Diag Ii-Final-Neurological Investigations

Front 1

What can be done in the case of a primary subarachnoid hemorrhage if CT is a false negative?

Back 1

LP

Front 2

If CT reveals no evidenc of a mass lesion or edema, then LP is usually needed in the presence of papilledema to establish the diagnosis of what?

Back 2

Pseudotumor cerebri and to exclude meningeal inflammation or malignancy

Front 3

If the pt is on heparin, what is needed to be given before an LP?

What about for warfarin?

Back 3

-protamine for heparin

-Vit K and FFP for warfarin

Front 4

What are some possible complications to a LP?

Back 4

-HA
-subarachnoid bleeding
-diplopia
-backache
-radicular symptoms

Front 5

What is the most common complication to a LP?

Back 5

-HA

Front 6

WHy does a HA result post LP?

Back 6

From low CSF pressures caused by persistend fluid leakage thru the dural hole

Front 7

What is one way to help deal with a post LP HA?

Back 7

lay in supine position

Front 8

What are some ways to avoid a post LP HA?

Back 8

Use a small guage stilletted needles is used and if multiple punctures are avoided

Front 9

CSF pressure should be measured how often?

Back 9

routinely

Front 10

What is the reference zero level for CSF when the patient is in the lateral decubitus position?

Back 10

Pressure in the right atrium

Front 11

When might CSF pressure be low?

Back 11

-previous LP
-dehydration
-spinal subarachnoid block
-presence of CSF fistulas

Front 12

When does increased CSF pressure happen?

Back 12

-brain edema
-intracranial mass lesions
-infections
-acute stroke
-cerebral venous occlusions
-CHF
-pulmonary insufficiency
-hepatic failure

Front 13

Normal CSF contains no more than how many lymphocytes?

Back 13

5

Front 14

The presence of blood in the subarachnoid space produces a secondary inflammatory response that leads to what?

Back 14

a disproportionate increase in the number of white cells

Front 15

After an acute SAH, when is blood in the CSF most marked?

Back 15

48 hrs after onset

Front 16

Acute Bacterial Meningitis:
-pressure
-Leukocytes
-protein
-glucose

Back 16

-elevated
-several hundred to thousands
-usually 100-500
-5-40 in most cases

Front 17

Tuberculous Meningitis
-pressure
-leukocytes
-protein
-glocose

Back 17

-usually elevated
-usually 25-100, rarely <500
-usually 100-200
-usually reduced, less than 45

Front 18

Cryptococcal Meningitis
-pressure
-leukocytes
-protein
-glucose

Back 18

-usually elevated
-0-800, average is 50
-20-500, average 100
-reduced in most cases, about 30

Front 19

Viral Meningitis
-pressure
-leukocytes
-protein
-glucose

Back 19

-normal to moderately elevated
-5-few hundred
-frequently normal to slightly elevated, less than 100 usually
-normal

Front 20

Syphilitic Meningitis:
-pressure
-leukocytes
-protein
-glucose

Back 20

-usually elevated
-average 500
-average 100
-normal usually

Front 21

In LP for a SAH, bleeding is usually seen in how many tubes?

Back 21

evenly in all three

Front 22

If the CSF total protein is greater than 150, will faint xanthochromia be present?

Back 22

yes

Front 23

What are the two pigments derived from RBCs that may be observed in the CSF?

Back 23

-oxyhemoglobin
-bilirubin

Front 24

Oxyhemoglobin is released with the of what?

Back 24

Lysis of RBCs and may be detected in the supernatant fluid within 2 hrs after a SAH

Front 25

Maximal levels of Oxyhemoglobin are reached when post SAH?

Back 25

36 hours

Front 26

Bilirubin is produced where?

Back 26

in vivo by leptomeningeal cells after red cell hemolysis

Front 27

Bilirubin is first detected about how long after the onset of a SAH?

Back 27

10 hours

max in 48 hrs

Front 28

Greatly increased total CSF protein is seen in what conditions?

Back 28

-meningits
-bloody fluids
-spinal cord tubor with spinal block

Front 29

Increased levels of about 100-300 are seen in what conditions?

Back 29

-polyneuritis
-diabetic rediculoneuropathy
-myxedema

Front 30

An increase of immunoglobulins is of dx importance?

Back 30

yes

Front 31

CSF glucose level is decreased characteristically in what diseases?

Back 31

-purulent meningitis
-tuberculous meningitis
-fungal meningitis

Front 32

CSF glucose levels are usually normal in what type of meningitis?

Back 32

-viral

Front 33

Nerve conduction studies measure what?

Back 33

speed and strength of an electrical impulse conducted along a peripheral nerve

Front 34

In sensory nerve conduction studies, the electrical strength of the impulse is indicated by what?

Back 34

The amplitude of the waveform, measured either in microvolts (sensory) or millivolts (motor) and is represented on the tracing by the vertical height of the waveform

Front 35

Both latency and conduction velocity depend on what?

Back 35

intact, myelinated nerve, as myelin and the salutatory conduction it fosters are essential for fast action potential propagation in normal subjects

Front 36

Slowing of conduction velocity implies what?

Back 36

demylelinating injury

Front 37

Loss of amplitude in nerve conduction studies usually correlated with what?

Back 37

axonal loss of dysfunction

Front 38

What are the 5 parameters that are measured during a needle EMG examination?

Back 38

1-insertional activity
2-spontaneous activity
3-motor unit configuration
4-motor unit recruitment
5-interference pattern

Front 39

What is insertional activity?

Back 39

Brief burst of electrical activity recorded when the EMG needle is moved through the muscle

Front 40

Increased insertional activity suggests excessive irritablity of the muscle fibers and is the hallmark of what?

Back 40

Denervating disorders

Front 41

Spontaneous activity is most strongly associated with denervating axonal injury at any point from where?

Back 41

anteriour horn to the nerve terminal

-seen in polymyositis and dermatomyositis

Front 42

MAUP parameters include what 3 things?

Back 42

-wave form duration
-amplitude
-morphology