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JJ > Spinal Injuries and Intracranial Disease > Flashcards

Spinal Injuries and Intracranial Disease Flashcards

1
Q

why is it important for nurses to be able to understand spinal injuries?

A

so that best nursing care can be provided

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2
Q

what is involved in the veterinary nurses role in the care of a spinal injury patient?

A

identify disease progression
understand how to assess and monitor
report accurately to the VS

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3
Q

how may some spinal injuries present?

A

as an emergency and so are time critical

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4
Q

what forms the extracranial part of the CNS?

A

spinal cord

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5
Q

what structure encases and protects the spinal cord and nerves?

A

spinal column

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6
Q

what is involved in the patient assessment of a neuro patient?

A 
history
physical exam
neurological exam
differential diagnosis based on previous findings
diagnostic tests
diagnosis / prognosis
treatment
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7
Q

when will a neurological exam be performed?

A

seizures
behavioural changes
gait abnormalities
change in posture / positioning

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8
Q

why is a neurological exam so important?

A

identify if nervous system is involved
identify specific location / localisation of injury
aid diagnosis and prognosis
continuous assessment of condition

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9
Q

what is neurolocalisation?

A

identification of which part of the spinal cord is affected by injury

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10
Q

what types of motor neurons are there?

A

upper

lower

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11
Q

what are the signs of upper motor neurone injury?

A

loss of motor function
paresis
reflexes are normal or increased
chronic atrophy

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12
Q

what are the signs of lower motor neurone injury?

A

reduced muscle tone
reflexes reduced or absent
atrophy

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13
Q

where are upper motor neurones located?

A

between the cerebral cortex and the spinal cord

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14
Q

what is the role of upper motor neurons?

A

send signals to lower motor neurons

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15
Q

what is the role of lower motor neurons?

A

connect the CNS to the effector organ (often muscles) and send signals to make them contract

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16
Q

what can neurologic signs help with?

A

localisation of lesion

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17
Q

what is involved in neurological examination?

A 
mentation
gait and posture
cranial nerves
postural reactions 
spinal reflexes
sensory evaluation
palpation
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18
Q

what is assessed about mentation during a neurological exam?

A

is the patient alert, obtunded, stuporous or comatose

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19
Q

what is assessed about gait and posture during a neurological exam?

A

is it normal for the individual

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20
Q

how can cranial nerves be assessed during a neurological examination?

A 
reflexes:
menace
PLR
gag
palpebral
vestibuloccular
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21
Q

what is assessed about postural reactions during a neurological exam?

A

propreoception

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22
Q

what is assessed about spinal reflexes during a neurological exam?

A

thoracic and pelvic limb assessment

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23
Q

what is assessed about deep pain during a neurological exam?

A

panniculus

deep pain

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24
Q

what areas of the body are palpated during a neurological exam?

A

head, spine, limbs

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25
Q

what is one of the most common presentations of spinal cord injuries?

A

gait abnormalities

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26
Q

what is assessed about gait during a neurological exam?

A

can the animals generate and make coordinated movements

is there normal limb use

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27
Q

how is gait assessed in a neurological exam?

A

owner / nurse walks animal up and down

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28
Q

what should be done if the animal makes no attempt to walk during a gait assessment in a neurological exam?

A

sling or support should be used

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29
Q

define ataxia

A

uncoordinated gait (may have normal strength in limbs)

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30
Q

define paresis / paretic

A

weakness

decreased voluntary movement

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31
Q

define paralysis / plegic

A

no voluntary movement

animal cannot move limbs at all

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32
Q

define mono paretic/plegic

A

one limb affected

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33
Q

define hemi paretic/plegic

A

both limbs on one side (L or R) affected

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34
Q

define para paretic/plegic

A

both pelvic limbs affected

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35
Q

define quadra or tetra paretic / plegic

A

all four limbs affected

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36
Q

why is a quadra/tetra plegic animal very rare?

A

will affect respiratory function as well as limbs so liely to die

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37
Q

what posture changes may indicate spinal cord injury?

A 
head tilt - one ear below the other
head turn - nose turned towards body
ventroflexion of the neck
curling of the spine
decerebrate rigidity
decerebrate rigidity
wide based stance - wider limb placement than normal
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38
Q

what is ventroflexion of the neck?

A

low head carriage - head is lower than normal

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39
Q

what are the 3 main altered curvatures of the spine?

