affected
tremor, myoclonus, TRAP
Investigation preferred for encephalitis
MRI
HSV - limbic
Abscess clinical feat
intracranial mass +/- infection
Headache 75%
Focal neurologic deficit: aphasia, ataxia >60%
Fever 50%
MC cause of abscess formation
Hematogenous spread: Endocarditis & pyogenic lung
Direct spread of an abscess
Mastoiditis
Sinusitis
Abscess investigation
MRI
Which sources are the most frequent causes are blood-borne infections?
lungs, heart, sinuses, and ears (chronic otitis media)
Tension HA clinical feat
F>M* Minutes - days NO Fam Hx Bilateral - frontal, Nuchal - occipital* Band-like; constant* Triggers: depression, anxiety, noise, hunger, sleep
Migraine: Clinical Features
AGE: 10 - 30
Sex Bias: F > M 3:1
Family History +++**
Location: UniLateral > bilateral; Fronto-temporal region**
Duration: Hours – days (4-72 hours)**
Quality: Throbbing/Pulsatile**
Severity: Moderate - Severe
Triggers: Tyramines (i.e. red wine), nitrites (i.e. processed meats), drugs, caffeine, alcohol, chocolate
Palliating: Rest, sleep
Assoc. Sy: Aura, N/V, Sensitivity to sound light
Cluster Headaches Feat
20 – 40 M > F Fam Hx + Retro-orbital 10 min – 2 h Rapid onset, daily attacks for weeks to months; more common early am or late pm Constant, aching, stabbing Severe (wakes from sleep) Light, Alcohol
** rhinorrhea, unilateral Horner’s (meiosis, ptosis, decreased sweating), unlilateral lacrimation, eye pain
Tx: 100 O2 ***
Idiopathic Intracranial Hypertension(Pseudotumor Cerebri) clinical feat:
Headache
• Pulsatile, diffuse, awakens the patient/worse in am, exacerbated by Valsalva
• Nausea/ vomiting
• Pulsatile tinnitus
• Visual disturbance
• Bilateral Papilledema** - increased ICP
What will investigations show for a IIH ?
normal CT
high opening pressure on LP
Ictal Hx for seizure
Tonic (stiffening) or clonic (jerking) limb and body movement
Automatisms
Head turning
Tongue biting
