Random

Question 1

Guillain-Barre Syndrome

Answer 1

A type of ACUTE Inflammatory Demyelinating Polyneuropathy

Acute
Relatively SYMMETRIC
Ascending Weakness / Paralysis
Possible involvement of Respiratory Muscles
AREFLEXIA
Distal Sensory Changes

Question 2

Guillain-Barre Facts

Answer 2

Most common cause of acute flaccid paralysis in the US
1-3 : 100,000

Classic history of bacterial or viral GI illness 2 to 4 weeks prior to the onset of paresthesias and weakness
C. Jejuni (40% have positive Ab or Stool Studies)
Other infections (H Flu, Mycoplasma, barrel burgdorferi, HIV, CMV, EBV)
Post Vaccination with influenza has been reported

5 Major Subtypes

Question 3

Guillain-Barre Diagnosis

Answer 3

CLINICAL EXAM
Ascending weakness
Paresthesias
AREFLEXIA

Measure FVC (less than 15ml/kg –> intubation)

Lumbar Puncture
Elevated Protein (up to 400) no cells
may take 1-2 weeks to peak
10% have NL protein

Ab and Stool Studies for C Jejuni
(only positive in 40%)

Check EKG
evaluate for AVblock, ST changes, arrhythmia

NCS
May show slowing due to demyelination

Question 4

Guillain-Barre Treatment

Answer 4

No Role for Steroids

IVIG

Plasmaphoresis / Plasma Exchange

Intubation if FVC is less than 15

Question 5

Chronic Inflammatory Demyelinating Polyneuropathy

CIDP

Answer 5

Slowly progressive skeletal muscle weakness and sensory loss of the extremities INCLUDING position and vibration

CIDP should be considered in patients with a progressive polyneuropathy that is relapsing/remitting, or slowly progressive over several months. Rule out common causes, like DM and vitamin deficiency.

The major diagnostic tests for CIDP are EMG/NCS, CSF evaluation, and NERVE BIOPSY.

CSF - elevated protein, not more than 10 cells

Tx with steroids, IVIG, plasma exchange, immunosuppression

Question 6

BPPV

Answer 6

Benign Paroxysmal Positional Vertigo

Otoliths in the posterior semicircular canal

Brief Episodes of Vertigo (spinning) with head motion/position changes

Dix Hallpike Maneuver - PATHOGNOMONIC
latent downbeat, rotatory nystagmus that reverses with upright position
- patient sitting, turn head one way and lie down
- check for nystagmus
- then sit up, nystagmus reverses

Question 7

Epidural Hematoma Pearls

Answer 7

EDH >30mL should be evacuated, REGARDLESS of GCS

EDH 8 WITHOUT focal deficit can be managed non-operatively with close observation and serial CT Scans

Comatose patients (GCS

Question 8

Chronic SDH Pearls

Answer 8

Age, alcoholism, and cerebral atrophy are all risk factors for development of cSDH

About 1/3 of patients with cSDH have no recall of trauma

1 year all cause mortality after cSDH is 32%