Neurologic Tests

Question 1

Contraindications LP

Answer 1

signs of herniation
mass effect causing increased ICP
unresolved coagulopathy
overlying infection
brain abscess

Question 2

How to distinguish bacterial, viral, TB meningitis on CSF?

Answer 2

bacterial - polymorphs/neutrophils, LOW glucose
viral - lymphocytes, normal glucose
TB/myco - lymphocytes, LOW glucose

SEE HOW PROTEIN DOESN’T HELP?
protein usually high or normal

Question 3

RBCs with and without xanthochromia

Answer 3

no xantho - traumatic tap

xantho - SAH, hemorrhagic encephalitis

Question 4

What other diseases besides MS can give you oligoclonal bands?

Answer 4

anything with demyelination
ADEM
CNS infection (lyme disease)
inflammation (SLE)

Question 5

MCC complication LP and how to treat

Answer 5

post LP headache
treat by having patient lie down, increase liquid intake/caffeine

can also do epidural blood patch

Question 6

What test MUST you do before LP and what is the exception?

Answer 6

always do CT before LP

EXCEPT during bacterial meningitis