Source / episode info
- **Episode:**45
- **Title:**Divine Intervention Episode 45 – Neurology Clerkship Shelf Review Part 2
- **Published:**2018-08-20
- Source:Episode page
One-liner
This episode reviews critical neurological topics including CSF findings in HSV vs. bacterial meningitis, the pathophysiology of primary adrenal insufficiency leading to Type 4 RTA, diagnosis and management of SAH (xanthochromia), Parkinsonian syndromes, pseudotumor cerebri, and various headache types.
High-yield summary
- HSV Meningoencephalitis: CSF shows lymphocytic pleocytosis, mildly decreased glucose, and mild protein elevation; PCR is the preferred diagnostic test.
- Bacterial Meningitis (Strep/Staph): CSF shows marked neutrophilic pleocytosis, very low glucose, and markedly elevated protein. The standard adult cocktail includes Vancomycin + Ceftriaxone + Clindamycin.
- Primary Adrenal Insufficiency: Leads to a non-anion gap metabolic acidosis and Type 4 RTA due to aldosterone deficiency impairing the alpha-intercalated cell proton pump.
- Subarachnoid Hemorrhage (SAH): The classic presentation is "worst headache of life." Diagnosis requires LP showing xanthochromia if CT head without contrast is negative. Management involves strict BP control and calcium channel blockers (e.g., Nicardipine).
- Pseudotumor Cerebri: Characterized by elevated intracranial pressure, papilledema, and symptoms in an obese female; diagnosis relies on measuring elevated opening pressure (>25 cm H₂O) via LP.
Learning objectives
- Differentiate CSF findings between viral (HSV) and bacterial meningitis.
- Understand the pathophysiology of primary adrenal insufficiency, including its metabolic consequences (Type 4 RTA).
- Interpret neuroimaging and lumbar puncture results in suspected subarachnoid hemorrhage.
- Recognize the clinical presentation and management principles for various headache syndromes (migraine vs. cluster).
- Master the differential diagnosis and treatment pathways for movement disorders like Parkinson's disease and dystonia.
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