Neurology Flashcards
(95 cards)
what is the max amount of CSF fluid you can remove for a sample?
1ml/kg
what is the site of sampling for CSF
cerebellomedullary cistern- easier more risk
lumbar cistern - more difficult less risk
contraindications for CSF sample?
increased ICP
coagulopathy
cerebellomedullary cistern contraindicated in some conditions eg cervical trauma
are the following evaluation of MRI or myelography in spinal diagnostics?
more soft tissue detail
more likely to be diagnostic
more expensive/ equipment
takes 1 hour
expertise necessary for interpretation
MRI
are the following evaluation of MRI or myelography in spinal diagnostics?
risk of seizure, neuro degen, dysrthmia, resp arrest, infection, death
cervical or lumbar punctures challenging
intra-axial lesions not shown
standard x-ray eqiupment only or CT
quicker
myelography
what spinal condition does AChR ab in blood indicate
acquired myasthenia gravis
what spinal condition does 2M Ab in blood indicate
masticatory myositis
what is the neostigmine response test used for?
test for junctionopathies eg myasthenia gravis
prolongs action of acetylcholine- see if improves condition
what are electrodiagnostics used for?
identify denervated muscles- extent and severity
what does electromyography test for
if spontaneous activity, is abnormal muscle nervation
what is motor neuron conduction velocity used to test
assess conduction along a nerve (minimum 2 sites)
what is F wave electrodiagnostics used for
assess nerve roots, help identify conditions such as polyradiculoneuritis
what is repetitive nerve stimulation used to test?
assess neuromuscular junction for myosethenia gravis
repeatedly stimulate nerve 3-5 times
what neurological condition is this?
Px: sympathetic denervation
Cx: miosis, ptosis of upper eyelid, protrusion 3rd eyelid, enophthalmus, conjunctival hyperaemia
Dx: +/- radiographs (neck, chest, bullae), MRI (brain, c-spine, brachial plexus),CSF
- 1% Phenylephrine topical administration to the cornea
o 1 st order – dilation in 60-90 minutes
o 2 nd order – dilation in 20-45minutes
o 3 rd order – dilation in
horners syndrome
seisures are due to dysfunction of what area of the brain
forebrain
paresis of all or ipsilateral limbs, decerebate rigidity, depression stumpour and coma, cranial nerve deficits and possible vestibular signs
indicate dysfunction of which area of the brain?
brainstem
intention tremors, abnormal menace with normal vision and PLR, delayed initial then hypermetric postural responses indicate lesion in which part of brain
indicate dysfunction of which area of the brain?
cerebellum
disorientation with contralateral blindness, normal gait and circling with decrease postural responses in contralateral limbs
indicate dysfunction of which area of the brain?
forebrain
how is intracranial pressure calculated? (ICP)
vestibular eye movements/ nystagmus good early indicator of increased ICP as swelling blocks front and back of brain so eyes dont follow head movement
clinical signs of increased ICP?
mental status changes: depression, stupor, coma bradycardia and hypertension altered PLR vestibular eye movements/ nystagmus abnormal postures
What brain condition is this:
fine tremor – rapid, low amplitude, worse with stress/excitement,
+/- other deficits: head tilt, reduced menace response, ataxia
Dx: CSF – very mildly inflammatory, +/- MRI to rule out other problems
how would you treat
idiopathyic tremor syndrome Tx: - corticosteroids for 4-6m - +/- other immunosuppressive drugs - diazepam initially
Pgx: fair to good prognosis but possibility of relapse
What brain condition is this
how would you treat
infection:
Cx: usually acute CNS signs (obtundation and CN deficits most common), neck pain , pyrexia
CSF: increased protein concentration and pleocytosis; phagocytosed organisms in CSF rare
CSF/blood culture (positive sometimes) inside abscess or in small amounts
bacterial meningitis
intoxication with
Organophosphates, pyrethrin and pyrethroids, lead, ivermectin, metaldehyde, tremorgenic mycotoxins, medications (antidepressants, amphetamines, metronidazole, etc)
often leads to which clinical signs?
brain condition
reactive seisures
acute (<24h) onset, often GI, cardiovascular or respiratory signs before or at same time
§muscle tremors and fasciculations often seen
how would you assess severity of head trauma in a patient?
modified glasgow coma scale (higher score= better prognosis)
this is a serial neurological assessment
