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Neurology > Pathology of the NS > Flashcards

Pathology of the NS Flashcards

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1
Q

What is Meningitis ?

A

Inflammation/infection of the meninges

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2
Q

What is Encephalitis ?

A

Infection/inflammation of the brain

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3
Q

What is Myelitis ?

A

Infection/inflammation of the spinal cord

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4
Q

How would a patient with Meningitis present ?

A
  • Fever
  • Headache
  • Stiff neck
  • Photophobia
  • Petechiae rash (Meningococcus)
  • N/V
  • Seizures
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5
Q

What are the main bacterial causes of Meningitis and who do they typically effect ?

A
  • Neisseria meningitis (meningococcus) - Young adults and children
  • Group B Strep - Neonates
  • E. coli - Neonates
  • Strep. pneumoniae (pneumococcus) - Adults
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6
Q

What are the main viral causes of Meningitis ?

A
  • HSV

- Enteroviruses (Polio)

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7
Q

How does a patient present with Encephalitis ?

A
  • Flu-prodrome
  • Progressive headache - Altered conscious levels
  • Fever
  • Abnormal behaviour
  • Seizures
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8
Q

What causes Encephalitis ?

A

It is usually viral e.g. HSV, Aborviruses. Can be autoimmune.

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9
Q

How do you investigate Meningitis ?

A
  • Bloods culture/cell count
  • CT/MRI
  • LP - CSF culture and microscopy
    - If viral suspected do PCR
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10
Q

How to investigate Encephalitis ?

A
  • Blood culture/cell count - In autoimmune look for Anti VGKC and Anti NMDA
  • CT/MRI
  • LP
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11
Q

When do you not perform a LP ?

A
  • Focal signs
  • Altered conscious level
  • Papilloedema
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12
Q

What CSF findings are found in bacterial Meningitis ?

A
  • Low sugar
  • High protein
  • High levels of neutrophils
  • Opening pressure is high
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13
Q

What CSF findings are found in viral Meningitis ?

A
  • Normal sugar
  • Normal protein
  • High levels of lymphocytes
  • Opening pressure is normal
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14
Q

How is HSV treated ?

A

Acyclovir

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15
Q

How are enteroviruses transmitted ?

A

Faecal-oral route

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16
Q

How are Arboviruses transmitted ?

A

By vector from non-human host. Some are preventable by immunisation.

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17
Q

How do you treat a patient with bacterial Meningitis ?

A

IV Ceftriaxone

Corticosteroids

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18
Q

How do you treat a patient with viral Meningitis ?

A 
Anti-virals 
Bed rest
Hydrate 
Analgesics 
Corticosteroids to reduce inflammation
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19
Q

How would a patient present who has an abscess ?

A
  • Fever
  • Headache
  • Nausea and vomiting
  • Papilloedema
  • Seizures
  • Altered conscious level
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20
Q

How do you investigate a brain abscess ?

A
  • CT/MRI
  • Blood cultures
  • Biopsy
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21
Q

How do you treat a brain abscess ?

A
  • Drainage

- High dose IV antibiotics (Penicillin for strep and metronidazole for anaerobes)

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22
Q

What brain diseases can HIV cause (3) ?

A
  • Meningitis
  • Brain abscesses
  • Dementia
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23
Q

What is seen in patients with HIV in bloods ?

A

Low CD4 count

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24
Q

What infective agents usually are found in patients with HIV ?

