week 11

Question 1

outline the pathophsyiology,clinical manifestations, clinical diagnosis and manegemnt of:
meningitis

Answer 1

meningitis = inflammation of the menigies due to bacteria, virus, parasite, autoimmune, drugs, etc.
viral is the most common and is transmitted via droplets, and bacterial is more associated with trauma or surgery but can also be transmitted via droplets.
The clinical features include:
headache (90%)
neck stiffness
altered mental state
fever
photophobia
petechial rash - non blanching

treatment includes:
early identification and PPE
early broad spectrum antibiotics
anticipate and treat shock
in hospital:
-confirmation with lumbar puncture - CSF
-steroids
-Antivirals
-ICU

Question 2

outline the pathophsyiology,clinical manifestations, clinical diagnosis and manegemnt of:
encephalitis

Answer 2

Encephalitis is inflammation of the brain itself
The severity is variable
has the same range of mechanisms of meningitis
clincial features:
- fever
- headache
- confusion
- seizures
- personality changes
- meningeal symptoms

management:
- early notification
- high clinical support backup
- sedation for agitiation
- anticipate seizures - may be treatment resistant

Question 3

outline the pathophsyiology,clinical manifestations, clinical diagnosis and manegemnt of:
brain abscess

Answer 3

Abcess = a collection of pus an inflammed tissue that builds up as a result of an infection
10% mortality
worse when supine (inc. ICP)
gradual onset
Difficult diagnosis

clinical features:
headache
fever
focal neurological signs (asphasia and hemiparesis)
vomiting
seizure

Transport and symptom management

Question 4

outline the pathophysiology, clinical manifestations of the common headache vs migraine

Answer 4

The current pathophysiology of migrains is poorly understood, however there is suspicion in hormones and genetics.
15% of the population globally has migrains

whereas headaches pretty much happens to anyone and is a result of:
dehydration
sinus infection
muscle strain
anxiety
cold/flu
idiopathic

Red flags for a headache include:
worse/different/first headache
thunderclap headache
LOC/collapse
age >50 or <5
neuro deficit
persistent
progressive

migrains can have 4 stages
prodromal stage:
- occurs 60% of cases
- days to weeks
- wide range of presentations
- depression/euphoria, heightened senses, food cravings, muscle aches, gi symptoms
Aura phase
- occurs 30% of cases
-appears suddenly and lasts <60mins
- visual, sensory, motor, effects
Pain:
- unilateral, throbbing, intense
- photophobia, phonophobia, stiff neck, nausea/vomiting, diaphoresis
Postdromal
- depression/euphoria
-fatigue
- cognitive deficit
- GI upset

Question 5

outline the current consensus on the management of patient with a headache or migraine

Answer 5

With either case, it is vital to ensure that you are hoping for the best, but prepared for the worse
- educate patient on what else the syptoms could be alluding
- ensure you take a good history

migrain treatment:
- rest in quiet dark environment
- antiemetic
- NSAID
- triptan (serotonin agonist)
- previously effective medication
- IV fluid
- opioid admin could worsen it