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ICM - OBS > Neurology > Flashcards

Neurology Flashcards

1
Q

Where is CSF produced?

A

choroid plexus of ventricles

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2
Q

How is CSF obtained?

A

Lumbar puncture

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3
Q

What is the normal pressure for CSF?

A

Normal 10-18cmH2O if on side

20-30cmH20 if sitting up

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4
Q

What investigations are carried out with CSF?

A

Biochemistry
Microscopy
Culture
PCR

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5
Q

What pathologies can be identified with CSF?

A

High pressure
Infection
Inflammation
Occult Bleeding (SAH)

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6
Q

What are CSF findings of bacterial meningitis?

A

Pressure: Elevated
Appearance: Turbid
Protein: Elevated
Glucose: Low

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7
Q

What are CSF findings of viral meningitis?

A

Pressure: Normal
Appearance: Clear
Protein: elevated
Glucose: normal

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8
Q

What are CSF findings of fundal/TB meningitis?

A

Pressure: Elevated
Appearance: Clear/fibrin web
Protein: elevated
Glucose: low

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9
Q

SAH - CSF findings

A

Pressure: Elevated
Appearance: Xanthochromia, bloody, or clear
Protein: elevated
Glucose: normal

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10
Q

Indications for Lumbar Puncture

A
  1. Diagnosis of meningitis and encephalitis
  2. Diagnosis of other neurological conditions
    - -> MS, neurosyphilis, GBS, Sarcoid etc…
  3. Diagnosis of SAH
  4. Measurement of CSF pressure (intracranial hypertension)
  5. Therapeutic removal of CSF
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11
Q

Contraindications of LP

A
  1. Suspicion of mass lesion in brain or spinal cord
    - -> May cause coning
  2. Raised intracranial pressure
    - -> Headache, nausea, vomiting, hypertension, low GCS, acute confusion, diplopia, unreactive pupils, papilloedema
  3. Local infection near site of puncture
  4. Congenital spinal problems
    - -> Spina bifida
  5. Low platelets (<40), coagulopathy, anticoagulants
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12
Q

Procedure of LP

A
  1. Informed consent, patient prepped and toileted
  2. Patient in L lateral, foetal position
  3. Identify 2nd and 3rd or 3rd and 4th interlumbar spaces
  4. Mark and sterilise area. Local
    anaesthetic to skin
  5. Spinal needle into midline of back towards umbilicus
  6. Penetrate Dura (feels a give/squish/squelch/crunch)
  7. Measure opening CSF pressure (using manometer) if indicated
  8. Collect 3 sequential samples (5-8 drops each)
  9. Get Blood Glucose as well as
  10. CSF Glucose sample
  11. Needle out, Dressing
  12. Lie patient flat for 1 hour
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13
Q

Complications of LP

A

BAD:

  • Cerebral and Spinal Herniation
  • Spinal Infection
  • Bleeding and spinal haematoma
NOT BAD:
Nerve irritation
Dural tap Headache
- Most common but not so bad
- Drinks lots of water and caffeine
- Epidural blood patch
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14
Q

Examples of Nerve tests

A
  1. Nerve Conduction Studies (NCS) – tests electrical conduction down specific nerves
  2. Needle Electromyography (EMG) – measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle

These usually happen in conjunction with each other

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15
Q

Indications for Nerve Tests

A
  1. Carpal tunnel syndrome, Cubital Tunnel Syndrome, Guillain–Barré syndrome, Guyon’s canal syndrome, peripheral neuropathy, Peroneal neuropathy, Spinal disc herniation, Tarsal Tunnel Syndrome, Ulnar neuropathy
  2. Peripheral sensory problem
  3. Peripheral motor problem
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16
Q

Contraindication for Nerve Test

A

Fairly low risk

- Anticoagulation

17
Q

Complication of Nerve Test

A

Risk of infection/bleeding/pain

Damaging underlying structures or the nerves

18
Q

Indications for brain radiology

A

Imaging of Bone
Imaging of Brain
Imaging of Blood vessels
Imaging of everything else

19
Q

Types of brain radiology

A 
Xray – Rarely done
CT – Most common	
MRI – Most detailed
USS – In children/Optic sheath for RICP
Others
-->PET/Angio/Isotope
20
Q

What is a CT?

A

Xray beam moves in a circle forming a cross-sectional view of the body.

Different attenuation of bone, brain, blood and soft tissues.

Pictures can be manipulated and viewed in different planes.

21
Q

Types of CT

A
  1. Non-contrast – no dye given. Good for bone and bleeding.
  2. Contrast – Given IV dye and timed to allow dye to diffuse around tissues. Useful for distinguishing soft tissue.
  3. Angiogram – Given dye and CT done at specific timing to show blood passing through arteries.
22
Q

WHAT DENSITY IS ACUTE BLOOD ON CT head?

A

Hyperdense (bright white)

Old blood - hypodense

23
Q

What is CT head good for?

A 
Tumours (>1cm)
Intracerebral Haemorrhage and Infarction
Sub- and extradural haematoma
Sub arachnoid bleed
Lateral shift of structures and ventricular dilatation
Atrophy
Bones
24
Q

Risks & contraindications for CT

A

Radiation

  • > Pregnancy
  • > Young
  • > Women

Contrast

  • > Allergy
  • > Renal impairment
25
Q

What is MRI?

A

Uses powerful magnets which produce a strong magnetic field that forces protons in the body to align with that field.

A radiofrequency current is then pulsed through the patient and the protons are stimulated, spinning out of equilibrium, straining against the pull of the magnetic field.

When the radiofrequency field is turned off, the MRI sensors are able to detect the energy released as the protons realign with the magnetic field.

Using this information, the body can be imaged in multiple planes.

26
Q

Types of MRI

A

Non contrast
Contrast (gadolinium) – generally safe (?renal problems)
MR Angiogram
MR Venogram

27
Q

Risks and Contraindications

of MRI

A

People with pacemakers/metalwork/foreign bodies
Non compliant patient
IV contrast

28
Q

How many hours post-headache starting do you perform LP?

A

12 hours

29
Q

2WW referral for Neuro

A

Consider an urgent, direct access, MRI scan of the brain (or CT scan if MRI is contraindicated; to be done within 2 weeks) to assess for brain or central nervous system cancer in adults with progressive, sub‑acute loss of central neurological function.

ICM - OBS (18 decks)

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