Normal CSF values:
- Appearance: cystal clear, colourless
- Pressure: 60-150cm H20 on recumbent
- Cell count < 5/mm3, no polymorphs, mononuclear cells only
- Protein 0.2 - 0.4 g/L
- Glucose 2/3 - 1/2 of blood glucose
- IgG <15% of total CSF protein
- Oligoclonal bands: Absent
===================================================
Subacute sclerosing panencephalitis (SSPE)
- A degenerative disease of CNS, pathogenesis not clear
- Progressive mental deterioration, fits, myoclonus, pyramidal signs
- Age usually <20yo
- Increased Measles antibody titre in blood and CSF
- Prevented by Measles vaccination
===================================================
Herpes simplex encephalitis
- High fever, headache, mood change, drowsiness over hours to days
- Followed by focal neurological signs, seizure, coma
- Then Death / Severe lasting brain injury (mortality 20%)
- CT / MRI: Diffuse areas of oedema, often in the temporal lobes
- EEG: slow wave changes
- CSF: Increased cell count, specific serology
- Rx: Immediate IV Aciclovir (specific for Herpes), symptomatic and supportive management
===================================================
Causes of transient vision loss (Amaurosis fugax)
- Emboli (from carotid art.)
- Migraine
- Multiple sclerosis
- Hysteria
- Temporal arteritis
===================================================
Thyroidectomy Complications:
Peri-operative:
- Uncontrollable hemorrhage
- Recurrent laryngeal nerve damage (airway obstruction if bilateral involvement)
- Tracheal / Oesophageal perforation
- Laryngeal muscle damage
1st 12hr Post-op:
- Major hemorrhage
- Mediastinal hemorrhage => shock
- Laryngeal edema => obstruction
- Thyrotoxic crisis / Thyroid storm
- Tracheomalacia
- Hypocalcaemia => Bronchospasm
Late post-op:
- Hypoparathyroidism
- Unilateral recurrent laryngeal nerve damage
- External laryngeal nerve damage => change in quality of voice
Long term complication:
- Hypothyroidism
- Recurrent thyrotoxicosis due to insufficient gland removal
===============================================
Causes of Swelling of Salivary Gland
- Acute infection: Viral (Mumps), Bacterial (Staph.)
- Duct obstruction (Calculi)
- Sialectasis (Chronic infection)
- Tumor
=> Benign (Pleomorphic adenoma, Adenolymphoma / Warthin's tumor)
=> Malignant
- Sarcoidosis
- Sjogren's syndrome
===============================================
Nystagmus
- A sign of disease of the ocular OR vestibular system and its connection
- Must be demonstrated within binocular gaze and able to sustain
(1) Jerk nystagmus
- Lesion in vestibular end-organ, CN VIII, brainstem, cerebellum or cortex (Rare)
- Has a fast and slow component
1a Horizontal / rotary jerk:
--- Peripheral cause: Acute, transient
--- Central cause: Long lasting, tends to wane after days to weeks
1b Vertical jerk:
--- Cause: only central cause
1c Down-beat jerk (rare)
--- Lesions around foramen magnum eg meningioma
1d Up-beat jerk
--- Lesions around midbrain / floor of 4th ventricle
(2) Pendular nystagmus
- To and fro at similar velocity and amplitude
- Almost always binocular, horizontal and can present in all directions of gaze
- Causes: Mostly ocular, congenital (a/w head nodding), brainstem disease (M.sclerosis, brainstem glioma)
===============================================
Causes of Vertigo
- Meniere's disease
- BPPV
- Vestibular neuronitis
- Toxins (Alcohol)
- Drugs (Aminoglycoside)
- Migraine
- Multiple sclerosis
- Acute cerebellar lesions
- Partial seizures (Temporal lobe)
- Brainstem ischaemia / infarction
- Acoustic neuroma (Schwannomas)
===============================================
Cause of Sensorineural deafness
End-organ:
- Advancing age
- Occupational acoustic trauma
- Meniere's disease
- Drugs (Gentamicin, Neomycin)
Cranial Nerve VIII lesion:
- Acoustic neuroma
- Cranial trauma
- Inflammatory lesion
=> Tuberculous meningitis
=> Sarcoidosis
=> Neurosyphilis
=> Carcinomatous meningitis
Brainstem lesions (rare)
- Multiple sclerosis
- Infarction
================================================
Meniere's disease
- Recurrent attacks of 3 symptoms: Vertigo, Tinnitus, Deafness
- Unknown cause. a/w dilatation of endolymph system
C/F:
- Sudden unprovoked attacks of vertigo, vomiting, loss of balance
- Tinnitus & deafness may be overshadowed by vertigo
- Ultimately deafness develops and vertigo ceases
- Also may have nystagmus
Management:
- Rest
- Vestibular sedatives
- Surgery: Endolymph drainage, ultrasound destruction of the labyrinth/vestibular nerve section)
================================================
Benign Paroxysmal Positional Vertigo (BPPV)
- Disorder of the utricle and presence of concretions in the semicircular canal.
