Week 3 - Neuro part 2

Question 1

3 protective layers of meninges

Answer 1

Dura Matter, Arachnoid, Pia matter

Question 2

Meningtitis Risk Factors

Answer 2

having a respiratory tract infection
smoking
living in a community setting (dorm, barracks)
asplenia (congenital or splenectomy)
immunocompromised

Question 3

Common pathogens causing meningitis

Answer 3

Neisseria meningitidis (most common)

& Streptococcus pneumoniae (<2yo and immunocompromised)

H. Influenzae type b
Viral meningitis
Fungal meningitis
Tubercular meningitis

Question 4

Meningeal Inflammatory signs

Answer 4

Severe throbbing headache
Severe photophobia
Nuchal rigidity
Positive Brudzinski & Kernig signs
Headache

Question 5

Describe Positive Brudzinski & Kernig signs

Answer 5

B: passive flexion of head in supine position results in flexion of knees and hips.
K: Extension of knee to 90% while supine elicits resistance or pain in lower back or posterior thigh.

Question 6

Neurologic signs in Meningitis

Answer 6

Decreased in level of consciousness
Focal neurologic deficits:
hemiparesis (one sided weakness)
hemiplegia (one sided paralysis)
ataxia (poor muscle control)
seizures

Question 7

Contraindications to lumbar puncture

Answer 7

Signs of brain herniation (papilloedema on fundoscopy)
Patient is unstable (new focal neurological deficits, seizures)
Patient has a coagulopathy

Question 8

How would bacterial vs viral meningitis Lumbar puncture results be different from each other, in terms of WBC, Glucose and protein?

Answer 8

Bacterial: High NEUTROPHILS Decreased Glucose, increased protein.

Viral: Increased LYMPHOCYTES, NORMAL glucose, slightly increased protein.

Question 9

Initial empiric therapy for Adults 18-50, Bacterial Meningitis.

Answer 9

3rd Generation Cephalosporin (Cetriaxone or Cefoxime IV) +/- Vancomycin or Ampicillin) if penicillcin resistant pneumococcus is a possibility. (and d/c the vanco as soon as 3rd generation ceph resistance is excluded).

Question 10

Chemoprophylaxis is recommended for individuals who have been exposed to bacterial meningitis caused by NEISSERIA MENINGITIDIS

Answer 10

Ciprofloxacin
Rifampin
Ceftriaxone
Vaccination

Question 11

Epilepsy is defined as a disease of the brain with what three components?

Answer 11

1) At least 2 unprovoked seizures occurring more than 24 hours apart
2) One unprovoked seizure and a probability of further seizures
3) A diagnosis of an epilepsy syndrome (?)

Question 12

Hypersynchronicity: when neurons begin rapidly firing, they can spread this hyper exciteability to neighbouring neurons.