AHN 572 neuro 2 Questions With Complete Solutions
CSF normal values - ANSWER-clear appearance
protein 15-60 mg/100ml
glucose 50-80mg/100ml
cell count 0-5 WBC, no RBC
CSF Opening Pressure - ANSWER-70-180
Meningitis symptoms - ANSWER-classic triad of headache, neck stiffness and fever
-photophobia, vomiting, altered mental status, cranial nerve palsies, seizure, exaggerated DTR
nuchal rigidity - ANSWER-stiffness in cervical neck area
Brudzinski's sign - ANSWER-pain with resistance and involuntary flex of hip/knee when neck is
flexed to chest when lying supine
Kernig's sign - ANSWER-Sign of meningitis; positive when the leg is fully bent at the hip and
knee, and subsequent extension of the knee leads to pain and spasm of hamstrings
Meningitis Diagnosis - ANSWER-1st: CT Brain
2nd: Lumbar puncture
meningitis CSF findings - ANSWER-cloudy
pressure > 180
elevated WBC 100-5000; polymorphonuclear
elevated total protein 100-500
decreased glucose 5-40
Jolt accentuation - ANSWER-turning head horizontally 2-3 times - worsening baseline HA
Babinski sign - ANSWER-The toes flex upward when sole of foot is stimulated - dorsiflexion
positive/abnormal finding in meningitis
,Pneumococcal meningitis - ANSWER-- head trauma, sinusitis, pna
- cranial nerve palsies/ obtundation
- csf wbc > 1000, polymorphonuclear
- glu < 40
- gram + cocci
Meningococcal meningitis - ANSWER-- high fever, chills, HA, myalgias, NV
- + kernigs / brudzinski
- petechial rash
- gram -
- DIC
- CSF with elevated pressures, inc protein and Dec glu
H. influenzae meningitis - ANSWER-adults with sinusitis or otitis
Klebsiella (meningitis) - ANSWER-infants/ elderly, immunocompromised
Fungal meningitis - ANSWER-common in clients who have AIDS
Chronic Meningitis - ANSWER-CSF wbc 100-1000 mostly lymphocytes, glu < 45, protein > 50
Meningitis treatment 18-50 - ANSWER-vancomycin + ceftraixone
Meningitis organisms 18-50 - ANSWER-s. pneumoniae, N. meninitidis
meningitis over 50 tx - ANSWER-vancomycin + ampicillin + ceftraixone
meningitis over 50 organisms - ANSWER-s pneumoniae, N meningitidis, Listeria monocytogenes,
gram - bacilli, group b strep
Meningitis treatment immunocompromised - ANSWER-vancomycin + ampicillin + cefepime
meningitis organisms immunocompromised - ANSWER-L monocytogenes, gram - bacilli, s
pneumoniae
meningitis post surgery / trauma tx - ANSWER-vancomycin + cefepime
post surgery/ trauma meningitis organisms - ANSWER-s aureus, s pneumoniae, aerobic gram -
bacilli,
brain abscess tx - ANSWER--IV abx (ceftriaxone + metronidazole + vancomycin)
, -Surgical drainage
brain abscess with dexamethasone - ANSWER-start within 2-4 days, prior to or with first dose
abx
0.15mg/kg IV q6h if s pneumoniae suspect
hydrocephalus - ANSWER-abnormal accumulation of fluid (CSF) in the brain
hydrocephalus leads to - ANSWER-changes in cerebral flow caused by displacement,
deformation, stretching, or decrease in caliber of cerebral vessels
Hydrocephalus symptoms - ANSWER-papilledema, HA, NV, gait changes, upward gaze
NPH triad of symptoms - ANSWER-dementia
gait disturbance
urinary incontinence
Hydrocephalus treatment - ANSWER-Implantation of ventriculoperitoneal (VP) shunt; removal
of mass
communicating hydrocephalus - ANSWER-ventricles patent, obstruction occurring past 4th
ventricle
impaired absorption or overproduction
noncommunicating hydrocephalus - ANSWER--The obstruction of cerebrospinal fluid from a
source within of the ventricular system
r/t tumor
NPH on CT/MRI - ANSWER-enlarged ventricles, overall brain atrophy
West Nile Virus encephalitis CSF - ANSWER-wbc variable
protein > 60
glu normal
lymphocytes pleocytosis and polymorphonuclear cells early
IgM capture ELISA
West Nile Diagnosis - ANSWER-4x increase in acute/convalescent IgG titers
West Nile S/S - ANSWER-muscle weakness, tremor, seizure, cranial nerve palsies, pathological
