Neuro Patho

Question 1

What is meningitis?

Answer 1

• Inflammation/infection of meninges around the brain or spinal cord
• Caused by bacteria, viruses, fungi, parasites, or toxins
• Source: normal inhabitants that get into wrong place, bloodstream infections, trauma, fracture
• Young, old, immunocompromised are most at risk

Question 2

Bacterial meningitis

Answer 2

• AKA septic (viral is called aseptic)
• Strep pneumonia: most common in adults and 2nd most common in peds
• Neisseria meningitides: most common in peds
• E coli and GBS: most common in newborns

Question 3

Pathophysiology of Meningitis

Answer 3

• Invading organism leads to inflammatory response (neutrophils, exudate block flow of CSF) which leads to cerebral changes (increased ICP and disrupt blood supply, risk of ischemia)
• Continued exacerbation of inflammatory response

Question 4

Clinical manifestations of meningitis

Answer 4

• Infectious: fever, tachycardia, chills, petechial rash
• Neurologic: all related to increased ICP (decreased LOC, cranial nerves, seizures, irritability, delirium)
• Irritation of meninges: throbbing headache, photophobia, nuchal rigidity (stiff neck), Brudzinski’s sign (bend neck up and child will flex knees), Kernig’s sign (flex hip 90 degrees and try to extend knee but painful)

Question 5

Evaluation of meningitis

Answer 5

• History and physical
• Lumbar puncture: culture and gram stain, increased pressure, CSF (find high WBCs, high neutrophils, high protein
• Bacterial = low glucose
• Viral = normal glucose

Question 6

Treatment of meningitis

Answer 6

• Bacterial = IV antibiotics
• Viral = antiviral and steroids
• Manage complications
• Supportive: rest, comfort measures, dark rooms, decreased stimulation

Question 7

Prevention of meningitis

Answer 7

• Vaccination
• Screening
• Active treatment of primary sources

Question 8

Increased Intracranial Pressure

Answer 8

• Cranium = fixed volume container that holds brain matter, CSF, and blood
• Less fixed in babies until fontanels close
• ICP = pressure exerted by contents of the cranium
• Normal = 0-15 mmHg

Question 9

Etiology of ICP

Answer 9

• Most common causes in adults: stroke, brain trauma, tumors

- Peds common causes: tumor, structural malformations, infections

Question 10

3 causes of Increased ICP

Answer 10

1. Cerebral edema (accumulation of fluid): vasogenic or cytotoxic edema and often occur together
2. Space-occupying processes: tumor, hematoma, abscess
3. Hydrocephalus: excessive accumulation of CSF

Question 11

Clinical manifestations of ICP

Answer 11

• headaches
• Changes in LOC
• Changes in eyes: pupils, vision
• Vomiting
• Changes in vital signs: increased systolic BP, decreased pulse, altered respiratory pattern (Cushing’s Triad)
• Seizures
• Decreased motor function
• Posturing
• Infants: bulging fontanels, increased head circumference, high pitched cry, poor feeding, sun-seeing eyes

Question 12

Evaluation of ICP

Answer 12

• History and physical
• Imaging
• Lumbar puncture: tells us about infectious process

Question 13

Treatment of ICP

Answer 13

• Treat underlying cause
• Monitor and alleviate pressure
• Cerebral oxygenation
• Pharm

Question 14

Seizures

Answer 14

• Transient neurologic event with excessive/abnormal electrical discharges
• Alteration in membrane potential that makes certain neurons abnormally hyperactive and hypersensitive to changes
• Interaction of complex genetic mutations with environmental effects that cause issues

Question 15

Variation within seizures

Answer 15

• Causes are different across the lifespan
• 1/2 of all causes are idiopathic (unknown cause)
• Classification: symptoms and ECG features
• Clinical manifestations depend on area of brain involved and where they spread (must do specific assessment)

Question 16

When seizure triggers and is started

Answer 16

• Triggers or precipitated by: infections, drinking, hypoglycemia
• Epileptogenic focus: where seizure starts
• Prodromal/aura: subjective sense that seizure is about to happen
• Status epilepticus: more than 5 minutes or back to back so can’t recover

Question 17

Generalized seizures

Answer 17

• Entire brain involved
• involvement of thalamus and reticular activating system results in loss of consciousness
• Absence or petite mal: staring
• Myoclonic: single/several jerks
• Atonic: drop attacks/fall down
• Tonic-clonic: jerking of many muscles
• Post ictal: after they regain consciousness in deep coma state (recovery time can last several hours)

Question 18

Partial seizures

Answer 18

• Limited to one brain hemisphere
• Simple: no change in LOC, motor/sensory/autonomic
• Complex: similar, lose or change in consciousness
• Secondarily generalized: begins partial but then involves both hemispheres

Question 19

Seizure diagnosis

Answer 19

• History and physical
• Neuro exam
• EEG
• Labs
• Imaging

Question 20

Treatment of seizures

Answer 20

• Airway and injury
• Good documentation is key
• Treat underlying cause
• Meds
• Patient ed: avoid triggers

Question 21

Febrile seizures

Answer 21

• Seizure accompanied by fever without CNS involvement
• Primarily btw 6 months and 5 years of age
• Genetics and environment
• Simple (single and short duration) vs complex (reoccur, prolonged)
• 1/3 of patients who have one will have another