A

scoliosis
lordosis
kyphotisis

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40
Q

what is scoliosis?

A

lateral curve in spine

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41
Q

what is lordosis?

A

abnormal ventral curve in spine

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42
Q

what is kyphosis?

A

abnormal dorsal curve in spine

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43
Q

define decerebrate rigidity

A

extension of all limbs, head and neck and unable to move

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44
Q

define decerebellate rigidity

A

extension of thoracic limbs, head and neck

pelvic limbs are flexed or normal

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45
Q

how can postural reactions be tested?

A 
propreoceptive positioning
hopping
visual placing
tactile placing
hemi-walking
wheelbarrwoing
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46
Q

how is propreoceptive positioning performed during a neurological exam?

A

tuck paw under with dorsal surface on floor - animal should correct this

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47
Q

how is hopping performed during a neurological exam?

A

one leg is lifted and the patient encouraged to move on other 3

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48
Q

how is visual placing performed during a neurological exam?

A

hold limb towards a table and then place paw on it - animal should reach out towards table

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49
Q

how is tactile placing performed during a neurological exam?

A

eyes are covered and foot is brushed towards the edge of a table
the animal should place the paw normally on the table

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50
Q

how is hemi-walking performed during a neurological exam?

A

paws on one side of the body lifted and animal encouraged to move

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51
Q

how is wheelbarrowing performed during a neurological exam?

A

hindlimbs are lifted and animal walks on forelimbs

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52
Q

what spinal reflexes can be used to assess nerve function?

A

thoracic limb
pelvic limb
perineal
panniculus

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53
Q

what are the spinal reflexes that are assessed in the forelimb?

A

withdrawal reflex

extensor carpi radialis and triceps reflex

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54
Q

what are the spinal reflexes that are assessed in the hindlimb?

A

patella reflex

cranial tibial and gastrocnemius

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55
Q

how are extensor carpi radialis, biceps, triceps, cranial tibial and gastrocnemius reflexes tested?

A

muscles are tapped with a hammer and a reaction should be seen

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56
Q

what is the most reliable spinal reflex in the thoracic limb?

A

withdrawal reflex

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57
Q

what is the perineal spinal reflex?

A

if area around perineum is touched there will be contraction of sphincter

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58
Q

what is the panniculus reflex?

A

pinching either side of the spinal column which should result in a twitch that runs down the spine

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59
Q

what can the panniculus reflex help with?

A

aid localisation of lesion in spinal cord

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60
Q

is the withdrawal reflex an indication of pain?

A

no

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61
Q

when is pain evaluation performed?

A

last investigation as it is stressful

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62
Q

why is it important to test deep pain sensation?

A

deepest tracts in spinal cord are the pain tracts - if these are affected it means there is severe spinal cord damage

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63
Q

how is pain evaluated in patients?

A

pinching / pressure is applied to digits on each limb and response is noted

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64
Q

what are you looking for during a pain evaluation to show that pain tracts in the spinal cord are undamaged?

A

reaction from the patient (e.g. turning, vocalising or trying to bite)

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65
Q

what is a negative result on a deep pain evaluation?

A

no pain sensation (may still see withdrawal)

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66
Q

what are acute causes of spinal injury?

A

intervertebral disc disease (IVDD)
trauma - fracture/luxation
infarction (fibrocartilaginous embolism FCE)

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67
Q

in waht breed of dogs is IVDD most common?

A

dachshund

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68
Q

what happens during FCE?

A

blood vessels supplying the spine becomes blocked by clot / fibrocartilageonous material

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69
Q

what are the chronic causes of spinal injuries?

A

degenerative disc disease
degenerative myelopathy
cervical stenotic myelopathy (wobblers)

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70
Q

in what breeds are degenerative myelopathy and cervical stenotic myelopathy common?

A

large breeds

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71
Q

what is happening in a patient with cervical stenotic myelopathy?

A

narrowing of spinal column in cervical region

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72
Q

what are the other potential causes of spinal injury?

A 
atlanto-occipital subluxation
vertebral abnormalities
neoplasia
inflammatory diseases
discospondylitis
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73
Q

what is discospondylitis?

A

infection within vertebral bodies

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74
Q

how are spinal injuries diagnosed?

A 
imaging (radiographs, CT and MRI)
CSF tap (possibly) - cisternal or lumbar
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75
Q

what is the best imaging modality for diagnosis of spinal injuries?

