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Neurology > Pathology of the NS > Flashcards

Pathology of the NS Flashcards

1
Q

What is Meningitis ?

A

Inflammation/infection of the meninges

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2
Q

What is Encephalitis ?

A

Infection/inflammation of the brain

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3
Q

What is Myelitis ?

A

Infection/inflammation of the spinal cord

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4
Q

How would a patient with Meningitis present ?

A
  • Fever
  • Headache
  • Stiff neck
  • Photophobia
  • Petechiae rash (Meningococcus)
  • N/V
  • Seizures
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5
Q

What are the main bacterial causes of Meningitis and who do they typically effect ?

A
  • Neisseria meningitis (meningococcus) - Young adults and children
  • Group B Strep - Neonates
  • E. coli - Neonates
  • Strep. pneumoniae (pneumococcus) - Adults
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6
Q

What are the main viral causes of Meningitis ?

A
  • HSV

- Enteroviruses (Polio)

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7
Q

How does a patient present with Encephalitis ?

A
  • Flu-prodrome
  • Progressive headache - Altered conscious levels
  • Fever
  • Abnormal behaviour
  • Seizures
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8
Q

What causes Encephalitis ?

A

It is usually viral e.g. HSV, Aborviruses. Can be autoimmune.

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9
Q

How do you investigate Meningitis ?

A
  • Bloods culture/cell count
  • CT/MRI
  • LP - CSF culture and microscopy
    - If viral suspected do PCR
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10
Q

How to investigate Encephalitis ?

A
  • Blood culture/cell count - In autoimmune look for Anti VGKC and Anti NMDA
  • CT/MRI
  • LP
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11
Q

When do you not perform a LP ?

A
  • Focal signs
  • Altered conscious level
  • Papilloedema
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12
Q

What CSF findings are found in bacterial Meningitis ?

A
  • Low sugar
  • High protein
  • High levels of neutrophils
  • Opening pressure is high
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13
Q

What CSF findings are found in viral Meningitis ?

A
  • Normal sugar
  • Normal protein
  • High levels of lymphocytes
  • Opening pressure is normal
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14
Q

How is HSV treated ?

A

Acyclovir

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15
Q

How are enteroviruses transmitted ?

A

Faecal-oral route

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16
Q

How are Arboviruses transmitted ?

A

By vector from non-human host. Some are preventable by immunisation.

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17
Q

How do you treat a patient with bacterial Meningitis ?

A

IV Ceftriaxone

Corticosteroids

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18
Q

How do you treat a patient with viral Meningitis ?

A 
Anti-virals 
Bed rest
Hydrate 
Analgesics 
Corticosteroids to reduce inflammation
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19
Q

How would a patient present who has an abscess ?

A
  • Fever
  • Headache
  • Nausea and vomiting
  • Papilloedema
  • Seizures
  • Altered conscious level
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20
Q

How do you investigate a brain abscess ?

A
  • CT/MRI
  • Blood cultures
  • Biopsy
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21
Q

How do you treat a brain abscess ?

A
  • Drainage

- High dose IV antibiotics (Penicillin for strep and metronidazole for anaerobes)

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22
Q

What brain diseases can HIV cause (3) ?

A
  • Meningitis
  • Brain abscesses
  • Dementia
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23
Q

What is seen in patients with HIV in bloods ?

A

Low CD4 count

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24
Q

What infective agents usually are found in patients with HIV ?

A
  • Crypotococcus neoformans
  • CMV
  • Toxoplasma gondri
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25
Q

How do you investigate HIV infections ?

A
  • PCR for CMV
  • Crypotococcal antigen
  • Toxoplasmosis serology
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26
Q

What are the two main Spirochaete’s ?

A 
Borrelia burgdorferi (Lymes disease)
Treponema Pallidum (Neurosyphilis)
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27
Q

How does Lyme’s disease present ?

A

Rash at site of tick bite, flu symptoms, one or more organs affected. Period of latency then chronic infection.

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28
Q

What investigations are done in Lyme’s disease ?

A
  • MRI
  • CSF lymphocytosis
  • EMG
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29
Q

How do you treat Lyme’s disease ?

A

IV Ceftriaxone

Doxycycline (oral)

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30
Q

How do you investigate Syphilis ?

A
  • Antibody tests

- CSF lymphoyctosis

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31
Q

How do you treat Syphilis ?

A

High dose penicillin

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32
Q

How does Polio usually present ?

A

Patients are asymptomatic and only 1% has paralysis

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33
Q

Can Polio be prevented ?

A

Vaccination - Polio virus given combined with other antigens

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34
Q

How does Rabies present ?

A

Disease of the PNS. Paraesthesia at the site of lesion. Paralysis starts distally and work way upwards.

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35
Q

How is Rabies investigated ?

A

PCR and serology

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36
Q

How is Rabies prevented ?

A

Rabies immunisation with killed vaccine.

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37
Q

How is rabies treated ?

