Neurological Emergancies Flashcards
(32 cards)
What are the signs and symptoms of meningitis?
- generalised headache, gradual onset
- vomiting, neck stiffness, fever, photophobia, altered consciousness
- Kernig’s sign - difficult to bend knee
- non-blanching rash
What the main risk factors for menginitis?
- extremes of age
- diabetes
- immunosuppression
- splenectomy
- alcoholism
- contagious infection
- defects in dura mater
- IV drug abuse
- ## malignancy
What are the most common causative organisms for bacterial meningitis?
- S.pneumoniae
- N. meningitides
- If pregnant or over 60 its more likely to be L. monocytogenes
- recently had surgery = S.aureus
What is the essential treatment if bacterial meningitis is suspected?
- start benzylpenicllins in case its meningococcus
What are the diagnostic tests for meningitis?
- CT indicated if impaired conciousness or focal neurological deficit
- LP to diagnose
- blood tests to look for DIC
What the CSF findings for bacterial meningitis?
- marked elevation of WBCs, mainly polymorphs
- usually elevated protein
- reduced glucose by 50%
What are the CSF findings for viral meningitis?
- WBC elevated, usually lymphocytes
- protein elevated
- normal glucose
What are the CSF findings for TB meningitis?
- elevated WBCs, mixed,
- usually very high protein
- reduced glucose
Malignant CSF findings
WBCs elevated
- often elevated protein
- reduced glucose
How does TB meningitis present?
- insidious onset, however acute presentation can occur if it is complicated by hydrocephalus or vasculitis
- often presents with mild heachace, lesions of CN 6, 3 and 4
- papilloemea, and optic nerve damage
How is TB meningitis treated?
- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
+ steroid over two months
How is viral meningitis treated?
- antipyretics and support until full recovery occurs
What is the treated of the following causes of bacterial meningitis?
- unknown
- meningococcus
- pneumococcus
- s.aureas
- unknown = cefotaximine
- meningococcus = cefotaximine/benzylpenicillin, if allergic chloramphenicol can be used, also give dexamethasone
- pneumococcus = cefotaximine
- s.aureas = rifampicin
What is encephalitis?
What are the symptoms?
- inflammation of the brain parenchyma
- symptoms include headache, fever, focal neurological deficit (dysphagia, weakness), seizures, and encephalopathy
What is the typical cause of encephalitis?
- typically viral in cause, usually HSV and other human herpesvirus
, but can also be due to bacteria such as listeria. Additionally autoimmune is increasing in prevelance
How should HSV encephalitis be treated?
- if suspected acyclovir should commence before investigation
What are the investigations for encephalitis?
- MRI, EEG, LP to culture virus
In all episodes of acute and sub-acute flaccid weakness it is important to…
- monitor respiration in all causes using FVC
What are the causes of acute and subacute neuromuscular failure?
- Nerve lesions include Guillain Barre
- Muscle disease such as inflammatory dermatomyositis and metabolic disorders such as acid maltase
- NMJ pathology includes myasthenia graves and botulism
What are the features of Guillain Barre?
most common cause of acute NMJ weakness, leading to inflammatory polyradiculopathy
- it normally is preceded by respiratory tract infection, generating antibodies that then cross-react with the myelin sheath of neurones
What are the symptoms of GBS?
- parastheisa but little sensory loss, back pain is common
- distal upper and proximal lower limb weakness, facial and bulbar involvement
- respiratory muscles may be involved
What are the investigations for GBS?
- LP, CSF will show elevated protein, and nerve conduction studies
Prognosis in GBS is poor if it is caused by …….. . Why?
Treatment?
campylobacter
- axonal loss, and the time to nadir is short-
Treatment - plasma exchange and IV Ig to accelerate recovery
What is MG?
- an autoimmune condition characterised by the presence of AChR antibodies that block the post-synaptic receptor at the NMJ
- this will present with fatiguable weakness of muscle function with no autonomic features
