Neuro week: emergencies, scenarios Flashcards
DIFFERENTIAL DIAGNOSES
- ascending peripheral polyneuropathy
- muscle atrophy
Guillain Barre
Cause of neuropathy
- ascending
- descending
- ascending: Guillain Barre
- descending: botulism
Which part of nervous system does B12 deficiency usually affect
Dorsal columns
What is Ramsey Hunt syndrome
Shingles (HZV) affecting facial nerve
Range of GCS score
3 to 15
Movement ranking in GCS
6 = Follows commands 5 = Localises to pain 4 = Withdraws from pain (but not at exact point eg squirming away) 3 = Flexion response to pain 2 = Extension response to pain 1 = No response
Verbal ranking in GCS
5 = Appropriate speech 4 = Confused speech 3 = Inappropriate speech 2 = Groans 1 = Nothing
Eye movements ranking in GCS
4 = Spontaneous 3 = Opens eyes to voice 2 = Opens eyes to pain 1 = Nothing
Classical Meningitis triad
- Headache
- Fever
- Neck stiffness
Describe Kernig’s
- flex hip to 90degrees, passively extend knee
- stretches meninges, causes neck pain
Describe Brudzinski
- passively flex neck
- causes involuntary hip flexion
How is bacterial meningitis treated
- in community
- in hospital
Community: IV/IM benzyl-penicillin
Hospital: IV 3rd gen cephalosporin
WHICH TYPE OF MENINGITIS
- elevated neutrophils (polymorphs)
- lymphocytes lower than neutrophils
- high protein
- low glucose
Bacterial
WHICH TYPE OF MENINGITIS
- elevated neutrophils (polymorphs)
- elevated lymphocytes
- high protein
- low glucose
Fungal/ TB
WHICH TYPE OF MENINGITIS
- slightly elevated neutrophils (polymorphs)
- elevated lymphocytes
- normal protein
- normal glucose
Viral
Most important complication of temporal arteritis
Irreversible blindness
Which CN are affected when a pt presents with the following
What’s the diagnosis
- Diplopia on R lateral gaze yesterday, now cannot move eye
- R eyelid drooping
- R eye looks oedematous
- R ptosis, mydriasis (dilated pupil)
- R eye down & out
- Decreased sensation R forehead
CN 3, 5 opthalmic branch, 6 affected
Diagnosis: cavernosus sinus thrombosis
What is considered low glucose in CSF
Less than 30% of serum level glucose
Explain the pathology in spondylosis
- Constant abnormal pressure from joint subluxation, sports, poor posture
- Narrowing of 2 adjacent vertebrae, resulting in compression of nerve root
Radiculopathy (pinched nerve) symptoms in spondylosis
- Severe pain in neck, shoulder, arm, back, leg
- muscle weakness
- paresthesia
Myelopathy (spinal cord injury symptoms in spondylosis)
- Global weakness
- gait dysfunction
- loss of balance
- loss of bladder/ bowel control
Pathophysiology of myasthenia gravis
Antibodies destroy nicotinic Ach receptors at NMJ
prevents nerve impulses from triggering muscle contractions
Common first symptoms of myasthenia gravis
Eye related symptoms
Ptosis, diplopia
Pattern of weakness with myasthenia gravis
Worsens during exertion, improves after rest
How is myasthenia gravis treated
Ach-esterase inhibitors
Most common viral cause of
- meningitis
- encephalitis
Meningitis: enterovirus
Encephalitis: HSV
Differentiate symptoms of meningitis vs encephalitis
Meningitis has more severe flu like symptoms.
Encephalitis has more mild symptoms.
Focal neurological symptoms are more likely to be encephalitis than meningitis
Why do you look for BILIRUBIN in lumbar puncture to diagnose SAH
Bilirubin is sign of broken down RBC. Use it to check how long blood cells have been in CSF
Where is lumbar puncture performed
L4/5
Contraindications for lumbar puncture
- Signs of raised ICP (acute seizure, papilloedema, focal signs)
- immunocompromised
- coagulopathy
- trauma/infection at site of needle insertion