A

MRI

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76
Q

how may spinal cord injuries be treated?

A

conservative treatment

surgery

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77
Q

what is involved in conservative treatment of spinal injuries?

A 
6 weeks of strict rest (cage if possible)
physiotherapy
anti-inflammatory drugs
analgesia
steroid therapy (occasionally)
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78
Q

what are the surgical options for treatment of spinal cord injury?

A

hemilaminectomy
ventral slot
dorsal laminectomy
spinal stabilisation / fixation

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79
Q

what area of the spine is operated on during hemilaminectomy surgery?

A

T3-L3 and L4-S3 regions

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80
Q

where is ventral slot surgery performed?

A

C1-T2 - ventral approach

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81
Q

when is surgical treatment of spinal injury needed?

A

negative deep pain test
extreme pain
disc material visualised in spinal column

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82
Q

what makes up a big proportion of nursing care in spinal injury patients?

A

bladder function

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83
Q

why is bladder function so significant in spinal cord injury patients?

A

many patients are incontinent

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84
Q

what are the 2 main types of bladder injury/damage seen with spinal cord injury patients?

A

upper motor neuron bladder

lower motor neuron bladder

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85
Q

describe what an upper motor neuron bladder is like

A 
increased urethral resistance
detrusor and urethral sphincter can contract at the same time
not able to control bladder function
urinary retention
kidney damage possible
difficult to manually express
requires catheterisation
intermittent squirting of urine as muscle and sphincter contract
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86
Q

are patients with upper motor neuron injuries able to control bladder function?

A

no

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87
Q

can upper motor neuron bladders be easily manually expressed?

A

o

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88
Q

is catheterisation advised for upper motor neuron bladders?

A

yes

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89
Q

describe the bladder of a patient with a spinal injury which affects lower motor neurons

A

flaccid bladder
doesn’t contract spontaneously
continues to fill which results in overflow leaking of urine
bladder muscle is overstretched
easy to manually express (will urinate with any pressure on bladder)

90
Q

how easy to express are lower motor neuron bladders?

A

easy - will express with minimal conact

91
Q

what are the main nursing considerations of patients with spinal injuries?

A

long term patients
holistic care and enrichment crucial
nutrition - encourage eating
turning and physio for recumbent patients
temperature control to prevent hyper/hypothermia
padded bedding to prevent pressure sores
excretion management (inco sheets, catheter or walked out)
grooming and TLC
hygiene

92
Q

what is intracranial disease?

A

a disease or injury which affects the brain

93
Q

is intracranial disease commonly seen in practice?

A

yes - head trauma common

94
Q

is intracranial disease an emergency?

A

yes, must be triaged and managed quickly as can be life threatening due to involvement of the brain

95
Q

why is any intracranial swelling or inflammation dangerous?

A

brain is encased within the skull vault which is a closed, inelastic compartment so there is no additional room

96
Q

what is contained within the skull vault?

A

parenchymal tissue (brain)
blood
CSF

97
Q

what percentage of the skull vault is taken up by parenchymal (brain) tissue?

A

80%

98
Q

what percentage of the skull vault is taken up by blood?

A

10%

99
Q

what percentage of the skull vault is taken up by CSF?

A

10%

100
Q

what does the CNS depend on to function?

A

blood flow

101
Q

why does the CNS depend on blood flow to function?

A

require large amount of O2 and energy via the blood to function
brain has especially high consumption and limited storage of O2 and glucose
neurons respire aerobically

102
Q

what autoregulatory mechanisms are in place in the normal brain?

A

those that maintain constant cerebral blood flow (CBF) over a wide range of MAP

103
Q

what is CBF?

A

cerebral blood flow

104
Q

what is the range of MAP that autoregulatory mechanisms can maintain constant cerebral blood flow?

A

50-150 mmHg

105
Q

what is intracranial pressure?

A

pressure exerted between skull and intracranial tissues

106
Q

what is normal ICP?

A

5-10 mmHg

107
Q

What is the name for disruption of normal ICP?

A

intracranial hypertension (ICH)

108
Q

what does intracranial hypertension result in?

A

reduced cerebral perfusion pressure (CPP)

reduced blood flow to the brain leading to secondary changes

109
Q

what leads to raised ICP?

A

increase in any volume in the brain without compensatory decrease or the presence of additional volume

110
Q

what is cerebral perfusion pressure made up of?