- Vertigo precipitated by head movement, usually at a particular position
- Sudden onset, transient (seconds to minutes), habituation*, fatigability*
- Hallpike's test (sudden movement of head), latent nystagmus (few seconds)
- No serious underlying cause found, sometimes vestibular neuronitis, head injury, ear infection
- Symptomatic Rx - vestibular sedatives, vestibular exercise
*Habituation: Lessening of symptoms with repeated trials
*Fatigability: Disappearance of symptoms with maintenance of offending position.
================================================
Horner's syndrome
- Anhidrosis
- Enophthalmus
- Vasodilation (warm pink cheek, nasal congestion)
- Myosis
- Ptosis
Cause:
- Posterior Inferior cerebellar artery thrombosis
- Spinal cord lesion: Syringomyelia
- Injuries to the lower roots of the brachial plexus
- Cervical sympathectomy
- Pancoast tumor
- Tumor in the neck
- Aneurysm & Dissection of the carotid artery
- Appearance: cystal clear, colourless
- Pressure: 60-150cm H20 on recumbent
- Cell count < 5/mm3, no polymorphs, mononuclear cells only
- Protein 0.2 - 0.4 g/L
- Glucose 2/3 - 1/2 of blood glucose
- IgG <15% of total CSF protein
- Oligoclonal bands: Absent
===================================================
Subacute sclerosing panencephalitis (SSPE)
- A degenerative disease of CNS, pathogenesis not clear
- Progressive mental deterioration, fits, myoclonus, pyramidal signs
- Age usually <20yo
- Increased Measles antibody titre in blood and CSF
- Prevented by Measles vaccination
===================================================
Herpes simplex encephalitis
- High fever, headache, mood change, drowsiness over hours to days
- Followed by focal neurological signs, seizure, coma
- Then Death / Severe lasting brain injury (mortality 20%)
- CT / MRI: Diffuse areas of oedema, often in the temporal lobes
- EEG: slow wave changes
- CSF: Increased cell count, specific serology
- Rx: Immediate IV Aciclovir (specific for Herpes), symptomatic and supportive management
===================================================
Causes of transient vision loss (Amaurosis fugax)
- Emboli (from carotid art.)
- Migraine
- Multiple sclerosis
- Hysteria
- Temporal arteritis
===================================================
Thyroidectomy Complications:
Peri-operative:
- Uncontrollable hemorrhage
- Recurrent laryngeal nerve damage (airway obstruction if bilateral involvement)
- Tracheal / Oesophageal perforation
- Laryngeal muscle damage
1st 12hr Post-op:
- Major hemorrhage
- Mediastinal hemorrhage => shock
- Laryngeal edema => obstruction
- Thyrotoxic crisis / Thyroid storm
- Tracheomalacia
- Hypocalcaemia => Bronchospasm
Late post-op:
- Hypoparathyroidism
- Unilateral recurrent laryngeal nerve damage
- External laryngeal nerve damage => change in quality of voice
Long term complication:
- Hypothyroidism
- Recurrent thyrotoxicosis due to insufficient gland removal
===============================================
Causes of Swelling of Salivary Gland
- Acute infection: Viral (Mumps), Bacterial (Staph.)