A
  • Crypotococcus neoformans
  • CMV
  • Toxoplasma gondri
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25
How do you investigate HIV infections ?
- PCR for CMV - Crypotococcal antigen - Toxoplasmosis serology
26
What are the two main Spirochaete's ?
``` Borrelia burgdorferi (Lymes disease) Treponema Pallidum (Neurosyphilis) ```
27
How does Lyme's disease present ?
Rash at site of tick bite, flu symptoms, one or more organs affected. Period of latency then chronic infection.
28
What investigations are done in Lyme's disease ?
- MRI - CSF lymphocytosis - EMG
29
How do you treat Lyme's disease ?
IV Ceftriaxone | Doxycycline (oral)
30
How do you investigate Syphilis ?
- Antibody tests | - CSF lymphoyctosis
31
How do you treat Syphilis ?
High dose penicillin
32
How does Polio usually present ?
Patients are asymptomatic and only 1% has paralysis
33
Can Polio be prevented ?
Vaccination - Polio virus given combined with other antigens
34
How does Rabies present ?
Disease of the PNS. Paraesthesia at the site of lesion. Paralysis starts distally and work way upwards.
35
How is Rabies investigated ?
PCR and serology
36
How is Rabies prevented ?
Rabies immunisation with killed vaccine.
37
How is rabies treated ?
Person given immunoglobulins and immunisation. Wound must be cleaned.
38
How does Tetanus present ?
Rigitidy and spasm
39
What is Tetanus ?
Clostridium Tetani anaerobic gram +ve bacillus, spore forming. Acts at the neuromuscular junction and block inhibition of motor neurones.
40
How is Tetanus treated ?
Immunoglobulins and high dose penicillin. Immunisation can be given to those at risk.
41
What is Botulism ?
Clostridium Botulinum anaerobic gram +ve bacillus. Neurotoxin binds to presynaptic membrane and prevent Ach release.
42
How does a patient present with Botulism ?
Descending paralysis
43
How do you investigate Botulism ?
- Serology | - Culture from wound
44
How do you treat Botulism
Penicillin and metronidazole. Antitoxins.
45
What is active immunity ?
Body actively makes antibodies against antigen
46
What is passive immunity ?
Body is given antibodies from another source
47
What is a post-inflammatory syndrome and give 2 examples ?
When the body mounts an autoimmune response against an infection or vaccination. CNS - ADEM (Acute Disseminated EncephaloMyelitis) PNS - Gullian-Barre Syndrome
48
What is a prion ?
A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally.
49
What disease is associated with Prions ?
CJD (Creutzfeldt - Jakob Disease)
50
How does sporadic CJD present ?
- Rapidly progressive Dementia - Jerks - Rigidity - Weakness - Spasms
51
How does new variant CJD present ?
- Early behavioural changes | - Linked to cattle
52
How do you investigate CJD ?
- MRI - small holes - EEG - LP - Bloods
53
``` GBS vs MG Reflexes ? Ptosis ? Fatigue ? Pain ? ```
Reflexes - GB absent and MG present Ptosis - MG present and GBS absent Fatigue - MG present and GBS absent Pain - GBS painful and MG no pain
54
MG vs MND Fatigue ? Ptosis ? Fasciculations ?
Fatigue - MG present and MND absent Ptosis - MG present and MND absent Fasciculations - MND present and MG absent
55
What signs are seen on examination in patients with MND ?
- Fasciculations - Hyperreflexia - Muscle wasting - Spasticity
56
Does MND effects the upper or lower MN's ?
Both
57
How is MND diagnosed ?
- LP - Blood tests - CT/MRI - EEG
58
How is MND treated ?
- Physio - SALT - OT - Riluzole - Anti-spasmodics - Anti-depressants
59
What is Myasthenia Gravis ?
Myasthenia gravis is an autoimmune disease which results from antibodies that block or destroy nicotinic acetylcholine receptors at the junction between the nerve and muscle.
60
How does Myasthenia Gravis present ?
- Skeletal muscle weakness - SOB - Slurred speech - Difficulty chewing - Ptosis - Diplopia
61
What is the Edrophonium test ?
They inject edrophonium chloride and if you have a sudden improvement in muscle strength its likely you have MG.
62
What is Gullian Barre syndrome ?
Guillain-Barré syndrome (GBS) is a rare condition in which a person's immune system attacks the peripheral nerves. More common in adults and in males. Most people recover fully.
63
What does GBS present like ?
Paralysis starts in hands and feet and spreads towards face and body.
64
What precedes GBS ?
Infection or vaccination
65
How is Gullian-Barre syndrome treated ?
- IV immunoglobulins - Plasma exchange - Analgesics - Physio - OT
66
How is MG treated ?
- Immunosuppressants - Steroids - Thymectomy - Plasma exchange - IV Immunoglobulins
67
Definition of Dementia
Progressive impairment of cognitive function in an alert patient leading to a loss of acquired skills.
68
