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TEAM E Morning Report 4/17/2015

TEAM E Morning Report 4/17/2015. History of CSF. CSF Pleocytosis. Diagnostic Studies. AFB Smear Sensitivity 10-60% Higher with large volume samples (6 ml) AFB Culture Sensitivity 25-75% 2-6 weeks of incubation to grow Yield increased with multiple samples and higher volume.

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TEAM E Morning Report 4/17/2015

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  1. TEAM E Morning Report4/17/2015

  2. History of CSF

  3. CSF Pleocytosis

  4. Diagnostic Studies • AFB Smear • Sensitivity 10-60% • Higher with large volume samples (6 ml) • AFB Culture • Sensitivity 25-75% • 2-6 weeks of incubation to grow • Yield increased with multiple samples and higher volume

  5. Sensitivity 84% and Specificity 82%

  6. Treatment • Often empiric due to lack of good diagnostic tests • Anti-TB • 4 drug therapy for 2 months followed by 2 drug therapy for 10 months • Steroids improve mortality but not morbidity • NEJM 2004 • Treat early if clinical suspicion high (CSF analysis, MRI, history) • 27% in hospital mortality and 49% had neurologic morbidity at discharge in one study

  7. Neurosarcoidosis • Definite • Biopsy confirmation from the nervous system • And Typical Clinical syndrome • Probable • MRI or spinal fluid evidence of inflammation • Plus 2 of the following 3: • Suggestive gallium scan • Typical chest imaging • Elevated ACE level • Possible • Typical clinical syndrome and no biopsy

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