Meningitis + Parkinsonism Flashcards
What is Brudsinki’s sign
neck flexion causes hip and knee flexion when supine
Most common pathogens causing meningitis
a) generally
b) in neonates, alcoholics, immunosuppressed, DM
c) infants (1-23months)
d) most common viral
a) Strep pneumonia, N. meningitides, TB, e coli, H influenza B, listeria
b) listeria, e coli, group B strep
c) strep pneumonia, H influenza, n meningitidis
d) HSV
RF for meninigitis
RF: immunocompromised, malignancy, diabetes, HIV, alcohol use, recent neurosurgery, head injury, recent abdo surgery, neonates, Indigenous, students in residence
Sx of meningitis
HA
Fever
Neck stiffness
N/V
Poor feeding
Altered MS, irritability
Kernigs sign
Kernig’s - pain with passive extension of flexed knee
Ix + results for meningitis
Blood cultures
CT
LP
Bacterial: high WBC (500-10K), reduced glucose ration, high proten, neutrophils, gram stain
Viral: WBC (10-500), lymphocytes, moderately increased protein
Empirical abx for ages:
0-4 wks
1-50yrs
>50yrs
0-4 wks: ampicillin + cefotaxime
1-50yrs: vancomycin + cefotaxime
>50yrs: vancomycin + cefotaxime + ampicillin
Other Rx for meningitis
Abx
Dex
Contact public health + ensure prophylaxis for family
Targeted antimicrobial therapy for
S pneumo
N meningitidis
Listeria
S agalactiae
H influenza
E coli
Targeted antimicrobial therapy
S pneumo: Ampicillin
N meningitidis: ampicillin
Listeria: ampicillin
S agalactiae: ampicillin
H influenza: ampicillin
E coli: cefotaxime
Complications of meningitis
HA
Sz
Cerebral edema
Hydrocephalus
SIADH
Deafness
Death
Signs of PD
Tremor
Rigidity
Akinesia or Bradykinesia
Postural Instability
Shuffling Gait
Decreased Arm Swing
Cogwheeling
Masked Facies
Hypophonia
Dysarthria
Bradyphrenia
Micrographia
Depression
Dementia
Psychosis
Sleep Disturbances
Autonomic Dysfunction
Rx for PD (classes + names for each)
MAO B Inhibitors e.g. rasagiline
Dopamine Agonists e.g. levodopa, pramipexole or bromocriptine
Anticholinergics e.g. benztropine
Antivirals e.g. amantadine
COMT Inhibitors e.g. tolcapone
Clinical phenomena seen when treating PD
“On-Off” - a switch from proper mobility to dyskinesia or even immobility
“Wearing Off” - symptoms start appearing again before the next dose is due
Sx of PD
Resting tremor
Stiffness
Bradykinesia
Imbalance
Gait disturbance
Rigidity
Postural instability
DDx of PD
Parkinsonian Syndrome
AD
Multiple cerebral infarcts
Drug induced (APs, lithium, metoclopramide)
Multiple system atrophy
Progressive supranuclear palsy