reflexes, myocarditis, hearing loss
CSF normal values - ANSWER-clear appearance
protein 15-60 mg/100ml
glucose 50-80mg/100ml
cell count 0-5 WBC, no RBC
CSF Opening Pressure - ANSWER-70-180
Meningitis symptoms - ANSWER-classic triad of headache, neck stiffness and fever
-photophobia, vomiting, altered mental status, cranial nerve palsies, seizure, exaggerated DTR
nuchal rigidity - ANSWER-stiffness in cervical neck area
Brudzinski's sign - ANSWER-pain with resistance and involuntary flex of hip/knee when neck is
flexed to chest when lying supine
Kernig's sign - ANSWER-Sign of meningitis; positive when the leg is fully bent at the hip and
knee, and subsequent extension of the knee leads to pain and spasm of hamstrings
Meningitis Diagnosis - ANSWER-1st: CT Brain
2nd: Lumbar puncture
meningitis CSF findings - ANSWER-cloudy
pressure > 180
elevated WBC 100-5000; polymorphonuclear
elevated total protein 100-500
decreased glucose 5-40
Jolt accentuation - ANSWER-turning head horizontally 2-3 times - worsening baseline HA
Babinski sign - ANSWER-The toes flex upward when sole of foot is stimulated - dorsiflexion
positive/abnormal finding in meningitis
,Pneumococcal meningitis - ANSWER-- head trauma, sinusitis, pna
- cranial nerve palsies/ obtundation
- csf wbc > 1000, polymorphonuclear
- glu < 40
- gram + cocci
Meningococcal meningitis - ANSWER-- high fever, chills, HA, myalgias, NV
- + kernigs / brudzinski
- petechial rash
- gram -
- DIC
- CSF with elevated pressures, inc protein and Dec glu
H. influenzae meningitis - ANSWER-adults with sinusitis or otitis
Klebsiella (meningitis) - ANSWER-infants/ elderly, immunocompromised
Fungal meningitis - ANSWER-common in clients who have AIDS
Chronic Meningitis - ANSWER-CSF wbc 100-1000 mostly lymphocytes, glu < 45, protein > 50
Meningitis treatment 18-50 - ANSWER-vancomycin + ceftraixone
Meningitis organisms 18-50 - ANSWER-s. pneumoniae, N. meninitidis
meningitis over 50 tx - ANSWER-vancomycin + ampicillin + ceftraixone
meningitis over 50 organisms - ANSWER-s pneumoniae, N meningitidis, Listeria monocytogenes,
gram - bacilli, group b strep
Meningitis treatment immunocompromised - ANSWER-vancomycin + ampicillin + cefepime
meningitis organisms immunocompromised - ANSWER-L monocytogenes, gram - bacilli, s
pneumoniae
meningitis post surgery / trauma tx - ANSWER-vancomycin + cefepime
post surgery/ trauma meningitis organisms - ANSWER-s aureus, s pneumoniae, aerobic gram -
bacilli,
brain abscess tx - ANSWER--IV abx (ceftriaxone + metronidazole + vancomycin)
, -Surgical drainage
brain abscess with dexamethasone - ANSWER-start within 2-4 days, prior to or with first dose
abx
0.15mg/kg IV q6h if s pneumoniae suspect
hydrocephalus - ANSWER-abnormal accumulation of fluid (CSF) in the brain
hydrocephalus leads to - ANSWER-changes in cerebral flow caused by displacement,
deformation, stretching, or decrease in caliber of cerebral vessels
Hydrocephalus symptoms - ANSWER-papilledema, HA, NV, gait changes, upward gaze
NPH triad of symptoms - ANSWER-dementia
gait disturbance
urinary incontinence
Hydrocephalus treatment - ANSWER-Implantation of ventriculoperitoneal (VP) shunt; removal
of mass
communicating hydrocephalus - ANSWER-ventricles patent, obstruction occurring past 4th
ventricle
impaired absorption or overproduction
noncommunicating hydrocephalus - ANSWER--The obstruction of cerebrospinal fluid from a
source within of the ventricular system
r/t tumor
NPH on CT/MRI - ANSWER-enlarged ventricles, overall brain atrophy
West Nile Virus encephalitis CSF - ANSWER-wbc variable
protein > 60
glu normal
lymphocytes pleocytosis and polymorphonuclear cells early
IgM capture ELISA
West Nile Diagnosis - ANSWER-4x increase in acute/convalescent IgG titers
West Nile S/S - ANSWER-muscle weakness, tremor, seizure, cranial nerve palsies, pathological
reflexes, myocarditis, hearing loss