What is Dementia usually cause by in older generation ? (3)
- Lewy bodies - Alzheimers disease - Vascular
69
What is Dementia usually caused by in the younger generations ? (3)
- HIV - CJD - Alcoholic dementia
70
How do you investigate Dementia ?
- Bloods - CT/ MRI - LP - EEG - Examine cognitive function
71
What are the signs of Fronto-Temporal Dementia ?
- Personality changes - Early dysphasia - Eating/behavioural problems
72
What is the treatment for Fronto-Temporal Dementia ?
No treatment
73
What are the signs of Temporo-Parietal Dementia ?
- Visuospatial problems - Memory problems - Cant understand speech
74
What are the 2 drug classes given to manage Temporo-Parietal Dementia/Lewy Body Dementia ?
- Acetylcholinesterase inhibitors (helps with cognition) | - NMDA receptor antagonist (reduce memory loss)
75
What are the signs of Vascular Dementia ?
- Stepwise decline | - Mixed symptoms (affects all parts of brain)
76
What advice should be given to patients with Dementia and their families ?
- Voluntary organisation they can contact - Help and support via NHS - Respite care - OT
77
What other medications can be given to control Dementia symptoms ?
Medications to control behaviour, depression and insomnia.
78
Name a NMDA receptor antagonist ?
Memantine
79
Name a Acetylcholinesterase inhibitor ?
Donepezil
80
Definition of Parkinsonism
Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability.
81
When is Parkinsonism seen ?
- Lewy body dementia - Vascular dementia - Drug induced
82
Good response to which neurotransmitter can be used to diagnose Parkinsonism ?
Dopamine
83
What functional imaging is commonly used in Parkinsonism ?
SPECT to look at dopamine uptake/transportation
84
What medication can be given to treat Parkinsonism ?
- Levodopa and Carbidopa - MAO inhibitors - COMT inhibitors - Dopamine agonists
85
What side effects do patients get during treatment of Parkinsonism ?
- Hallucinations | - Involuntary, jerky movements
86
What are the long-term complications of Parkinsonism ?
- Bladder and bowel incontinence - Depression - Slurred speech
87
What other non-medication treatment is available to treat Parkinson's
Deep brain stimulation
88
What does EEG measure ?
EEG measures the electrical activity of the brain
89
What are Evoked Potentials used for ?
To investigate problems with central pathways
90
Which neurophysiological test can be used to test for Myasthenia Gravis and what is don't during the test ?
EMG and the muscles are repeatedly stimulated to look for signs of fatigue
91
What can be seen in the EMG results in muscles disease ? (2)
- Jitters | - Loss of tight relationship between AP's of two muscle fibres
92
Definition of Encephalopathy
Brain disease or dysfunction
93
What can EEG be used for ?
- Diagnose brain death - Seizures - People having difficulty sleeping
94
What do Evoked Potentials measure ?
The time is takes for a signal from a stimulus to be sent to the brain and for the brain to respond.
95
UMN signs
- Hyperreflexia - Increased tone - Extensors plantars - No wasting
96
LMN signs
- Absent reflexes - Decreased tone - Flexor plantars - Wasting
97
What is Browns-Sequard syndrome ?
A lesion in the spinal cord causes loss of sensation on one side of the body and weakness/paralysis on the other side
98
What type of lesion causes Browns-Sequard syndrome ?
Hemicord lesion (one half)
99
What are some causes of spinal cord lesion symptoms ?
- Trauma - Tumours - Degenerative disease - B12 deficiency
100
Where do the anterior spinal arteries arise from ?
Aorta
101
Where do the posterior spinal arteries arise from ?
Vertebral arteries
102
What are the 3 main causes of spinal cord ischaemia ?
- Thromboembolic disease - Atheromatous disease - Vasculitis
103
Define paraparesis/paraplegia
Weakness or paralysis in one side of the body
104
Define paraesthesia
Tinging
105
What may the occlusion of the central sulcal artery present like ?
Brown-Sequard syndrome
106
How would you treat spinal cord ischaemia ?
- Anticoagulants - BP monitoring - OT/Physio - Arrhythmias need sorting
107
In MS is there very few or lots of WBC's ?
Very few <50
108
What is the treatment for MS ?
Methylprednisolone and supportive
109
What factors make people more at risk of B12 deficiency
- Vegan diet - Pernicious anaemia - Crohns, gastrectomy or tape worms
110
How does B12 deficiency present ?
- Paraesthesia in hands and feet - Arreflexia - Fatigue - Paraplegia - Painless retention of urine
111
How do you investigate B12 deficiency ?
- FBC | - B12 levels
112
How do you treat B12 deficiency ?
Intramuscular B12

Neurology (16 decks)

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