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Pathophysiology
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
Regarding meningitis, which of the following statements are true and which are false? Meningitis usually presents with a triad of headache, neck stiffness and fever.Petechial rash is highly associated with pneumococcal infection.Brudzinski’s sign is elicited by attempting passive flexion of the neck.Typical CSF changes of viral meningitis involve glucose concentrations less than half that of blood glucose.Immediate treatment for suspected meningococcal meningitis involves benzylpenicillin or, if intolerant, a tertiary cephalosporin.
Cerebrospinal fluid drainage
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Vincent J. Alentado, Michael P. Steinmetz
Patients with lumbar drainage should be examined for signs of meningeal irritation such as nuchal rigidity, photophobia, and headache. Other tests for meningeal irritation include Kernig and Brudzinski signs. Kernig sign is positive when the hip and knee are bent at a 90° angle, and extension of the knee is painful.Brudzinski sign is positive when lifting the head of a supine patient causes flexion of the hips.
Clinical Problem Solving
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
Meningeal irritation refers to inflammatory changes to the meninges due to a noxious agent such as blood, infection or sometimes a chemical such as contrast material that has been introduced into the subarachnoid space. A clinical sign of meningsmus is extreme neck stiffness (due to irritation of the meninges) when flexing either the head or the legs. Brudzinski’s sign occurs with meningeal irritation, causing reflex flexion of the legs when the head is flexed on the neck by the examiner. Similarly, Kernig’s sign is an inability for the examiner to fully extend the flexed knee because of reflex resistance from the hamstring muscles. Neither of these signs is specific but if present should guide the clinician to look for causes of meningeal irritation by performing a lumbar puncture if there are no contraindications.
Vision treatment strategy for acute blindness in adolescent female with diffuse leptomeningeal glioneuronal tumor
Published in International Journal of Neuroscience, 2020
Siqin Zhou, Miao Zhang, Huihui Wu, Guangjian Liu, Ying Wang, Yi Bao
A 16-year-old female, 40 Kg, with decreased vision and headache for 20 days, previous physical health, no history of infection, no history of trauma, no history of allergies. Physical examination: the right palpebral fissure was smaller, anisocoria was seen (pupils’ diameter ratio right to left was like 5:4), the pupillary light reflex was slow, and the patient’s vision was reduced to: only 1 m of hand movement could be seen in front of her eyes, neck stiffness (5 transverse fingers), bilateral Kernig sign and Brudzinski sign were positive, the rest physical examination were negative. The Electrocardiogram (ECG) was normal, brain Computed Tomography (CT) showed mild hydrocephalus, brain Magnetic Resonance Venogram (MRV) and chest CT showed no abnormality. Cerebrospinal fluid (CSF) pressure was significantly greater than 400 mm H2O, light yellow, slightly muddy, no clot, Pandy test positive, white blood cell (WBC) 13 × 106/L, protein (Pro) 4.97 g/L, chlorine (Cl) 105.2 mmol/L, glucose (Glu) 4.98 mmol/L, lactate dehydrogenase (LDH) 34 IU/L, high sensitivity C reflection protein (hsCRP) 0.37 mg/L, adenosine deaminase (ADA) 0.41 U/L; CSF ink staining (-), acid-fast staining (-). Neuromyelitis optica spectrum disorders (NMOSD)-related antibodies: aquaporin 4 (AQP-4), neuromyelitis optica(NMO)-IgG, myelin oligodendrocyte glycoprotein (MOG) were negative, autoimmune encephalitis related antibodies: NMDA-R-Ab, GABA-R-Ab, AMPA2-R-Ab, CASPR2-Ab, LGI1-Ab were all negative. Emergency dehydration reduced intracranial pressure and prevents cerebral palsy: Mannitol (125 ml, intravenous drip, 4 times/day), Glycerol fructose (250 ml, intravenous drip, 2 times/day). The patient’s vision decreased sharply the next day. Please consult the ophthalmology: visual acuity without anterior manual, conjunctival edema, pupil diameter (right: left = 5:4), slow papillary light reflex, intraocular pressure (IOP) was much greater than 21 mmHg, bilaterally the optic disc was edematous, plus albumin (10 g, 2 times/day), furosemide (10 mg, 2 times/day) dehydration to reduce intracranial pressure.
Evaluating and managing severe headache in the emergency department
Published in Expert Review of Neurotherapeutics, 2021
Michelangelo Luciani, Andrea Negro, Valerio Spuntarelli, Enrico Bentivegna, Paolo Martelletti
Physical examination includes Kernig’s sign, Brudzinski’s sign and the ‘head jolt’ test to assess meningitis irritation. Although these signs are of low sensitivity for the diagnosis of meningitis, some studies have demonstrated their good specificity for predicting CSF pleocytosis.