Neurology Flashcards
Brain tumors of any type can present with a variety of symptoms and signs that may be general, focal or a combination of both. Which of the following characterizes the classic headache associated with a brain tumor? (H20 C86 P643)
A. Headache associated with focal or lateralizing findings
B. Headache associated with head movements relative to gravity
C. Headache most evident in the morning and improves during the day
D. Headache which is very severe and episodic
The answer is C. Brain tumors of any type can present with a variety of symptoms and signs that fall into two categories: general and focal; patients often have a combination of the two (Table 86-1). General or nonspecific symptoms include headache, with or without nausea or vomiting, cognitive difficulties, personality change, and gait disorder. Generalized symptoms arise when the enlarging tumor and its surrounding edema cause an increase in intracranial pressure or compression of cerebrospinal fluid (CSF) circulation leading to hydrocephalus. The classic brain tumor headache predominates in the morning and improves during the day, but this pattern is seen only in a minority of patients. Headaches are often holocephalic but can be ipsilateral to the side of a tumor. Occasionally, headaches have features of a typical migraine with unilateral throbbing pain associated with visual scotoma. Personality changes may include apathy and withdrawal from social situations, mimicking depression. Focal or lateralizing findings include hemiparesis, aphasia, or visual field defect. Lateralizing symptoms are typically subacute and progressive; language difficulties may be mistaken for confusion. Seizures are common, occurring in ~25% of patients with brain metastases or malignant gliomas and are the presenting symptom in up to 90% of patients with a low- grade glioma. All seizures that arise from a brain tumor will have a focal onset whether or not it is apparent clinically.
In what CNS infection does giving dexamethasone have striking improvement in outcomes? (H20 C133 P1002-3) A. CMV meningitis B. Listeria meningitis C. Meningococcal meningitis D. Pneumococcal meningitis
The answer is D. A prospective European trial of adjunctive therapy for acute bacterial meningitis in 301 adults found that dexamethasone reduced the number of unfavorable outcomes (15 vs 25%, p = .03) including death (7 vs 15%, p = .04). The benefits were most striking in patients with pneumococcal meningitis. These results were confirmed in a second trial of dexamethasone in adults with pneumococcal meningitis.
