Nuero Review 2

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Anonymous
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192332
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Nuero Review 2
Updated:
2013-01-11 22:28:28
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PANCE
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  1. Clinical Presentation of Menigitis
    • Fever
    • Headache
    • Stiff neck
    • Nausea
    • Vomiting
    • Seizures
    • Signs of Meningeal irritation- postive kernig's and Budzinski signs
  2. Causes of Meningitis in Newborns
    (0- 6 Months of age)
    Little GooGoo GaaGaa

    • Listera
    • GNR
    • Group B strep
  3. Causes of Meningitis in Children
    (6 months to  6 years)
    • HENS
    • 1. H. influenzae type B
    • 2. Enteroviruses
    • 3. N. Meningitidis
    • 4. S.pnemoniae
  4. Causes of Meningitis in patients 6-60  years of age
    • Hens
    • 1.HSV
    • 2.Enteroviruses
    • 3.N.Meningitidis
    • 4.S.pneumoniae
  5. Causes meningitis in elderly (persons over 60 years of age)
    • Grandies Need Some Love
    • 1.GNR
    • 2. N. Mingingitidis
    • 3. S. Pneumoniae
    • 4. Listera
  6. Tuberculosis Meningitis Etiology
    •  1.Caused by Mycobacterium tuberculosis
    •  2. Seen in malnourished, debilitated or immunosuppressed people
    •  
  7. Fungal Meningitis Etiology
    Common malnourished, immunosuppressed or debitated

    • Common Pathogens:
    • 1. Cryptococcus
    • 2. Candida
    • 3. Fusarium

    • Rare Pathogens:infections in healthy people
    • 1. Histoplasma
    • 2. Coccidioides
    • 3. Paracoccidiodes
  8. Meningitis Diagnostic Studies
    • CSF
    • 1.Protein and Glucose
    • 2.Cell count
    • 3.PCR for HSV

    Blood Culture

    • Latex Agglutination for -H.influ, S.pneumo
    • N. Meningitis

    CT/MRI- prior to LP if focal signs
  9. Contraindictation for LP
    • Papilledema
    • Focal Neurologic Sign
    • Coagulopathy
  10. Spinal Fluid Profile for Bacterial Meningitis
    • Increased -opening pressure
    • Increased WBC 50-10,000 mostly polys
    • Increased protein
    • Decreased Glucose
  11. Spinal Fluid profile in fungal or TB Meningitis
    • increased opening pressure
    • whites count increased bwt 50-10,000 both polys and lymphs
    • Increased protein
    • decreased glucose
  12. Spinal  Fluis Profile in Viral Meningitis
    • Normal to slightly increased opening pressure
    • WBC 20- 1,000 mostly lymphs
    • Slightly Increased protein
    • Normal glucose
  13. Management of Fungal Meningitis
    Hospitalization for observation and  IV antifungal medications.

    • Medications include
    • 1. Amphortericin B
    • 2. Flucytosine and be used in addition to increase efficacy

    mortality rate 20-50 %
  14. Management of Viral Meningitis
    mostly supportive care
  15. Managment of Bacterial Meningitis
    • Hospitalization
    • Empirial antibotics
    • -Vancomyacin and Ciprofloxacin or
    • -Ampicillin
    • -Consider giving steroid dexamethasone before antibiotic
    • -treat close contacts with rifampin, ciprofloxacin or ceftriaxone
  16. Management of TB Meningitis
    "RIPE"

    • R- rifampin
    • I- Isoniazid
    • P-pyrazidamide
    • E-ethambutal

    For 18-24 Months
  17. Guillian- Barre Syndrome Definitions
    Autoimmune disease that targets gangliosides and leads to rapidly progressing, ascending, areflexic motor paralyses with or without sensory distrubances.
  18. Guillain Barre Syndrome Etiology
    • Males > than Females
    • Adults > Children
    • 85%  Recovery Rate
    • 5% Death Rate
    • 60-70% of patients have a acute  GI/Respiratory infection proir to neurologic symptoms.
    • Organsims assocated with disease include
    • 1. Campylobactor Jejuni
    • 2. CMV
    • 3. EBV
  19. Guillian Barre Syndrome inital symptoms
    Ascending weakness that evoles over days to reach a peak at 14-30 days

    Loss of DTR at about day 3

    Bulbar weakness and respiratory muscle paralysis may occur

    50%  of pat ients havefacial weakness

    pains and tingling sensations
  20. Treatment of Guillain Barre syndromes
    • IV IGG
    • Plasma Exchange
    • Rehab
    • No steroids -not helpful
    • monitor FVC FVC< 15 indication for ICU and Intubation
  21. Clinical Maniestation of Autonomic Neuropathies
    • Orthostatic Hypotension
    • Diarrhea
    • Constipation
    • Early Satiety
    • Tachycardia/Palpitation
    • Blurred Vision
    • Urinary Retention
    • Erectile Dysfunction
  22. Guillain-Barre syndrome Diagnostic testing
    CSF shows increased protein greater than55mg/dl with few or no cells called albulminocytologic

    May have positive antibodies
  23. Man
  24. Managment of Cluster Headaches
    May spontaneously regress untill next episode

    • inhalation of 100% O2 for 20 mins while
    • sitting upright
    • Triptans
    • Prednisone, veraparmil, methylsergide

    trigeminal nerve resecion or injection
  25.  Management of Mirgrains
    Simple Dugs-OTC pain medication taken at 1st onset

    Drugs that induce Sleep

    Ergotamine, s=- all constrict cerebral and systemic blood vessels and prevents release of inflammatory mediators from trigeminal nerve

    N/V may make oral medications ineefective

    Triptans
  26. Prophylactic Treatment of Migraines
    Indicated for patient who have  for or more mirgraines a month

    • regular excerise
    • regular sleep schedule
    • avoid  alcohol, caffeine or other triggers

    Medications- reduce migraines by 50%when taken dailly

    • amitriptyline
    • olivaloproex sodium
    • propanolol
    • timolol
  27. Management of Tension Type Headaches
    • Relaxation techniqques- Hot/Cold paxks
    • bths/showers, massage, meditation

    OTC analgesics- high doses may cause rebound HAs

    Sleep medication

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