Download 21 Encephalitis. Myelities

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METHODICAL INSTRUCTIONS
FOR INDIVIDUAL WORK OF STUDENTS IN PREPARATION FOR
PRACTICAL CLASSES
Subject
Neurology
Topic.
Encephalitis. Arachnoiditis. Myelities. Poliomyelitis.
Year
Faculty
IV
Medical
2
Topicality:
Death rate from inflammation diseases of brain especially in young people makes up
considerable part. Acute course of arachnoiditis, encephalitis, myelitis need quick decisions and
actions of doctors. Each physician has to be able to diagnose meningitis, encephalitis on time and
administer correct treatment. Timeliness of treatment administrations often makes for result of disease.
Only timely diagnostics and good therapy lets avoid or decrease progress of the disease and its
complications.
2.Specific purposes:
To know classification of inflammation diseases of nervous system; to know basic clinical
syndromes and symptoms of encephalitis.
To be able to analyze additional methods of examination in diagnostics of inflammation
diseases of nervous system.
To be able to formulate the diagnosis and administer the treatment scheme of patient with
inflammation disease of nervous system.
3. Basic knowledge, skills and competences which are necessary for topic studying (
interdisciplinary integration)
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Subject
To know
To be able to
1.
Human
anatomy
Anatomy of brain and spinal cord, brain membrane. —
2.
General
physiology
Cerebral fluid, its citculation, structure.
To estimate liquor
structure
3.
Human
pathology
Stages of inflammation process; morphological
changes in nervous system in inflammation
processes.
—
4.
Physiopatholog Aetiology and pathogenesis of inflammation
y
diseases of nervous system; types and stages of
inflammation process; pathological syndromes of
liquor system abnormalities.
5.
Micro
biology
Characteristics of causative agents of inflammation To administer methods
diseases of nervous system (bacteria, viruses, fungi) of causative agents
determining
6.
Pharma
cology
Principles of treatment of inflammation diseases.
Antibiotics medications.
І
To estimate
pathological changes in
liquor
To give a prescription
of necessary
medications.
4. Tasks for individual work during preparation for classes:
1.Diagnostic criteria of arachnoiditis.
2.Classification of arachnoiditis.
3. Classification of encephalitis.
4. Clinical manifestations of acute and chronical stages of epidemic encephalitis; treatment principles.
5. Clinical manifestations of acute and chronical stages of tick-borne encephalitis; treatment principles.
6. Clinical picture of herpetic encephalitis, treatment.
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7. Clinical signs of myelities. Treatment principles.
8. Poliomyelitis. Paralytic and non-paralytic forms.
9. General principles of treatment of inflammation diseases of nervous system.
а) The list of the basic terms, characteristic, which students must master in preparation for the
class:
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Term
Definition
1.
Arachnoiditis
Disease which characterizes by inflammation process in
arachnoid membrane of brain.
2.
Encephalitis
Symptom complex of signs of inflammation process of
brain membranes.
The list of theoretical questions:
Ways of infection penetration in nervous system
1. Diagnostic criteria of arachnoiditis.
2.Classification of arachnoiditis.
3. Classification of encephalitis.
4. Clinical manifestations of acute and chronical stages of epidemic encephalitis; treatment principles.
5. Clinical manifestations of acute and chronical stages of tick-borne encephalitis; treatment
principles.
6. Clinical picture of herpetic encephalitis, treatment.
7. General principles of treatment of inflammation diseases of nervous system.
с) Practical tasks made at the lesson:
1. methods of examination of neurological state in patient with encephalitis
2. examination of patients with inflammation diseases of nervous system.
To master methods of neurological examination of patients with meningitis, to carry on examination of
the patient with encephalitis or arachnoiditis.
To collect complaints and anamnesis.
2. To check focal and meningeal symptoms.
3. To estimate abnormalities of innervation of cerebral nerves.
4. Determining of reflex status.
5. To formulate the diagnosis.
6. To determine the tactics of examination of the patient, to administer treatment.
To determine seriousness of disease, stage of process.
