Lesson 6. INFECTIONS OF THE NERVOUS SYSTEM.
QUESTIONS
1. What is the definition of meningitis?
2. Classify the meningitis by types
3. What are the major causes of purulent meningitis?
4. What symptoms and signs allow to suspect purulent meningitis?
5. What are the specific features of Neisseria meningitides meningitis, of Streptococcus pneumoniae meningitis and of Haemophilis influenzae meningitis?
6. What diagnostic tests should be use for the verification of a purulent meningitis?
7. Describe the changes of cerebrospinal fluid typical for the bacterial purulent meningitis
8. What emergency therapy might be considered in the patient with purulent meningitis?
9. How would you prescribe antibiotic therapy for a purulent meningitis?
10. Give a few etiologies for aseptic meningitis
11. How would you make a diagnosis of a viral infection of CNS?
12. What medicines are available for the treatment of viral meningitis?
13. What are the neurological manifestations of tuberculosis meningitis?
14. Describe the diagnostic tests for tuberculosis meningitis.
Task № 1.
А 21 years old male patient applies to a clinic with complaint of the intensive headache, vomiting, doublevision. From anamnesis it is known, that the patient , 10 days ago , felt a general weakness, some headache. He had a subfebrile temperature. During 6 days the intensivity of headache , increased to the level of “terrible “and developed doublevision, vomiting.
Objectively: rigidity of the neck muscles and 3 fingers, positive Kernig signs from the angle 100 o , anisocoria with mydriasis on the left side, ptosis on the left side, strabismus divergence( lost of movement of the left eye in the medial side). In cerebro-spinal fluid – lymphocytic pleocytosis , decreased content of sugar.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigation methods.
4. Prescribe a treatment.
Task №2
How would you comment the following CSF?
Pleocytosis is 120/mm3
Lymphocytes are 100/ mm3
Polymorphonuclear leukocytes are 20/ mm3
Proteins are 1.66 g/L
Sugar content is 20 mg/dL
CSF is shining.
1. Make a clinical diagnosis.
Task №3
How would you comment the following CSF?
Liquor pressure is 400 mm H2O;
The CSF is cloudy and of yellow-green color;
Cytosis is 2000/ mm3
polymorphonuclear leukocytes (neutrophyles) prevail;
Proteins are 5,6 g/L
Sugar content is 20 mg/dL.
1. Make a clinical diagnosis.
Task № 4.
А 30 years old female patient was transported to clinic emergency department, with an unknown diagnosis . The onset of disease was acute. During 2 days he has developed the intensive headache with high temperature 38,0-38,5 o without catarrhal signs . Then the temperature increased to 39,0 o , the nausea and vomiting developed. Objectively: rigidity of the neck muscles and3 cm, positive Kernig signs. Other neurological disturbances are absent. After investigation of the skin some a few roseoles on the chest and stomach were found , decreased content of sugar.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigation methods.
4. Prescribe a treatment.
Task № 5.
А 40 years old male patient was transported to hospital emergency department, in very severe state: very intensive headache, vomiting, high temperature-39,0 o .
Objectively: without catarrhal signs, but the rigidity of the neck muscles and positive Kernig signs are present. In CSF- cytosis is 20/ mm3 , with lymphocytes as the predominant cells, proteins are 0,6 g/L. After 5 days the general state became better stopped vomiting, the headache decreased, the temperature decreased to the subfebrile figures.
At the same time the patient marked the increased weakness in the neck muscles (with difficulty to fix the head ) and in the arms( inability to elevate the arms up).
In neurological state- proximal paresis in the arms with a decreas of the tendon reflexes.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigation methods.
4. Prescribe a treatment.
Lesson 7. TUMORS OF THE BRAIN. SPINAL TUMORS. TRAUMA OF NERVOUS SYSTEM.
Questions
1. Classify the brain tumors with histological types.
2. What symptoms and signs allow one to suspect spinal tumors?
3. What diagnostic tests would you use for the verification of a blockade of cerebrospinal fluid passage by growth of the spinal tumors?
4. Describe the typical changes of cerebrospinal fluid due to the growth of the spinal tumors.
5. Classify the spinal tumors.
6. What emerge therapy might be considered in the patient with intensive headache with CNS tumor?
7. What medicines are available for the treatment with syndrome of increased cerebral pressure (ICP)?
8. What are the neurological manifestations of ICP- syndrome with CNS tumor?
9. Describe the diagnostic tests for CNS tumors (RCT, MRY, angiography, ophtalmoscopy).
10. Describe the general neurological singes with presence of CNS tumors.
11. Describe the focal neurological singes with different location of CNS tumors.
12. Classify the brain trauma.
13. Describe a difference between types of a brain injury.
14. What does a concussion mean?
15. What does a contusion mean?
16. What does a diffuse axonal degeneration (DAG) of the brain mean?
17. Classify different types of compression of the brain.
18. Give the description of triad of a singes in a clinical picture of subdural hematom.
19. Classify a spinal injury.
20. What emerge therapy might be considered in the patient with intensive headachs with CNS trauma?
Task № 1.
