Neurology — Flashcards

Flashcard 491: What is the first-line pharmacological agent for raised intracranial pressure? _____

Answer: IV mannitol

Extra: - **Mechanism**: Mannitol is an osmotic diuretic that reduces ICP by withdrawing water from the brain parenchyma into the intravascular compartment. - **Alternatives**: Hypertonic saline (3%) is also considered a first-line agent and is increasingly preferred in some protocols. - **Contraindications**: Anuria, severe pulmonary edema, or active intracranial bleeding (except during craniotomy).

Flashcard 492: What blood investigations are done for suspected meningitis? _____

Answer: Blood cultures

Flashcard 493: Initial antibiotics for pneumococcal meningitis is _____

Answer: IV cefotaxime

Flashcard 494: Bacterial meningitis initial empiric antibiotics ≥ 60 years = _____

Answer: Vancomycin + Ceftriaxone/Cefotaxime + Amoxicillin/Ampicillin

Extra: In patients > 50-60 years or immunocompromised, Listeria monocytogenes coverage must be added to the standard regimen of Ceftriaxone + Vancomycin. Amoxicillin or Ampicillin provides this coverage.

Flashcard 495: _____ refers to meningitis and/or septicaemia caused by Neisseria meningitidis

Answer: Meningococcal disease

Flashcard 496: Lumbar puncture for bacterial meningitis is contraindicated if _____, focal neurology, & signs of severe shock/sepsis

Answer: signs of ↑ ICP

Flashcard 497: If ICP >_____mmHg then further management may be needed to ↓ ICP

Answer: 20

Flashcard 498: A patient with raised ICP should be positioned _____

Answer: with head elevation of 30°

Flashcard 499: _____ is a possible clinical sign of meningitis that is described as flexion of the hip to 90o with pain on passive extension of the leg

Answer: Kernig's Sign

Flashcard 500: Bacterial meningitis initial empiric antibiotics (3 months to 50 years): _____

Answer: Vancomycin + 3rd gen cephalosporin (Ceftriaxone or Cefotaxime)

Extra: Covers S. pneumoniae and N. meningitidis. Add Ampicillin if <1 month or >50 years/immunocompromised (to cover Listeria monocytogenes).