Topic content (see sources).
Materials for self-control:
А. Tasks for self-control (tables, schemes, drawings, diagrams):
Б. Tasks for self-control:
1. Typical clinical forms of acute period of lethargic encephalitis:
1. meningeal
2. bulbar
3. oculo- lethargic
4. polyneuritic
5. polymyelitic
2. Tick the syndrome which is typical for chronical stage of lethargic encephalitis:
1. Argyll Robertson syndrom
2. Parinaud's Syndrome
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3. Bernard-Horner syndrome
4. Meningeal
5. parkinsonism
3. There are basic clinical forms of acute period of tick-borne encephalitis. Odd one out: 1.bulbar
2. encephalitic
3. meningeal
4. polymyelic
5. okulo- lethargic
4. Tick syndrome which is typical for chronical stage of tick-borne encephalitis:
1. parkinsonism
2. syringomyelia syndrome
3. meningeal
4. Kojewnikoff's epilepsy
5. upper spastic paresis
5. There are clinical forms of cerebral arachnoiditis. Odd one out
1. cerebellopontine angle
2. posterior cranial fossa
3. subcortical
4. convexital
5. optico- chiasmatic
6. Tick the basic additional method of diagnostic of cerebral arachnoiditis:
1. electroencephalography
2. examination of fundus of eye
3. craniography
4. radiography of spine
5. brain computed tomography;
Models of right answers: 1--5, 2.-5, 3.-4, 4.-3, 5.-5. 6.-2.
Tests for determining of knowledge level:
1. Constraint, finger tremble, difficult walking developed gradually in the patient in a year after serious
acute respiratory disease. It is evident: masklike face, bawdiness of the face, parting speech,
hyperptyalism, shuffle walking, bradykinesia.
Tick the most reliable diagnose:
1. arachnoiditis
2. toxic parkinsonism
3. atherosclerotic parkinsonism
4. postencephalitic parkinsonism
5. tick-borne encephalitis
2. Asthenia in lower extremities, abnormality of pain sensitivity from the level of right and left
hypochondrium, urinary retention developed in the patient at the background of high temperature.
Tick the most reliable diagnose:
1. poliomyelitis
2. acute lumbar myelities
3. disseminated sclerosis
4. acute disseminated encephalomyelitis
5. encephalitis
3. 12-year old child was suffering from sharp pain, nausea, high temperature. It is evident: the child is
sleepy, he\she is crying. Temperature is 40 С. Kernig's symptom and Brudzinski symptom are sharply
marked, rigidity of occipitals. There is hemorrhagic rash on the skin of body and arms.In examination
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of liquor there is При дослідженні ліквору: troubled colour, yellowish, 9 000 leucocytes in 1 мм ,
0,9 g/l of protein. Tick what causative agent can be revealed in liquor more evidently:
1. meningococcus
2. staphylococcus
3. pneumococcus
4. hemolytic streptococcus
5. colon bacillus
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4. 33-year old woman is complaining on headache, nausea, vomiting, spasms. She felt ill yesterday
after becoming too cool. It is evident: temperature 40°С. Somnolentia state. Rigidity of occiput
muscles, Kernig's symptom on both sides, general hyperesthesia are revealed. In blood there are
leukocytosis, rapid ESR. Liquor is trouble, yellowish. What typical changes of cerebral fluid are the
most evident:
1. neutrophilic pleocytosis
2. lymphocytic pleocytosis
3. protein-cellular dissociation
4. liquor with blood
5. xanthochromic liquor
5. 5-year old child had irritability, he was piteous, he had appetite loss, headache, night low grade
fever during 2 weeks. Then his temperature increased to 39, headache became sharp, and gradually
loss of consciousness became. Neurological state: ptosis on the left, coincident strabismus. Arms and
legs reflexes are torpid. Rigidity of occiput muscles, positive Kernig's symptom and Brudzinski
symptom. Diffuse stable dermographism. There are no pathological changes revealed in X-ray of
thorax organs. Liquor is clear, a little xanthochromic, cytosis - 200 in 1 mkl (70% lymphocyte, 30%
neutrophil) protein - 0,97g/l, chloride - 100 mmol/l, glucose - 1,0 mmol/l. In 24 hours there is a soft
fibrin pellicle in liquor. Make a diagnosis:
1. meningococcal meningitis.