A

Person given immunoglobulins and immunisation. Wound must be cleaned.

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38
Q

How does Tetanus present ?

A

Rigitidy and spasm

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39
Q

What is Tetanus ?

A

Clostridium Tetani anaerobic gram +ve bacillus, spore forming. Acts at the neuromuscular junction and block inhibition of motor neurones.

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40
Q

How is Tetanus treated ?

A

Immunoglobulins and high dose penicillin. Immunisation can be given to those at risk.

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41
Q

What is Botulism ?

A

Clostridium Botulinum anaerobic gram +ve bacillus. Neurotoxin binds to presynaptic membrane and prevent Ach release.

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42
Q

How does a patient present with Botulism ?

A

Descending paralysis

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43
Q

How do you investigate Botulism ?

A
  • Serology

- Culture from wound

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44
Q

How do you treat Botulism

A

Penicillin and metronidazole. Antitoxins.

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45
Q

What is active immunity ?

A

Body actively makes antibodies against antigen

46
Q

What is passive immunity ?

A

Body is given antibodies from another source

47
Q

What is a post-inflammatory syndrome and give 2 examples ?

A

When the body mounts an autoimmune response against an infection or vaccination.

CNS - ADEM (Acute Disseminated EncephaloMyelitis)
PNS - Gullian-Barre Syndrome

48
Q

What is a prion ?

A

A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally.

49
Q

What disease is associated with Prions ?

A

CJD (Creutzfeldt - Jakob Disease)

50
Q

How does sporadic CJD present ?

A
  • Rapidly progressive Dementia
  • Jerks
  • Rigidity
  • Weakness
  • Spasms
51
Q

How does new variant CJD present ?

A
  • Early behavioural changes

- Linked to cattle

52
Q

How do you investigate CJD ?

A
  • MRI - small holes
  • EEG
  • LP
  • Bloods
53
Q 
GBS vs MG
Reflexes ?
Ptosis ?
Fatigue ?
Pain ?
A

Reflexes - GB absent and MG present
Ptosis - MG present and GBS absent
Fatigue - MG present and GBS absent
Pain - GBS painful and MG no pain

54
Q

MG vs MND
Fatigue ?
Ptosis ?
Fasciculations ?

A

Fatigue - MG present and MND absent
Ptosis - MG present and MND absent
Fasciculations - MND present and MG absent

55
Q

What signs are seen on examination in patients with MND ?

A
  • Fasciculations
  • Hyperreflexia
  • Muscle wasting
  • Spasticity
56
Q

Does MND effects the upper or lower MN’s ?

A

Both

57
Q

How is MND diagnosed ?

A
  • LP
  • Blood tests
  • CT/MRI
  • EEG
58
Q

How is MND treated ?

A
  • Physio
  • SALT
  • OT
  • Riluzole
  • Anti-spasmodics
  • Anti-depressants
59
Q

What is Myasthenia Gravis ?

A

Myasthenia gravis is an autoimmune disease which results from antibodies that block or destroy nicotinic acetylcholine receptors at the junction between the nerve and muscle.

60
Q

How does Myasthenia Gravis present ?

A
  • Skeletal muscle weakness
  • SOB
  • Slurred speech
  • Difficulty chewing
  • Ptosis
  • Diplopia
61
Q

What is the Edrophonium test ?

A

They inject edrophonium chloride and if you have a sudden improvement in muscle strength its likely you have MG.

62
Q

What is Gullian Barre syndrome ?

A

Guillain-Barré syndrome (GBS) is a rare condition in which a person’s immune system attacks the peripheral nerves. More common in adults and in males. Most people recover fully.

63
Q

What does GBS present like ?

A

Paralysis starts in hands and feet and spreads towards face and body.

64
Q

What precedes GBS ?

A

Infection or vaccination

65
Q

How is Gullian-Barre syndrome treated ?

A
  • IV immunoglobulins
  • Plasma exchange
  • Analgesics
  • Physio
  • OT
66
Q

How is MG treated ?

A
  • Immunosuppressants
  • Steroids
  • Thymectomy
  • Plasma exchange
  • IV Immunoglobulins
67
Q

Definition of Dementia

A

Progressive impairment of cognitive function in an alert patient leading to a loss of acquired skills.

68
Q

What is Dementia usually cause by in older generation ? (3)

A
  • Lewy bodies
  • Alzheimers disease
  • Vascular
69
Q

What is Dementia usually caused by in the younger generations ? (3)

A
  • HIV
  • CJD
  • Alcoholic dementia
70
Q

How do you investigate Dementia ?

A
  • Bloods
  • CT/ MRI
  • LP
  • EEG
  • Examine cognitive function
71
Q

What are the signs of Fronto-Temporal Dementia ?

A
  • Personality changes
  • Early dysphasia
  • Eating/behavioural problems
72
Q

What is the treatment for Fronto-Temporal Dementia ?