A

MAP - ICP

111
Q

what happens if autoregulatory mechanisms within teh brain are compromised?

A

CPP will decrease as MAP decreases and ICP increases leading to overall decrease in CBF

112
Q

what is CBF?

A

cerebral blood flow

113
Q

what causes an overall decrease in CBF if autoregulatory mechanisms are compromised?

A

CPP will decrease as MAP decreases and ICP increases

114
Q

how can the body compensate for increased ICP?

A

reduction of CSF and blood volume in the brain to compensate for raised ICP

115
Q

what reflex are you monitoring for in patients with intracranial disease?

A

cushings reflex

116
Q

what is the cushings reflex triggered by?

A

severe and acute increase in ICP

117
Q

what are the signs of cushings reflex?

A

marked risk in MAP and relfex bradycardia

118
Q

what is the cushings reflex a sign of?

A

potentially life threatening increase in ICP and so should be treated immediately

119
Q

what are the causes of intracranial disease?

A 
trauma
inflammatory
infectious
neoplastic
toxins
seizures
anomalous
120
Q

what are examples of trauma that may cause intracranial disease?

A 
RTA
fall
horse kick
being stepped on
BB gun pellet
121
Q

what are examples of inflammatory causes of intracranial disease?

A

meningoencephalitis of unknown origin (MUO)

122
Q

what are examples of infectious causes of intracranial disease?

A

viral
protozoal
fungal
bacterial

123
Q

what are examples of neoplastic causes of intracranial disease?

A

meningioma
glioma
choroid plexus tumor

124
Q

what are examples of toxins that may cause intracranial disease?

A

lead

ivermectin

125
Q

what are examples of anomalous causes of intracranial disease?

A

hydrocephalus

126
Q

what is involved in a neurological exam?

A

mentation
gait and posture - is it normal
cranial nerves
postural reactions - proprioception
spinal reflexes - thoracic and pelvic limbs
sensory evaluation - panniculus and deep pain
palpation of head, spine and limbs

127
Q

what are the two key elements of the neurological examination that will show intracranial disease?

A

mentation

cranial nerves

128
Q

what are the 4 main categories to assign when assessing mentation?

A

alert
obtunded
stuporous
comatose

129
Q

describe alert mentation

A

normal response to surrundings

130
Q

describe obtunded mentation

A

awake but less responsive

will sleep if left

131
Q

describe stuporous mentation

A

only responds to noxious or painful stimuli

132
Q

describe comatose mentation

A

unconscious

unresponsive to any stimuli

133
Q

what behaviours may an animal show if they have intracranial disease?

A 
circling in tight circles, one way
head pressing
pacing
head tilt - one ear below the other
head turn - nose turned towards the body
134
Q

what is head pressing a sign of?

A

increased ICP and pain

135
Q

what are the ways in which cranial nerve function can be assessed?

A 
menace response
palpebral reflex
pupillary light reflex (PLR)
gag reflex
oculocephalic relfex
nystagmus
136
Q

how many cranial nerves are there?

A

12

137
Q

how can the menace response be tested?

A

cover one eye and move hand towards face in menacing gesture - patient should draw away from hand

138
Q

how is the palpebral reflex tested?

A

touch on medial canthus of eye - blink should be shown

139
Q

what is the pupillary light reflex?

A

constriction of one or both pupils in response to bright light

140
Q

how is the gag reflex assessed?

A

touch larynx

141
Q

what is the oculocephalic reflex?

A

physiological nystagmus which corrects with movement

142
Q

what is physiological nystagmus?

A

flicking of eyes in response to fast movement which will stop once patient isn’t moving

143
Q

how is the oculocephalic reflex tested?

A

patient is moved quickly through room or spun and response of eyes watched

144
Q

what does an absence of oculocephalic reflex indicate?

A

poor prognosis

severe brainstem damage

145
Q

is nystagmus when patient is still normal?

A

no

146
Q

what is a miosis / miotic pupil?

A

constricted

147
Q

what is a mydriasis / mydriatic pupil?

A

dilated

148
Q

what is anisocoria?

A

asymmetric pupils

149
Q

what about patients pupils will indicate neurological deterioration?

A

if patients pupil goes from miotic to mydratic

150
Q

what must be monitored and recorded about pupil size?

A

any changes

151
Q

what is indicated by mid sized, fixed pupils that are unresponsive to light?

