spinal Disorders, brain abscess Flashcards
causes of brain abscess / organisms?
- spread from contguous infection in the sinuses, mastoid air cells or otitis media
- bacteremia (esp pneumonia and endocaditis)
organisms: staph, strep, gram (-) bacillim anaerobes (frequently mixed)
how to distinguish brain cancer from abscess
no way (not even on imaging study) --> only with biopsy (cancer can give fever) --> also to determine the precise organism and its sensitivity
brain abscess - best initial test / most accurate
- best initial: CT or MRI: ring or contrast enhancing lesions that will likely have surrounding edema and mass effect
- most accurate: brain biopsy
- LP: useless and contraindicated
brain abscess - treatment
- empiric therapy with penicillin + metronidazole + ceftriaxone (or cefepime) is acceptable while waiting for results
- if recent neurosurgery and risk risk of staph: vancomycin
- avoid prolonged empiric therapy
anterior spinal artery infraction - manifestation + treatment
- loss of al function except the posterior column (position + vibration intact)
- flaccid paralysis below infraction
- loss of DTR at the level of the infraction
- loss of pain and Q
- extensor plantar response
- evolves plastic paraplegia several wks later
- no specific treatment
sabacute combined degeneration of the Cord - causes and manifestation
- from b12 def or neurosyphilis
- position and vibratory sensation are lost
vitamin B12 deficiency - spinal cord lesions
sabacute combined degeneration –> demyelination of dorsal column, lateral corticospinal tracts, and spinocerebellar tracts
vitamin B12 deficiency - symptoms because of spinal cord lesions
- ataxic gaits
- paresthesia
- impaired progression and vibration sense
- weakness
tabes dorsasis - spinal cord lesion?
degeneration (DEMYELINATION) of dorsal columns and roots
spinal trauma - treatment
glucocorticoids
spinal trauma - manifestation
acute onset of limb weakness and/or ensory disturbance below the level of the injury with the severity in proportion to the degree of injury.
- Sphincter function impaired
- loss of DTRs at the level of injury and hyperreflecia below
Brown-Sequard syndrome - manifestation
- ispilateral UMN signs below the level of lesion
- ipsilateral loss of tactile, proprioception, vibration below the level of lesion
- contralateral pain and temperature loss below the level of lesion
- Ipsilateral loss of all sensation AT LEVEL OF LESION
- ispilateral UMN sign at the level of lesion
- Horner syndrome (if lesion above T1)
syringomyelia ?
fluid filled, dilated central canal in pinal cord –> widening bubble or cavitation first damages neural fibers passing near the center of the spine (bytumore or trauma or congenital) –> loss of pain and Q bilaterally across the upper back and both arms (capelike distribution –> ALSO LOSS OF REFLEXES + MUSCLE ATROPHY IN THE SAME BILATERAL DISTRIBUTION
Tourrete Disorder - diagnostic tests / treatment
- no specific diagnostic tests
- fluphenazine, clonazepam, pimozide or other neuroleptic. Methylphenidate and ADHD treatment are intrinsic to Tourrete management
Huntington disease - chromosome of trinucleotide / trinucleotide repeat / age
ch 4
CAG
30-50
Huntington disease - symptoms
- choreiform movements (dyskinesia)
- aggression
- depression
- dementia
Huntington disease - movement disorder
starts with fidgetiness or restlessness progressing to dystonic posturing, rigidity and akinesia
- movement disorder may be troubling, but it is far worse to progress to no movement (rigidity)
(also athetosis and chorea)
Huntington disease - diagnostic test
specific genetic test (99% sensitive) –> CAG trinucleotide repeat sequences are found on genetic analysis –> symptom triad (movement/memory/mood) is confirmed with the test
Huntington disease - treatment
no treatment reveres HD
- dyskenesia is treated with tetrabenazine, reseprine
- psychosis is treated with Haloperidol, quatiapine
Huntington disease - MRI
Atrophy of caudate and putamen nuclei with hydrocephalus ex vacuo
Huntington disease - a common cause of death / is sometimes mistaken for
- suicide
- substance abuse
Restless Leg syndrome - presentation
patient reports an uncomfortable sensation in the leg that is creepy and crawly at night –> discomfort is worsened by caffeine and relieved by moving the legs.
Restless Leg syndrome - treatment
dopamine agonists such as pramipexole
Movement disorders - types
- athetosis 2. chorea 3, Dystonia 4. Essential tremor
- Hmiballismus 6. intention tremor 7. Myoclonus
- Resting tremor
