Neurology Flashcards
Bacterial Meningitis: ETIOLOGY/Pathogens for: NEWBORNS INFANTS TODDLERS - 6Y/O TEENAGERS + YOUNG ADULTS ADULTS
NEWBORNS: Group B Strep
INFANTS; E. Coli
TODDLERS- 6 y/o: Haemophilis Influenza (HIB)
TEENS: Neisseria Meningitidis
ADULTS: Strep Pneumoniae (70% of all cases are Strep)
Kernig’s vs Brudzinksi’s
Kernig: Pt is supine with hips and knees flexed to 90 degrees. Positive Kerning’s is pain with extending the knee with hips flexed
Brudzinski’s: pt is supine, when neck is flexed, pt will involuntarily flex hips and knees
Petechial rash associated with what infection?
Nesseria Meningitidis
LP for meningitis
Elevated WBC (from normal of 5 to up to 10,000 during infection) Protein elevated (normal 5-60, elevated to 100-500) Decreased glucose (normal is 60% of serum, during infection down to 40%)
Bacterial Meningitis tx
Newborns and infants: gentamicin and ampicillin
Young children-early adulthood: 3rd gen Cephalosporin + vanco or chloramphenicol
Adults: PCN
Follow tx with serial LPs
Essential Tremor tx?
Avoid triggers (fatigue, stress, caffeine)
1st: B blockers
2nd: anti-epileptics: topiramate, gabapentin
2nd: BZDs
What chromosome affected by Huntington’s?
4
CT findings in Huntington’s
Atrophy of caudate nucleus and cerebral atrophy
TX of chorea in Huntington’s
Typical and atypical neuroleptics: olanzapine, risperidone haldol
What vaccination greatly reduces Meningitis in infants?
H Flu
Triad sx for normal pressure hydrocephalus
Gait disturbance
Urinary incontinence
Dementia
How many pts with syphilis will develop neurosyphilis?
7%
Argyll Robertson pupils
Pupils react poorly to light but well to accommodation
S/S Tabes Dorsalis (late stage syphilis)
Impaired proprioception vibratory sense Loss of DTRS at knees and ankles Argyll Robertson pupils Lightning pains Progressive ataxia Impaires sensation Weakness and hypotonia of muscles Joint damage (Charcot's joints) especially LE Neurogenic bladder with overflow incontinence Optic atrophy with visual loss
DX Syphilis
CSF pleocytosis , + VDRL, or FTA-ABS (fluorescent treponemal Ab absorption) in serum
TX syphilis
IV Pen G 18-24 million U/day x 10-14 days
TX syphilis if PCN allergic
Mild PCN allergic: Ceftriaxone 2g IV qd x 10-14d
Anaphylaxis with PCN: densensitation to B lactams under direction of allergist
Serum VDRL titer should decrease after therapy
FTA-ABS remain reactive for life
CSF WBCs are normal 6 months after tx completed, if CSF WBCs are still abnormal after 6 months, pt needs to be retreated
Most common meningitis pathogen in adults?
Strep pneumoniae
Infant with irritability, lethargy, anorexia and bulging fontanelles, suspect what?
meningitis
TX viral meningitis
Symptomatic: analgesics for HA, antiemetics for nausea, not required to be inpatient. Excellent prognosis: 1-2 weeks
ABX therapy for meningitis (empiric) age 2 mo-adult
Ceftriaxone + vanco. Add ampicillin if elderly. Consider corticosteroids (dexamethasone)
Viral encephalitis: most common pathogen?
HSV (70% mortality rate if left untreated). Typically affects the temporal lobe. PCR very sensitive and specific. CT with contrast 60% positive. MRI: 90% have temporal lobe abnormalities.
CLinical manifestations West Nile virus?
diffuse paralysis + peripheral neuropathy
TX CMV encephalitis
Gancivlovir+ Foscarnet. Watch for SIADH syndrome.
Name 3 associated conditions with Bell’s Palsy
Diabetes Pregnancy Herpes Zoster Positive family history Immunodeficiency
S/S Myasthenia Gravis
Diplopia
Ptosis, weakness of eye closure ( in 90% of pts)
Difficulty chewing
Regurgitation of fluids
Dysphagia
Nasal speech or low voice volume
Disease then progresses until weakness noted in the limbs, neck and respiratory muscles. PUPILS ARE NORMAL
Myasthenia Gravis associated with what other disorders
SLE, RA, thymic tumors, thyrotoxicosis (because it is an autoimmune disease)
Diagnostics for Myasthenia Gravis?
Serum anti-Ach receptor antibody levels
EMGs, Thyroid function, CXR (r/o thymoma)
Tensilon test (goal is to abate muscle weakness in 1-2 minutes)
Neostigmine 1.5mg IM improves weakness in 10-15 min
Ice pack test: place ice pack on eyelids to cool muscles x 1 minute, test for ptosis
Tx Myasthenia Gravis
Anti cholinesterase agents: Pyridostigmine 15-90mg q 6 hours and 180mgLA bedtime
Neostigmine 15mg before activity or meals OBSERVE for cholinergic crisis (nausea, vomiting, sweating, pallor, salivation, colic, diarrhea, meiosis, bradycardia)