A

grave prognosis - patient is likely dead

152
Q

what are the clinical signs of intracranial disease?

A 
circling
ataxia
blindness
altered mentation
loss of consciousness
seizures
Cheyne-stokes respiration
head tilt
head turn
coma
loss of gag reflex
loss of oculocephalic reflex
strabismus
non-responsive pupils
apneustic or ataxic respiratory pattern (sign of deterioration)
decerebrate posture
decerebellate posture
nystagmus
153
Q

what are the 3 domains of the modified glasgow coma score?

A

motor activity
brainstem reflexes
level of conciousness

154
Q

what score is possible in each domain of the modified glasgow coma scale?

A

1-6

155
Q

what is the final score possible on the glasgow coma score?

A

between 3 and 18

156
Q

what score indicates more severe neurological deficits and grave prognosis?

A

lower score

157
Q

what prognosis is indicated by a MGCS of 3-8?

A

grave

158
Q

what prognosis is indicated by a MGCS of 9-14?

A

guarded - potential for deterioration

159
Q

what prognosis is indicated by a MGCS of 15-18?

A

good

160
Q

how is raised intracranial pressure treated?

A

Mannitol infusion

hypertonic saline IVFT

161
Q

what is the action of Mannitol?

A

hyperosmolar
reduces cerebral oedema
increases CPP and cerebral blood flow

162
Q

how rapid is the onset of action of Mannitol?

A

rapid - can see improvement in clinical signs within minutes

163
Q

how long do the ffects of Mannitol last?

A

1.5-6 hours

164
Q

how is Mannitol given?

A

boluses of 0.5-1.5 g/kg every 1.5-6 hours

165
Q

what is the most significant side effect of Mannitol?

A

profound diuretic

166
Q

how can the side effects of Mannitol be managed?

A

isotonic fluids to follow up

maintain vasuclar volume

167
Q

what must happen to Mannitol before it is administered?

A

must be warmed

168
Q

how does hypertonic saline work to treat raised ICP?

A

similar osmolarity to Mannitol

improves haemodynamic status

169
Q

what is the preferred method o treatment for raised ICP?

A

Mannitol

170
Q

what may prove beneficial if patient is not responding to treatment for raised ICP?

A

switching between Mannitol and hypertonic saline or vice versa

171
Q

what is indicated by a poor response to Mannitol?

A

poor prognosis

172
Q

How is raised ICP treated alongside Mannitol or hypertonic saline?

A 
sedatives - encourage patient rest
analgesia
anaesthesia if severe
mechanical ventilation if comatose
CRI may be needed
intensive care and monitoring needed
173
Q

when may CRI be needed to treat a patient with raised ICP?

A

maintaining sedated state before switching to full anaesthesia (e.g. patient is seizing)

174
Q

are corticosterioids indicated for use in patients with raised ICP?

A

no

175
Q

how should the recumbent patient be managed?

A

turn every 2-4 hours
padding adequate
physio to prevent muscle wastage and joint stiffness
monitoring and management of excretions to prevent scauld

176
Q

how must the raised ICP patient be positioned?

A

cranial part of body elevated (not just head) by 30-40 degrees

177
Q

why must the cranial part of the body and not just the head be elevated in patients with raised ICP?

A

avoid compression of the jugular vein which can further increase ICP

178
Q

what blood sampling method is not appropriate in raised ICP patients?

A

jugular

179
Q

by how many degress should the cranial part of an animals body be elevated?

A

30-40 degrees

180
Q

what is involved in the occular care of an recumbent patient?

A

eye drops to prevent drying

wipe eyes to keep clean

181
Q

what is involved in oral care of the recumbent / comatose patient?

A

prevent saliva and excretion build up in mouth by clearing with a damp swab
monitor for coughing

182
Q

how often should oral checks be performed in the recumbent / comatose patient?

A

4-6 hours

183
Q

how can nutrition be provided to recumbent/comatose patients

A

offer in sternal every 4-6 hours if concious

feeding tube if not

184
Q

are feeding tubes often used in comatose raised ICP patients?

A

unlikely as there survival rate is low

185
Q

what feeding tube must be avoided in patients with raised ICP?

A

N/O as can cause sneezing

186
Q

what monitoring form may need to be completed in raised ICP patients?

A

anaesthetic monitoring

187
Q

what is hydrocephalus?

A

excessive accumulation of CSF within the ventricular system

188
Q

what can hydrocephalus be caused by?