- Duct obstruction (Calculi)
- Sialectasis (Chronic infection)
- Tumor
=> Benign (Pleomorphic adenoma, Adenolymphoma / Warthin's tumor)
=> Malignant
- Sarcoidosis
- Sjogren's syndrome
===============================================
Nystagmus
- A sign of disease of the ocular OR vestibular system and its connection
- Must be demonstrated within binocular gaze and able to sustain
(1) Jerk nystagmus
- Lesion in vestibular end-organ, CN VIII, brainstem, cerebellum or cortex (Rare)
- Has a fast and slow component
1a Horizontal / rotary jerk:
--- Peripheral cause: Acute, transient
--- Central cause: Long lasting, tends to wane after days to weeks
1b Vertical jerk:
--- Cause: only central cause
1c Down-beat jerk (rare)
--- Lesions around foramen magnum eg meningioma
1d Up-beat jerk
--- Lesions around midbrain / floor of 4th ventricle
(2) Pendular nystagmus
- To and fro at similar velocity and amplitude
- Almost always binocular, horizontal and can present in all directions of gaze
- Causes: Mostly ocular, congenital (a/w head nodding), brainstem disease (M.sclerosis, brainstem glioma)
===============================================
Causes of Vertigo
- Meniere's disease
- BPPV
- Vestibular neuronitis
- Toxins (Alcohol)
- Drugs (Aminoglycoside)
- Migraine
- Multiple sclerosis
- Acute cerebellar lesions
- Partial seizures (Temporal lobe)
- Brainstem ischaemia / infarction
- Acoustic neuroma (Schwannomas)
===============================================
Cause of Sensorineural deafness
End-organ:
- Advancing age
- Occupational acoustic trauma
- Meniere's disease
- Drugs (Gentamicin, Neomycin)
Cranial Nerve VIII lesion:
- Acoustic neuroma
- Cranial trauma
- Inflammatory lesion
=> Tuberculous meningitis
=> Sarcoidosis
=> Neurosyphilis
=> Carcinomatous meningitis
Brainstem lesions (rare)
- Multiple sclerosis
- Infarction
================================================
Meniere's disease
- Recurrent attacks of 3 symptoms: Vertigo, Tinnitus, Deafness
- Unknown cause. a/w dilatation of endolymph system
C/F:
- Sudden unprovoked attacks of vertigo, vomiting, loss of balance
- Tinnitus & deafness may be overshadowed by vertigo
- Ultimately deafness develops and vertigo ceases
- Also may have nystagmus
Management:
- Rest
- Vestibular sedatives
- Surgery: Endolymph drainage, ultrasound destruction of the labyrinth/vestibular nerve section)
================================================
Benign Paroxysmal Positional Vertigo (BPPV)
- Disorder of the utricle and presence of concretions in the semicircular canal.
- Vertigo precipitated by head movement, usually at a particular position
- Sudden onset, transient (seconds to minutes), habituation*, fatigability*
- Hallpike's test (sudden movement of head), latent nystagmus (few seconds)
- No serious underlying cause found, sometimes vestibular neuronitis, head injury, ear infection
- Symptomatic Rx - vestibular sedatives, vestibular exercise
*Habituation: Lessening of symptoms with repeated trials
*Fatigability: Disappearance of symptoms with maintenance of offending position.
================================================
Horner's syndrome
- Anhidrosis
- Enophthalmus
- Vasodilation (warm pink cheek, nasal congestion)
- Myosis
- Ptosis
Cause:
- Posterior Inferior cerebellar artery thrombosis
- Spinal cord lesion: Syringomyelia
- Injuries to the lower roots of the brachial plexus
- Cervical sympathectomy
- Pancoast tumor
- Tumor in the neck
- Aneurysm & Dissection of the carotid artery
No comments:
Post a Comment