Diseases Test 2 Flashcards Preview

Neuro Mike Rose > Diseases Test 2 > Flashcards

Flashcards in Diseases Test 2 Deck (13):
1

Meningitis

Infection of the sub-arachnoid space.

Symptoms: headache, fever, NUCHAL RIGIDITY, and altered mental ability.

Causes: Viral (most common) - enteroviruses/picornovirus, Bacterial (life-threatening) - Streptococcus pneumonia, Neisseria meningitidis, and Haemophilus influenza type b, protozoa and fungal (immuno-compromised)

Most common

Different pathogens affect different age groups (see lectures)

Virulence factors like capsules allow pathogens to evade immune system

Vaccines available against several strains of life-threatening bacteria.

Treatment: H&P, blood culture, empiric treatment, neuroimaging, LP/biopsy, identify organism, finally switch to definitive therapy. Must start therapy ASAP for bacterial meningitis.

2

Encephalitis

Infx of parenchyma

Symptoms: fever, headache, and alteration of mental status, motor and sensory deficits (not seen in meningitis), progression to seizures, speech disturbances, lethargy, and coma.

Causative agents: Viral - Enterovirus, Arbovirus, Herpes Virus, Rabies
Bacterial - Rickettsia, Mycoplasma, Acute disseminated encephalomyelitis (ADEM)

3

Brain Abscess

Symptoms: Fever, headache, neurolgic effects

Mechanism of disease: pre-existing ischemia, necrosis begins as cerebritis and then becomes encapsulated.

Causative agent: Streptococci (most common), Pseudomonas, Haemophilus, Staphylococcus, Bacteroides,

Mycobacterium, fungi, or parasites (immunocompromised)

Can rupture and cause meningitis

4

Encephalopathy

Diffuse cerebral dysfunction without inflammation usually due to toxin or metabolic dysfunction

5

Aseptic Meningitis Syndrome

Misnomer often viral but could be noninfectious.

Symptoms: fever, headache, and photophobia. Less neck stiffness and altered mental status. Incidence highest during first year of life.

Lab values: CSF increase in lymphocytes and monocytes, slight increase in protein, and normal glucose

Treatment: supportive therapy

6

Tension-type headache

Symptoms: 30 min to one week in length. Pressing/tightening. Mild to moderate in intensity (not debilitating). Bilateral (think headband distribution). Not aggravated by physical activity. No nausea or vomiting. Some photo/phono phobia.

Mechanism of disease: Muscle contraction causing greater occiptal nerve compression. Exacerbated by emotional stress.

Epidemiology: women > men (possibly sampling bias). Onset < 40 years old. Episodic if < 180/year; Chronic if < 180/year. Increased prevalence with increased educational attainment.

Treatment: Often self-treated, Analgesics (ibu, asa, tyenol), acupuncture, biofeedback, relaxation technique

Treatment

7

Cluster headache

Symptoms: Severe, unilateral, orbital, supraorbital, or temporal pain lasting 15-180 minutes. Circadian periodocity. Every other day to every 8th day. AUTONOMIC SYMPTOMS: lacrimation, nasal congestion, rhinorrhea, forehead sweating, miosis, ptosis, eyelid edema, conjunctival injection.

Epidemiology: Male:female 4:1. Mean onset age 27-31. Incidence 2.5/100,000/year. Prevalence: 1/1000

Mechanism: Incompletely understood. Hypothalamic activation of trigeminovascular autonomic system and parasympathetics.

Treatment: OXYGEN. Triptans too, and prophylaxis for episodic clusters.

8

Migraine

Symptoms: Intermittent, unilateral, throbbing, crescendo-decrescendo headache lasting hours to days. Gradual onset, associated with nausea; family history. Aura +/-

Epidemiology: Female:male = 3:1. Onset < 40. Prevalence 18% women and 6% men. Lifetime prevalence 20-25%. >50% people with migraines miss > 2 days a work/month.

Pathophysiology: Uncertain. Linked to low seratonin levels followed by seratonin spike and vasoconstriction which is followed by disease causing vasodilation.

Treatments: Attacks = Triptans, Dihydroegotamine (DHE), Percholoperazine, metoclopramide, Tyenol, ibu, naproxen, dexamethasone (Triptan and DHE most emphasized)

Prophylaxis: AMITRYPTALINE, divalproex sodium/socium valproate, propanolol, timolol.

Contraindications: With Aura avoid OCPs! Viagra?

9

Primary Measles Encephalitis (PME)

Pathophysiology: virus invades and replicates within brain cells. Typically at the same time of rash presentation.

Epidemiology: 1-3 of 1,000 patients.

Treatment - supportive therapy

Morbidity/Mortalitiy: 10-15% mortality rate. Of those that survive, 25% experience lifelong neuro problems.

10

Measles induced Acute Disseminated Encephalomyelitis (APME)

Results in demyelination. Can be seen with a recent history of measles infx.

Epidemiology: 1 in 1000 measles infx.

11

Measles Subacute Sclerosing Panencephalitis (SSPE)

Children who contact measles before the age of two are at the greatest risk. Symptom free for 6 to 15 years post acute infx and survive 1 to 3 years after symptoms develop.

Epidemiology: 4 to 11 per 100,000 cases.

12

Reye's syndrome

Rare often fatal syndrome that is correlated with aspirin use in children in the presence of a viral infection (VZV etc.) Causes liver and brain damage.

13

Horner Syndrome

Results from interruption of sympathetic pathways on the ipsilateral side either in the:

1. Cervical Sympathetic trunk (lung cancer metastasis)
2. Sympathetic fibers in the brain stem and spinal cord (stroke) and Most common.

Symptoms: Ptosis,- drooping of the eyelids.
Miosis - pupillary constriction
Anhidrosis - absence of sweating
Flushing of face (redness/vasodialation).