A

No treatment

73
Q

What are the signs of Temporo-Parietal Dementia ?

A
  • Visuospatial problems
  • Memory problems
  • Cant understand speech
74
Q

What are the 2 drug classes given to manage Temporo-Parietal Dementia/Lewy Body Dementia ?

A
  • Acetylcholinesterase inhibitors (helps with cognition)

- NMDA receptor antagonist (reduce memory loss)

75
Q

What are the signs of Vascular Dementia ?

A
  • Stepwise decline

- Mixed symptoms (affects all parts of brain)

76
Q

What advice should be given to patients with Dementia and their families ?

A
  • Voluntary organisation they can contact
  • Help and support via NHS
  • Respite care
  • OT
77
Q

What other medications can be given to control Dementia symptoms ?

A

Medications to control behaviour, depression and insomnia.

78
Q

Name a NMDA receptor antagonist ?

A

Memantine

79
Q

Name a Acetylcholinesterase inhibitor ?

A

Donepezil

80
Q

Definition of Parkinsonism

A

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability.

81
Q

When is Parkinsonism seen ?

A
  • Lewy body dementia
  • Vascular dementia
  • Drug induced
82
Q

Good response to which neurotransmitter can be used to diagnose Parkinsonism ?

A

Dopamine

83
Q

What functional imaging is commonly used in Parkinsonism ?

A

SPECT to look at dopamine uptake/transportation

84
Q

What medication can be given to treat Parkinsonism ?

A
  • Levodopa and Carbidopa
  • MAO inhibitors
  • COMT inhibitors
  • Dopamine agonists
85
Q

What side effects do patients get during treatment of Parkinsonism ?

A
  • Hallucinations

- Involuntary, jerky movements

86
Q

What are the long-term complications of Parkinsonism ?

A
  • Bladder and bowel incontinence
  • Depression
  • Slurred speech
87
Q

What other non-medication treatment is available to treat Parkinson’s

A

Deep brain stimulation

88
Q

What does EEG measure ?

A

EEG measures the electrical activity of the brain

89
Q

What are Evoked Potentials used for ?

A

To investigate problems with central pathways

90
Q

Which neurophysiological test can be used to test for Myasthenia Gravis and what is don’t during the test ?

A

EMG and the muscles are repeatedly stimulated to look for signs of fatigue

91
Q

What can be seen in the EMG results in muscles disease ? (2)

A
  • Jitters

- Loss of tight relationship between AP’s of two muscle fibres

92
Q

Definition of Encephalopathy

A

Brain disease or dysfunction

93
Q

What can EEG be used for ?

A
  • Diagnose brain death
  • Seizures
  • People having difficulty sleeping
94
Q

What do Evoked Potentials measure ?

A

The time is takes for a signal from a stimulus to be sent to the brain and for the brain to respond.

95
Q

UMN signs

A
  • Hyperreflexia
  • Increased tone
  • Extensors plantars
  • No wasting
96
Q

LMN signs

A
  • Absent reflexes
  • Decreased tone
  • Flexor plantars
  • Wasting
97
Q

What is Browns-Sequard syndrome ?

A

A lesion in the spinal cord causes loss of sensation on one side of the body and weakness/paralysis on the other side

98
Q

What type of lesion causes Browns-Sequard syndrome ?

A

Hemicord lesion (one half)

99
Q

What are some causes of spinal cord lesion symptoms ?

A
  • Trauma
  • Tumours
  • Degenerative disease
  • B12 deficiency
100
Q

Where do the anterior spinal arteries arise from ?

A

Aorta

101
Q

Where do the posterior spinal arteries arise from ?

A

Vertebral arteries

102
Q

What are the 3 main causes of spinal cord ischaemia ?

A
  • Thromboembolic disease
  • Atheromatous disease
  • Vasculitis
103
Q

Define paraparesis/paraplegia

A

Weakness or paralysis in one side of the body

104
Q

Define paraesthesia

A

Tinging

105
Q

What may the occlusion of the central sulcal artery present like ?

A

Brown-Sequard syndrome

106
Q

How would you treat spinal cord ischaemia ?

A
  • Anticoagulants
  • BP monitoring
  • OT/Physio
  • Arrhythmias need sorting
107
Q

In MS is there very few or lots of WBC’s ?

A

Very few <50

108
Q

What is the treatment for MS ?

A

Methylprednisolone and supportive

109
Q

What factors make people more at risk of B12 deficiency

A
  • Vegan diet
  • Pernicious anaemia
  • Crohns, gastrectomy or tape worms
110
Q

How does B12 deficiency present ?

A
  • Paraesthesia in hands and feet
  • Arreflexia
  • Fatigue
  • Paraplegia
  • Painless retention of urine
111
Q

How do you investigate B12 deficiency ?

A
  • FBC

- B12 levels

112
Q

How do you treat B12 deficiency ?

A

Intramuscular B12

Neurology (16 decks)

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