2. tuberculous meningitis
3. arachnoiditis
4. encephalitis
5. subarachnoid hemorrhage
6. 6-year old patient had increasing of temperature to 39,3 in 7 days after swell of admaxillary gland;
bad headache, repeated vomiting, delirium appeared. In neurological state there is rigidity of occiput
muscles, Kernig's symptom and Brudzinski symptom. Liquor is clear, colourless, pressure 260 ml. of
water, protein - 0,8 g/l, cytosis - 300 in 1mkl, glucose - 2,5 mmol/l. Make a diagnosis:
1. Kussmaul-Landry paralysis
2. acute aseptic meningitis
3. epidemic cerebrospinal meningitis
4. tuberculous meningitis
5. acute encephalitis
7. A bad headache, vomiting, psychic dormancy appeared in 38-year old woman after chronical
purulent otitis, then epileptic seizure developed. What is the most evident diagnosis:
1. brain abscess
2. ischemic stroke
3. hemorrhagic stroke
4. epilepsy
5. brain tumour
8. Leg asthenia, then body muscles, arms, neck and face asthenia, difficult speech and swallowing had
been developing gradually during a week in 37-year old man after acute respiratory disease. In
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neurological state there is bulbar syndrome, dysphagy, dysphonia, breathing impairment, impairment
of heart activity, combine tetraparesis. What is the most necessary action concerning the patient:
1. hospitalization to resuscitation departmen
2. hospitalization to therapeutics department
3. hospitalization to infectious department
4. hospitalization to neurological department
5. treatment inoutpatient department
9. 12-year old child has sharp headache, high temperature. It is evident that the child is sleepy, he is
crying. Temperature is 40 С. Kernig's symptom and Brudzinski symptom are clear marked, rigidity of
occiput muscles. There is hemorrhagic rash on skin of body and arms. In examination of liquor:
colour is trouble, yellowish, 9 000 leucocytes in 1 mm3, 0,9 g/l of protein. Tick what the causative
agent can be revealed in liquor:
1. menengococus
2. staphylococcus
3. pneumococcus
4. hemolytic streptococcus
5. colon bacillus
10. 33-year old woman is complaining of headache, nausea, vomiting, spasms. She felt ill after
becoming too cool yesterday. It is evident: temperature is 40°С. Somnolentia state. Rigidity of occiput
muscles, Kernig’s symptom on both sides, general hyperesthesia. There is leukocytosis, increasing
ESR in blood. Liquor is trouble, yellowish. What typical changes of cerebral fluid are the most
evident:
1. neutrophilic pleocytosis
2. lymphocytic pleocytosis
3. protein-cellular dissociation
4. liquor with blood
5. xanthochromic liquor
Models of right answers: 1.-4, 2.-2, 3.-1, 4.-1, 5.-2, 6.-2, 7.-1, 8.-1, 9.-1, 10.-1.
Information Sources
Lecture
1. Shcrobot S.I., Hara I.I. Neurology in lecture (Selected lectures) . Ternopil, TSMU,
«Ukrmedknyha», 2008. 319 p.
2. Reinhard Rohkamm. Color Atlas of Neurology © 2004 Thieme. 440 p.
3. Crash course Neurology by Anish Bahra and Katia Cikurel. Copyright 2006, Elsevier, Inc. 244
p.
4. Adams and Victors. Principles of neurology. © 2005 McGraw-Hill . Medical Publishing
Division.
5. Mayo Clinic Internal Medicine Review 2006-2007. Chapter 18. Editor-in-Chief Thomas M.
Habermann, MD