Neurological/Neuromuscular

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Neurological/Neuromuscular

  1. 1. Neurological/Neuromuscular
  2. 2. Meningitis <ul><li>An infection of the meninges </li></ul><ul><li>Causes </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><ul><li>Community acquired: pneumococcus/meningococcus, hemophilus </li></ul></ul></ul><ul><ul><ul><li>Hospital acquired: staphylococcus, gram- rods </li></ul></ul></ul><ul><ul><li>Viral </li></ul></ul><ul><ul><ul><li>Coxsackie, mumps, mycobacterium TB, leptospirosis </li></ul></ul></ul><ul><ul><ul><li>Liseria and crytococcus more common in immunosuppressed patients </li></ul></ul></ul>
  3. 3. Meningitis <ul><li>Clinical features </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><ul><li>Sepsis </li></ul></ul><ul><ul><li>Malaise </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Endocarditis </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Neck stiffness </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul><ul><ul><li>Photophobia </li></ul></ul>
  4. 4. Meningitis <ul><li>Investigation </li></ul><ul><ul><li>Lumbar puncture </li></ul></ul><ul><ul><li>Blood cultures </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>For bacterial, use ATB </li></ul></ul><ul><ul><li>Steroids can reduce complications </li></ul></ul><ul><ul><li>Rifampin given to those in close contact for meningococcal and hemophilus </li></ul></ul>
  5. 5. Encephalitis <ul><li>An acute, usually viral, brain infection </li></ul><ul><li>A rare complication of common viral diseases like chickenpox and mumps </li></ul><ul><li>Clinical features: drowsiness, irritability, fever, neurological signs </li></ul><ul><li>Severe cases progress to sz, coma, death </li></ul><ul><li>CSF has elevated lymphocytes and protein </li></ul><ul><li>Management is mostly supportive </li></ul><ul><li>Antivirals (acyclovir/gancyclovir) may be used </li></ul>
  6. 6. Other neurological infections <ul><li>Tetanus </li></ul><ul><ul><li>Caused by Clostridium tetani </li></ul></ul><ul><ul><li>Enters body through a wound </li></ul></ul><ul><ul><li>Muscle rigidity, spasms, and respiratory failure </li></ul></ul><ul><ul><li>Requires heavy sedation/paralysis and mechanical ventilation </li></ul></ul><ul><ul><li>Treated with immunoglobulin, ATB, and surgical debridement of the infected wound </li></ul></ul><ul><li>Polio, botulism, and rabies also cause paralytic neurological infections </li></ul>
  7. 7. Guillain-Barre Syndrome <ul><li>The most common cause of generalized flaccid paralysis </li></ul><ul><li>Usually follows a flu-like illness, but can also follow Epstein-Barr virus, CMV, HIV, hepatitis, campylobacter infections </li></ul><ul><li>Causes a demyelinating neuropathy </li></ul><ul><li>Clinical features </li></ul><ul><ul><li>Starts with distal parasthesia </li></ul></ul><ul><ul><li>Ascending weakness/paralysis </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>About 1/3 of GB patients require ventilation </li></ul></ul><ul><ul><li>Mortality is low (<10%) but about 10% of survivors have residual effects </li></ul></ul>
  8. 8. Myasthenia Gravis <ul><li>An autoimmune disorder with muscle weakness </li></ul><ul><li>Acetylcholine receptors are attacked by antibodies, reducing transmission of impulses to the muscles </li></ul><ul><li>Thymus gland abnormalities are found in ~75% of cases </li></ul><ul><li>Clinical features </li></ul><ul><ul><li>Onset is slow and develops over weeks </li></ul></ul><ul><ul><li>Muscle weakness that increases with repetitive use </li></ul></ul><ul><ul><li>Eye muscles frequently involved </li></ul></ul><ul><ul><li>Ptosis and diplopia are most common presenting features </li></ul></ul><ul><li>Myasthenia crisis </li></ul><ul><ul><li>A life-threatening deterioration of MG caused by infection, fever, surgery, or drugs…leads to rapid respiratory failure </li></ul></ul>
  9. 9. Myasthenia Gravis <ul><li>Investigation </li></ul><ul><ul><li>Check blood for Ach receptor antibodies </li></ul></ul><ul><ul><li>EMG – shows decline in muscle fx </li></ul></ul><ul><ul><li>Tensilon test </li></ul></ul><ul><ul><ul><li>Tensilon prevents breakdown of Ach </li></ul></ul></ul><ul><ul><ul><li>Increased Ach levels will increase muscle fx </li></ul></ul></ul><ul><ul><ul><li>Improved strength after Tensilon administration is diagnostic for MG </li></ul></ul></ul><ul><li>Management </li></ul><ul><ul><li>Follow VC/NIF </li></ul></ul><ul><ul><li>Check swallow </li></ul></ul><ul><ul><li>Thromboembolytic precautions </li></ul></ul>
  10. 10. Myasthenia Gravis <ul><li>Specific treatment </li></ul><ul><ul><li>Anticholinesterase drugs </li></ul></ul><ul><ul><ul><li>Provide symptomatic relieve </li></ul></ul></ul><ul><ul><ul><li>Pyridostigmine </li></ul></ul></ul><ul><ul><ul><li>Can’t use Tensilon because it doesn’t last long </li></ul></ul></ul><ul><ul><li>Immunosuppressive drugs </li></ul></ul><ul><ul><ul><li>Suppress antibody formation </li></ul></ul></ul><ul><ul><ul><li>Steroids </li></ul></ul></ul><ul><ul><li>Plasma exchange </li></ul></ul><ul><ul><ul><li>Produces short-lived (~1 month) improvement </li></ul></ul></ul><ul><ul><ul><li>May be used to facilitate weaning </li></ul></ul></ul><ul><ul><li>Thymectomy </li></ul></ul><ul><ul><ul><li>Improves ~80% of MG </li></ul></ul></ul>
  11. 11. Critical Illness Polyneuropathy <ul><li>Occurs after sepsis, MOF, or high-dose steroids (especially if combined with paralytics) </li></ul><ul><li>Can cause degeneration of the motor and/or sensory nerves </li></ul><ul><li>Leads to weakness, wasting, weaning failure, and loss of reflexes </li></ul><ul><li>Treatment is symptomatic and recovery can be extended </li></ul>

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