А 47 year old male patient , 11 month ago began the decrease of the sharpness of the hearing on the left ear. During the half year he complaints of the permanent presence of the noise in the same ear. For a last 2 month the headache, nausea has observed, the numbness in the left half on the face developed.
On admission in clinic- objectively : decrease of hearing on the left side in the type of the lesion of sounds-perceiving apparatus , a light paresis of the left facial nerve, hypoesthesia in the left half of the face, light ataxia in the left extremities.
In ophtalmoscopy- odem of the discs of optical nerves.
In CSF- proteins- 1,4 %, cytosis- 12\3, liquor pressure-240 mm water tr.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigation methods.
4. Prescribe a treatment.
Task № 2.
A 21 year old male patient hit with the head on the glass while the car accident, it has the loss of conciseness during 30-40 min. The patient transported to the hospital in 1,5 hour after injury. On admission: conciseness is clear; it is oriented in the time and place, complaint of the headache and vomiting, by trying stand up the dizziness observed. The patient may not answered where and how happened a trauma.
Pulse 84 beat pro min., the breathing is rhythmical 18 pro min., the skin is pallor and moist, focal neurological and meningeal signs are absent.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigations methods.
4. Prescribe a treatment.
Task № 3.
A 21 year old male patient get the head injury while the exercise on the horizontal bar. It was a moment of a loss of conciseness during the 1 hour. The patient transported to the hospital during 1 hour after trauma.
On admission: conciseness is clear, he complain of the headache, vomiting and feeling of “the deafness” in the left ear. Pulse 92 beat per min., AP- 130\91 mm Hg ., the breathing -20-22 per min., on the head in the left temporo-parietal region-odema of the soft tissues of the skin, the blood and clear fluid from the left acusticus external porus flow out, the left angle of the mouth is lowered, of lefts eye screwing up is impossible. The tendon reflexes are higher from the right side, the slight rigidity of the neck muscles and positive Kernig sign are present on the both sides.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigations methods.
4. Prescribe a treatment.
Lesson 8. DAMAGE OF PERIPHERAL NERVOUS SYSTEM . POLYNEUROPATHY . BACK PAIN SYNDROMES.
Questions-
1. Classify the neuropathy by subtypes.
2. What is the difference between a polyneurophathy and a mononeuropathy?
4. What investigations should be initiated to rule out the treatable neuropathies?
5. Describe the clinical features of Guillain-Barre syndrome
6. Give a few etiologies for low back pain.
7. What are the different variants of radiculopathies and their characteristic presentations?
8. List the clinical signs of the ulnar nerve palsy and the radial nerve palsy
9. List the clinical signs of the median nerve lesion
10. Describe the signs of peroneal nerve injury
11. What is the clinic of the tibial nerve function interruption?
12. What are the EMG signs of peripheral nervous system lesions?
13. What therapy might be considered in the patient with peripheral nerves damage?
Task № 1.
In a 51 old female patient, after the severe cooling during the 24 hours, the weakness and numbness in the legs have developed and delay of the micturition has appeared.
Objectively: active movements in the legs are intensive limited, the muscle power in them is – 2 balls; the intercostals muscles don’t work on respiration; tendon reflexes in the legs are increased, the superficial abdominal reflexes are absent, clonuses in foots and patellae are on both sides, pathological reflexes in the legs are positive. The disturbance of all kinds of sensation is decreased from the level of intramammal line on both sides. The independent micturition is impossible.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigations methods.
4. Prescribe a treatment.
Task № 2.
In a 37 old male patient, during the last year, the weakness in the lower extremities and disturbances of the micturition has gradually grown.
Objectively: the rang of movements in the legs is limited, the muscle power is increased to 2 balls, tendon reflexes in the legs are lost, the muscle tone is intensively increased, the hypotrophy in the left muscles of the shins and thighs. The sensation (all kinds) is decreased from the level of the ilioinguinal wrinkle.
1. Where is the pathological object localized?
2. Make a clinical diagnosis.
3. Call necessary neurophysiologic investigations methods.
4 Prescribe a treatment.