Neurology. MS, meningitis, encephalitis, incranial & cerebral abscesses, neurosyphilis, CJD

MULTIPLY SCLEROSIS
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11 февраля 20XX

MULTIPLY SCLEROSIS
Cause is unknown
It’s linked to:
Genetic: female (20-40 years); genes encoding for HLA-DR2
Infections
Vitamin D deficiancy
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11 февраля 20XX

MULTIPLY SCLEROSIS
Charcot’s neurologic triad
Dysarthria
Nystagmus
Intension tremor
Specific signs:
Uhthoff’s sign
Lhermitte’s sign
11 февраля 20XX

LHERMITTE’S SIGN
Electric shock sensation which occurs with neck flexion and often radiates down the spine
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MULTIPLY SCLEROSIS
Diagnosis
MRI
Cerebrospinal fluid
Visual evoked potential
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MULTIPLY SCLEROSIS
Treatment
RRMS
Corticosteroids, cyclophosphamide, intravenous immunoglobulin
Plasmapheresis
Immunosuppressant: recombinant b-IFN
Progressive MS
Manage symptoms
Physical therapy
Cognitive rehabilitation therapy
11 февраля 20XX

MENINGITIS ENCEPHALITIS MYELITIS
11 февраля 20XX

ENCEPHALITIS
MYELITIS
Multiply sclerosis
Multiply sclerosis

MENINGITIS
Inflammation triggers
Autoimmune disease
Adverse reaction to medication
Infection
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11 февраля 20XX
Two ways of spreading
Direct spread
Through overlying skin
Up through nose
Anatomical defect
Hematogenous spread
Through binding to surface receptor
Areas of damage
Vulnerable spot

CAUSES
Bacteria
Newborns: group B streptococci, E coli, Listeria monocytogenes
Children and teens: Neisseria meningitidis, Streptococcus pneumonia
Adults and elderly: Streptococcus pneumonia, Listeria monocytogenes
Tick-borne: Borrelia burgdorferi
Viruses:
Enteroviruses, Herpes simplex, HIV
Mumps, Varicella zoster, Lymphocytic Choriomeningitis
Fungi: Cryptococcus genuses, Coccidioides genuses
Tubercular meningitis
Parasitic cause: Plasmodium falciparum

SYMPTOMS
Meningitis
Headache, fever, nuchal rigidity
Photophobia and phonophobia
Encephalitis
Fever, altered mental status, seizure or focal neurologic symptoms
Myelitis
Flaccid paralysis and sensory loss
11 февраля 20XX

DIAGNOSIS
OF MENINGITIS
11 февраля 20XX

DIAGNOSIS
Lumbar puncture
PCR
Western blot
Thin blood swear
11 февраля 20XX

TREATMENT
Bacterial: Steroids and antibiotics
Antivirals, antibacterial, antifungals, antiparasitic
Prevention vaccine: Neisseria Meningitidis, Disseminated tuberculosis
11 февраля 20XX

BRAIN ABSCESS
Direct spread
Cause a single brain abscess
Primary infection include:
Subacute and chronic otitis media and mastoiditis (the inferior temporal lobe and cerebellum)
Frontal or ethmoid sinuses and dental infection
(the frontal lobe)

BRAIN ABSCESS
11 февраля 20XX
Hematogenous spread
Usually multiply abscess
Most commonly located in the distribution of the middle cerebral artery
Sources:
Skin infection, pelvic infection, intraabdominal infection, esophageal dilation, bacterial endocarditis, cyanotic congenital heart disease

BRAIN ABSCESS
Symptoms
A headache (69% to 70%)
Mental status changes (65%) lethargy progressing to coma is indicative of severe cerebral edema
Focal neurologic deficits (50% to 65%)
Fever (45% to 53%)
Seizures (25% to 35%).
Nausea and vomiting (40%)
Nuchal rigidity (15%)
11 февраля 20XX
Diagnosis
Clinical: focal symptoms and signs
Papilledema
MRI

BRAIN ABSCESS
Treatment
IV antibiotic: PenG + Chloramphenicol or Metronidazole
For MSSA: Nafcillin or Oxacillin
Surgery
Aspiration
Glucocorticoids: dexamethasone

NEUROSYPHILIS
Neurosyphilis is caused by Treponema pallidum
There are different forms of neurosyphilis:
asymptomatic neurosyphilis
meningeal neurosyphilis
meningovascular neurosyphilis
general paresis
tabes dorsalis
ЗАГОЛОВОК ПРЕЗЕНТАЦИИ
11 февраля 20XX

NEUROSIPHYLIS
Early
Asymptomatic neurosyphilis
Acute symptomatic syphilitic meningitis: nausea, vomiting, headache, CN 2,4-8 abnormalizes
Meningovascular syphilis
5-6 years after infection
Focal neurologic signs, vasculitis, stroke, transverse myelitis
Late
Dementia paralytica
10-20 years after infection
Slow cognitive decline, weakness, tremor, pupillary abnormalities, bowel-bladder incontinence
Tabes dorsalis
15-20 years after infection
Radicular paresthesia, “thunder bolt” pain in limbs, back or face; broad-based, foot-slapping gain, loss of reflexes in lower limbs, Argyll-Robertson pupils
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11 февраля 20XX

NEUROSYPHILIS
11 февраля 20XX

NEUROSYPHILIS
Diagnosis
Serum nontreponemal tests : RPR, VDRL
Nonreactive in late neurosyphilis
Serum treponemal test: FTA-ABS, TPA or syphilis EIA
LP: lymphpcytic pleocytosis
, high protein, low or NM glucose, reactive csf-VDRL
11 февраля 20XX

NEUROSYPHILIS
Treatment
Aqueous crystalline penicillin G (18 to 24 million units per day, administered as 3 to 4 million units intravenous every four hours, or 18 to 24 million units daily as a continuous infusion) for 10 to 14 days, or
Procaine penicillin G (2.4 million units intramuscular [IM] once daily) plus probenecid (500 mg orally four times a day), both for 10 to 14 days
Ceftriaxone 2 g IV daily 10-12 days
ЗАГОЛОВОК ПРЕЗЕНТАЦИИ
11 февраля 20XX

CREUTZFELDT-JAKOB DISEASE
CJD is a neurodegenerative disease with a rapid onset characterized by progressive dementia, myoclonus and also cerebellar, pyramidal and extrapyramidal signs.
Abnormal prion protein accumulate in the brain and it can cause irreversible damage. It lead to brain atrophy or wasting; cytoplasmic vacuoles in neurons and astrocytes
Symptoms: fatigue, sleep problems, reduces appetite; dementia, behavior changes and confusion; cerebellar ataxia, aphasia, visual disturbances and motor weakness
Diagnostic: exclude infection and toxicity. Brain biopsy
Treatment: no cure
ЗАГОЛОВОК ПРЕЗЕНТАЦИИ
11 февраля 20XX

CREUTZFELDT-JAKOB DISEASE
ЗАГОЛОВОК ПРЕЗЕНТАЦИИ
11 февраля 20XX