Repetera-utvalda Flashcards
How many pt w HIV/AIDS get neurologic symtoms?
40-60%
What is Ramsay Hunt syndrome?
It is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis.
What is herpes zoster called in english?
Shingles
What are the 5 most common focal CNS lesions caused by -correlated to AIDS?
- Toxoplasmosis - Toxoplasma Gondhii
- primary CNS lymphoma.
- progressive multifocal leukoencephalopathy - viral
- Cryptococcal abscesses (more commonly manifest as meningitis)
*TB
How is Lyme disease diagnosed?
- By the history/precsence of migrans.
- By waiting 2-3 weeks when antibodies to B.Burgdorferi can be reliably found.
- if the patient has been in an pandemic area, its enough with one of these.
What is the course of CJD?
Encephalopathy with rapidly progressive dementia, ataxia and myoclonus and invariably death.
Seizure usually occur late in the disease
What is the recommended sterilization procedure for JCD?
- Steam autoclavation for 1h in 132 degrees
or - Immersion in sodium hydroxide NaOH for 1h in room temperature
or
Differential diagnostics to CJD?
- Tertiary Syphilis
- Bismouth, Bromide or LITHIUM intox
wMost common bacteria in immunocompetent (normal) patients?
Gram positive: 60% S.Aureus, else Epidermidis
Gram negative: E-Coli or Pseudomonas Aerginosa.
Name 7 important neuro-parasites
- Cysticercosis
- Toxoplasmosis
- Echinoccoccus
- Amebiasis
- Schistosomiasis
- Malaria
- African Trypanosomiasis
What is the number 1 aquired EP in the world?
Neurocysticercosis. (the most common cause of seizures in some countries)
What is cysticercosis actually caused by?
Its the larval stage of Taenia Solium - pork tapeworm.
How is cysticercosis usually aquried?
By eating food or drinking water contaminated by tapeworms EGGS from human feces from someone with Taeniasis (that usually have essentially no symptoms). The eggs are liberated by gastric acid. actively cross the bowel wall. Via blood to muscles and brain etc.
What are the medications for Neurocysticercosis?
*surgery
*Treatment: * Praziquantel or *Albendazole.
*During treatment: Steroids for anti-inflammation purpous
* Antiepileptics
What is the intermediate host for taenia solium?
Pig.
How does neurocysticercosis look on imaging?
Som en sweizerost.
Massive number of small cysts within the brain.
How can cysticercosis be detected?
Serological test-western blot 100% specific and 98% sensitive.
What might be the cause of dysembryogenesis of the roof of the rhombencephalon and creating of a Dandy Walker malformation?
*Rubella
* CMV - cytomegalo virus
* Toxoplasmosis
(Warfarin, alkohol and isoretinoin)
Name two common infections causing inflammation and aqueductal stenosis ?
- TB
- Syphilis
How dangerous is community aquired meningitis?
Considered medical emergency
WHat is the treatment of community aquired meningitis
- Corticosteroids, 0.12mg/kg before first dose of Ab.
- 3.
What is Waterhouse-Friedriscen syndrome?
Affecting 10-20% of children under 10 yo with meningococcal INFECTION -usually from dissaminating infection.
* large petechial hemorrhages
* septic shock
* adrenal failure
*DIC
Surgical treatment in case of Waterhouse Friedrichsen syndrome?
If comatose not localizing pt:
EVD.
If EVD is refractory - consider decompressive hemicraniectomy.
What neurosurgical treatable condition is not unkommon after Cryptococcal meningitis?
Acute hcph
What are the most common agens to infect after neurosurgery?
- KNS
- Staff. Aureus
- Entero?
- Pseudomonas
What is Cryptococcal meningitis?
A Fungal infection spreading from the lungs.
What ab is used for the treatment in neurosurgical postoperative infection?
- Vancomycin (to cover MRSA)
- Cefipime 2gx3
In severe PC allergy - use:
Aztreonam
or
Ciprofloxacine
In ADULTS; which are the most common Community Acquired Meningitis causing bacteria for people with intact immune system?
- Neisseria Meningitis
- Streptococcus pneumoniae
- Hamophilus influenza type B
What specific subgroup of people are more ogften affected by cryptococcal meningitis?
Patients with that are immunocompromised. The subsaharan area has had great problems with AIDS.
Data from 2009 estimated that of the almost one million cases of cryptococcal meningitis that occurred worldwide annually, 700,000 occurred in sub-Saharan Africa and 600,000 per year died.[13] Cryptococcosis was rare before the 1970s which saw an increase in at-risk groups such as people with organ transplant or on immunosuppressant medications.
What is the rec. for pt with rhinorrhea and meningitis within 2 weeks after craniospinal injury?
- Antibitotics to be continued 1 week after sterile CSF
- If persistent rhinorrhea, exploration and seal
What needs to be looked for in recurrent meningitis?
A fitulae!
What are the three most common causes of chronical meningitis?
- Tuberculosis
- Fungal infection
- Cystercosis, neurocystercosis
What is the rec. for pt with rhinorrhea and meningitis within 2 weeks after craniospinal injury?