A

obstruction to CSF outflow
decreased absorption of CSF
increased production of CSF

189
Q

what are the 2 main types of hydrocephalus?

A

congenital - present at birth

acquired

190
Q

what breeds are pre-disposed to congenital hydrocephalus?

A

chihuahua

191
Q

what causes acquired hydrocephalus?

A

tumor
inflammation
haemorrhage

192
Q

what are the clinical signs of hydrocephalus?

A 
behavioural changes
slowness in learning (e.g. toilet training)
loss of coordination
visual deficits
seizures
circling
depressed / obtunded mentation
enlarged and dome shaped skull
193
Q

what is the most common sign of hydrocephalus?

A

enlarged and dome-shaped skull

194
Q

are signs of hydrocephalus consistent?

A

no - may wax and wane particularly congenital

195
Q

what are the 2 main methods of treatment of hydrocephalus?

A

medical

surgical

196
Q

what are the aims of medical treatment of hydrocephalus?

A

reduce production of CSF

197
Q

what are the main drugs used for medical treatment of hydrocephalus?

A

Prednisolone
Frusemide
Omeprazole

198
Q

what is the aim of surgical treatment of hydrocephalus?

A

diverting CSF to another location

199
Q

what is the main surgery performed to treat hydrocephalus?

A

ventriculoperitoneal shunt (VP shunt)

200
Q

what is involved in a ventriculoperitoneal shunt?

A

tubing placed from ventricle to peritoneal cavity to drain excess CSF

201
Q

what are the main complications associated with VP shunt to treat hydrocephalus?

A

blockage
tube dislodged
infection

202
Q

what is the outcome of hydrocephalus treatment dependent on?

A

cause and severity of signs

203
Q

what outcome is suggested by severe hydrocephalus signs?

A

guarded

204
Q

when may hydrocephalus be found?

A

incidental during MRI for another issue

205
Q

what is the prognosis for hydrocephalus due to infectious cause?

A

good with treatment for underlying infection and removal of CSF build up

206
Q

what is the prognosis for hydrocephalus treated with VP shunt?

A

good

207
Q

what is the prognosis of hydrocephalus due to obstruction by tumor?

A

guarded

208
Q

what type of illness is meningoencephalitis of unknown origin (MUO)?

A

non-infectious inflammatory disorder of CNS

209
Q

what are the 3 types of meningoencephalitis of unknown origin (MUO)?

A 
granulomatous ME (GME)
necrotising (NME)
necrotising leukoencephalitis (NLE)
210
Q

what does meningoencephalitis of unknown origin (MUO) result in?

A

brain and spinal cord changes due to autoimmune disease

211
Q

when can the 3 different types of meningoencephalitis of unknown origin (MUO) be determined?

A

only PM as only difference seen at a cellular level

212
Q

what is the signalment of meningoencephalitis of unknown origin (MUO)?

A

small dog
female more than male
>6 months of age
some breed disposition (e.g. bichon freise)

213
Q

what are the signs of meningoencephalitis of unknown origin (MUO)?

A 
neurological
seizures
muscle tremors
blindness
head tilt
altered balance and posture
circling
214
Q

how is meningoencephalitis of unknown origin (MUO) diagnosed?

A

clinical exam
blood tests
MRI of brain with contrast
CSF analysis for inflammatory signs

215
Q

how is meningoencephalitis of unknown origin (MUO) managed?

A

immunosuppressive drugs
antiepileptics if seizing
nursing care

216
Q

what immunosuppressive drugs may be used to treat meningoencephalitis of unknown origin (MUO)?

A

steroids
cyclosporine
azathioprine
cytarabine

217
Q

why must care be taken when administering cytarabine?

A

is cytotoxic

218
Q

what is the prognosis of meningoencephalitis of unknown origin (MUO) like?

A

variable

219
Q

what is the prognosis of meningoencephalitis of unknown origin (MUO) patients who present with seizures?

A

poorer

220
Q

what is the prognosis of meningoencephalitis of unknown origin (MUO) patients who present with focal lesions rather than multifocal?

A

better with focal lesions

221
Q

what is the prognosis of meningoencephalitis of unknown origin (MUO) patients who show improvement within 3 months of beginning treatment?

A

good

222
Q

can meningoencephalitis of unknown origin (MUO) return in patients who have been successfully treated?

A

yes and signs may be more severe

JJ (33 decks)

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