Neurology Flashcards
Whats the difference between bacterial, viral and fungal/TB CSF?
Bacterial - Turbid/cloudy appearance, high protein, low glucose, WCC>500 +VE gram stain.
Viral - Clear appearance, normal protein & glucose, wcc >1000
+ Monocytes
Fungal/TB - Fibrin Web Appearance
+ Monocytes
Indications of a lumbar puncture?
Bacterial/viral meningitis Subarachnoid haemorrhage Intracranial hypertension Diagnosis of MS/GBS/Sarcoid Therapeutic removal of CSF
Contraindications of lumbar puncture
Raised intracranial pressure Mass lesion in brain/spinal cord Local infection near site of LP congenital spinal problems (spina bifida) Low platelets <40) or on anticoagulants
SAH lumbar puncture shows what type of cells?
Elevated RBC to WBC ratio 1:1000
Xanthochromia (Yellowish) LP > 12 hours later
Elevated opening pressure
Which dermatomes are commonly affected in shingles
T1-L2
Do you get a prodromal period with shingles if so what do you experience?
Burning pain over the dermatomes affected, followed by fever, headache and lethargy.
Macular rash which becomes vesicular. It does not cross the midline.
What investigations should be carried out for a suspected TIA?
Offer aspirin 300 mg immediately (loading dose)
Immediate hospital admission if symptoms are currently occurring
Urgent CT scan to rule out haemorrhage
Urgent referral for investigation within 24 hours if symptoms occurred within 7 days
urgent referral within 72 hours if symptoms occurred over 7 days ago.
Do not use ABCD2 scoring system.
blood tests - glucose and ECG to rule out other causes if it doesn’t cause delay
Gold standard investigation for Meningitis
Lumber Puncture
How is active TB investigated?
acid-fast bacilli
Stroke Management
Alteplase is recommended in the treatment of acute ischaemic stroke if it can be administered within 4.5 hours of symptom onset and if intracranial haemorrhage has been excluded by CT
How do you investigate Lyme disease, Borrelia burgdoferi?
- Erythema migrans (bulls eye rash)
2. ELISA antibodies to Borrelia burgdoferi
What condition is seen in Obese female patient, with headaches, pappilodema, diplopia and unreactive pupils? and what is the investigation?
idiopathic intracranial Hypertension
Lumber puncture
Elderly patient, memory problems, confusion, walking difficulties, inability to focus on tasks? what condition is this and what is the treatment/?
Normal pressure hydrocephalus Lumber pressure (will note the high pressure)
Symptoms - Hyperacusis, loss of nasiolabial fold, tearing eyes, tingling jaw and pain behind the ears, facial weakness. would you refer for this condition?
Bell’s Palsy
NO - treat with steroids within 72 hours
conservative management - tapes, eye drops
How is essential tremor diagnosed?
Clinical - tremor with fine motor actions, can involve the head or voice. Is not present after drinking alcohol or taking benzodiazepams.
When would you admit to hospital a patient with shingles?
Shingles - varicella-zoster virus. Refer if they are demonstrating Hutchinson’s sign - vesicles appearing on the tip, root or side of the nose. This indicates it is effecting the nasocillary nerve, which will eventually effect the eye.
If they have a red eye.
visual symptoms.
Name some reasons for blackouts and its investigations:
Epilepsy - tongue biting, tonic clonic movements, post confusion, prodromal de ja vu, loss of bowel/urine. Refer 2 weeks to neurology for assessment.
Fainting - 3’ps (vaso-vagal) - Pro dromal - hot, sweating, pale, flushing. posture - prolonged standing, provoking factors - pain, medical procedure. - Tilt test.
Carotid sinus - when moving head to the side. first line investigation - carotid sinus massage.
Arrhythmia - feeling or palpitations, gallop beating, ECG, family history of cardiology - refer within 24 hours.
Orthostatic hypotension - medications, dehydration. Worse when standing, relieved by lying down.
Micturition syncope
straining when constipated
unexplained syncope -ambulatory ECG.
Dangerous causes of black outs
Neuro - Strokes, haemorrhages
cardiac - MI, arrythmias, cardiac tamponade
GI - Aortic dissection
Resp - PE
Heam - occult bleeding, ectopics, abdominal bleed, rectoperineal bleeding
Endocrine - Addissions disease, hypoglycemia
diagnostic investigation for a female patient, 30-40’s with optic neuritis, muscle weakness, and loss of sensation, shock like sensation radiating down their neck Lhermitte’s symptom and ataxia.
Multiple sclerosis note Only a consultant neurologist should make a diagnosis of MS based on McDonald criteria.
MRI scan and lumbar puncture. If these tests show lesions in the central nervous system and oligoclonal bands in your spinal fluid, a diagnosis of MS could be made immediately.
what is the Cavernous sinus ?
Spaces located behind each eye socket, under the brain. It is where the jugular vein drains back from the brain to the rest of the body. You can get a thrombis here - which is one swollen eye with the other swelling within 48 hours.
how is cavernous sinus thrombosis investigated?
Clinical and CT scan is considered superior to MRI for the detection of early clot formation in the cavernous sinuses,[47] whereas MRI is superior for the rest of the dural venous sinuses.
How do you differentiate between aseptic and septic cavernous sinus thrombosis?
FBC - Leukocytosis.
Thunderclap headaches peaks between 1-5 mins lasts an hour and have nausea and vomiting, how is this condition diagnoised?
CT head - Hyperdense bleed.
If there is no findings, wait 12 hours them proceed with a lumber puncture.
How do you investigate suspected pulmonary TB ?
Chest x ray and 3 sputum samples
spontaneously-produced, deep cough sputum samples
1. early morning sample for acid-fast bacilli
2. Mycobacteria culture
3. specialist molecular tests/drug sensitivity testing, depending on local laboratory protocols.
