22
CT: - Suspected skull fracture, - Suspected intracranial bleed (acute bleeds appear white on CT scan within 20 min of onset, intracerebral hemorrhage and SA bleeds - Trauma: safer, faster - Monitoring hydrocephalus’s: monitoring increase in ventricle size MRI - T1: bone = no signal, CSF, black, gray matter is darker, white matter is lighter. Used for studying anatomy of brain. Very bright areas will contain high degree of fat, protein subacute bleed or contrast agent. Can use gadolinium enhancement to increase resolution - TW: bone: no signal, gray matter is lighter, white matter is darker, and CSF appears white, pathology will be white due to edema and water accumulation in areas of pathology. - Fluid attenuation inversion recovery (FLAIR imaging): bright CSF is subtracted away, - Diffuse weighted imaging DWI): T2 sequence, used in suspected stroke to determine if ischemic event is occurring. Ischemic areas will be white Stroke - MCA: CL trunk/arm/face, Broca’s Wernicke’s (dominant, neglect (non-dominant) - ACA: leg/foot/ cognitive changes, bladder incontinence - PCA: vision reading writing - Basilar: coma, locked in syndrome, CN palsies, drop attacks 50-80 Usually inc (100- 300) Normal or slightly inc (80-150) Usually inc Leukocytes < 5 >1000 100-500 10-50 & PMNS 0 >50% <20% Varies Protein 20-45 100-500 50-200 25-500 Glucose >50 or 75% serum glucose <40 or <66% serum Generally normal <50, continues to dec if not treated Lab cultures Gram stain of CSF CSF PCR may sow HSV or enterovirus Budding yeast, serum and CSF cryptococcal antigen Bacteria Treatment Neonates <1 month GBS, gram neg enteric bacilli, listeria, e coli Ampicillin and gentamicin or ampicillin and cefotaxime Infants (1-24 months) Strep pneumo, Neisseria meningitis, H influenzae type b 3 rd generation cephalosporin, add vanc until sensitivities are known Children >24 month Same - ADEM: postviral or para infectious AI process targeted against CNS myelin that leads to inflammation of white matter in brain and SC> o Presents wit h headache, lethargy, coma seizures, stiff neck, fever, ataxia, optic neuritis, transverse myelitis, monoparesis, bladder/bowel dysfunction