- Antibitotics to be continued 1 week after sterile CSF
- If persistent rhinorrhea, exploration and seal
What vaccines are given at 3mo, 5mo and 12 mo in Sweden, Which has addition in 5-6yo and which has also in 14-15yo? (asterix for neuro-interresting diseases)
()diphteria, + and +
tetanus, + and +
whooping cough, + and +
*polio, +
** Hib-haemophilus influenzae type B,
Hepatitis B,
** Pneumococcus.
Which of Measles, Mumps and Rubella might cause encephalitis?
Rubella
How is abscess differentiated from tumor on MRI?
The abscess usually do have a core of restricted diffusion, seen on DWI sequences. (DWI bright and ADC dark implies viscous fluid.)
What is the most common spread route of cerebral abscesses?
- Hematogenous spread,
* pulonary infections - empyema
* bacterial endocarditis
* dental abscesses
What are the 2 most common agens of bacterial abscess intracranially?
- Streptococcus
- Anaerobic or microaerophilic agens
The agens differs if the patient has had surgery to the head previously. What are the 2 most common agens then?
Staff. epidermidis and Staff aureus.
How many patients with an abscess present with hemiparesis or seizures?
30-50%
What is the normal “aging/stages” of an abscess?
- early cerebritis
- late cerebritis - develope necrotic centre
- early capsule
- Late capsule - necrotic centre and collagen center “pop” on entrance.
When should an abscess be drained?
Only those that are not responding to antibiotics alone and that are 2-6 cm. OR those that are already over 3 cm when found.
What is the estimated size of an abcess to respond well to antibiotics?
0.8-2.5cm
Indications except size over 3cm or non-responders to antibiotics:
- significant masseffect/ sign raised ICP
- Proximity to ventricle
- Poor neurologic condition
- traumatic abscess w foreign material
- Fungal abscess
*difficulty diagnosing but be aware of different etiologies.
What is the medical treatment of an abscess?
- Vancomycin
- Metronidazole
- 3rd generation cephalosporine
All together. MInd the difference to meningitis treatment!
What is the difference in treatment of meningitis and an abscess?
In meningitis a 4th generation cephalosporine is used.
In meningitis no metronidazole is used.
In meningitis its important to add corticosteroid treatment fast.
In meningitis vaccination is recommended
How emergent is subdural empyema in comparison to an abscess?
Its more emergent. It might be complicated with *cerebral abscess, * cortical venous thrombosis, * localised cerebritis
What are the two most common pathogens of non-iatrogenic subdural empyema?
- Streptococcus
- Staphylococcus
SIgns of spinal epidural abscess?
- back pain
- fever
- spine tenderness
Risk factors for spinal epidural abscess?
- DM
- IV drug use
- Chronic renal failure
- Alkohol overuse
- chronic steroid use
- resent spinal procedure
- trauma - recent back trauma is common.
How many % of pt w spinal epidural abscess are immunocompromised or have a chronic disease?
65%
What is th number one finding on clinical examination of a patient with spinal epidural abscess??
EXCRUCIATING pain on percusion over spine.
WHat are the two most common pathogens in epidural abscesses?
- Staff. aureus
- Streptococcus
In chronic cases of spinal epidural abscesses, what is the most common pathogen?
TB!
what is the correct treatment of an epidural abscess in the spine?
- EARLY surgical evacuation and antibiotic treatment.
What should be done in case of an infected vertebra (osteoma)
HIgh risk of instability with laminectomy and instrumentation is needed. Use titan.
What is the rec. combination of antibiotics in spinal epidural abscess?
Ceftriaxone (rocephalin, 3rd gen cephalosporine rec for both meningitis and bone inf.)
Metronidazole
Vancomycin
+/-Rifampicin (mostly TB/mycobacterium impl)
How often is a spinal epidural abscess fatal?
in 3-31%
what are the two most common agens for vertebral infections?
- S.Aureus
- E.Coli
What are the three most common ways to get a vertebral osteomylitis?
*. urinary tract infection
*. respiratory tract infection
*. soft tissue infection
- hematigous spread
- direct spread.
when is surgery performed in vertebral osteomyelitis?
- needle biopsy for culture and to rule out malignancy
- Only if signs of instability.
What is Potts disease?
It tuberculous vertebral osteomyelitis
What is typical for Potts disease clinically?
- symphtomatic for months
- usually more than 2 levels
- prediletion for vertebral bodies.
- Commonly associated to psoas abscess.
- neurologic deficiency in 10-47%
- RARELY extend to medulla.
How is potts disease diagnosed?
y needle percutanous biopsy and identification of acid fast bacteria.
Obs! WBC count is usually not elevated.
When is surgery a choice for potts disease?
Surgery is only performed if signs of cord compression, instability or abcess is found.
What is juvenile discitis and what age is common?
Lumbar discitis
Age 2-3 years.
Risk disolves at 20-30yo when primordial feeding arteries that nourish the nucleus pulposus disappear.
When and how is juvenile discitis treated?
Most often nothing 8 not even immobilisation).
antibiotics if +culture (blood or biopsy) or High WBC count with systemic symtoms or high fever.
* surgery only for rare cases that progress albeit ab.
What are the 2 most common agens in adult form discitis?
- Staf aureus
- if drug abucer - Pseudomonas.
How many % of pt w adult form discitis need surgery?
25%.
- for differential diagnosis -neoplasm?
- to decompress
- drainage of abcess
* rarely due to instable spine.
