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Neurology > 1(E): Encephalitis, Cerebral Abscess, Toxoplasmosis > Flashcards

1(E): Encephalitis, Cerebral Abscess, Toxoplasmosis Flashcards

(47 cards)

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1
Q

Define encephalitis

A

Inflammation brain parenchyma

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2
Q

What regions of the brain are more commonly affected by encephalitis

A
  • Inferior Frontal

- Medial Temporal

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3
Q

What is the age distribution of encephalitis

A

<20 years-old and >50 years-old

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4
Q

What are the two types of encpehalitis

A

Viral

Autoimmune

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5
Q

What causes 90% of viral encephalitis in adults

A

HSV1

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6
Q

What can cause viral encephalitis in neonates

A

HSV2

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7
Q

What can cause viral encephalitis in immunocompromised

A

CMV

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8
Q

What are the two types of autoimmune encephalitis

A

NMDA encephalitis

Pareneoplastic encephalitis

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9
Q

What are the symptoms of encephalitis

A
  • Strange behaviour: hyper-sexual, hypomanic
  • Psychiatric
  • Decrease GCS
  • Fever, Vomitting, Headache
  • Focal Neurological signs
  • Seizures
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10
Q

What bloods should be taken in suspected encephalitis

A

PCR
Blood Culture
Toxoplasmosis IgM

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11
Q

What imaging is taken for encephalitis

A

CT

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12
Q

What will be seen on CT imaging

A

Petechial haemorrhages in middle-temporal and inferior-frontal lobe

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13
Q

What will be seen on LP in encephalitis

A

Lymphocytosis

Raised Protein

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14
Q

What will be seen on EEG in encephalitis

A

periodic 2Hz discharges

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15
Q

What is used to manage encephalitis

A

acyclovir

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16
Q

How quickly should acyclovir be started for suspected encephalitis

A

30-minutes

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17
Q

What is a cerebral abscess

A

Suppurative collection of pus within brain parecchyma

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18
Q

What typically causes cerebral abscess

A

Secondary to infections:

  • Otogenic
  • Oral
  • Sinusitus
  • Meningeal
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19
Q

What are rare causes of cerebral abscess

Study These Flashcards
A

Skull Fracture
Septic Foci
Neurosurgery

20
Q

What pathogen is most common cause of cerebral abscess

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A

S. Viridian’s (50%)

Others:
- Staph. Aureus (15%)

21
Q

What does strep viridian’s cause prior to cerebral abscess

22
Q

What can cause cerebral abscess if immunocompromised

Study These Flashcards
A

Toxoplasmosis

23
Q

What is the triad of signs/symptoms in cerebral abscess

Study These Flashcards
A
  • Raised WCC
  • Fever
  • Raised ICP
24
Q

What headache is present in cerebral abscess

Study These Flashcards
A

Dull persistent headache

25
What does rupture of cerebral abscess cause
If abscess ruptures, headache suddenly worsens and is associated with meningism
26
What are symptoms of raised ICP
- Vomitting - Papilloedema - Altered mental state
27
What are focal neurological deficits associated with cerebral abscess
CN3 palsy CN6 palsy = occur due to raised ICP
28
Apart from raised ICP, what other neurological feature may be present
Seizures
29
What is a systemic feature of cerebral abscess
Fever
30
Explain spread of pathogen in cerebral abscess
Pathogen can either spread via direct contamination (eg. skull fracture) or haematogenously
31
What happens 3-5 after pathogen infiltration
Early cerebritis - infiltration of neutrophils and oedema
32
What happens in late cerebritis (2-3W)
necrosis, liquefaction and macrophage infiltration. Then eventually a fibrotic capsule will form around the lesion
33
What are 3 blood tests for cerebral abscess
- FBC - Blood Culture - CRP
34
What will be seen on CT or MRI in cerebral abscess
Ring-enhancing lesions in peripheries
35
What is difference between cerebral abscess on CT/MRI and in toxoplasmosis gondii
Toxoplasmosis gondii = ring-enhancing lesions in basal ganglia. Cerebral abscess = ring-enhancing lesions in periphery
36
How is cerebral abscess managed
- Refer to neurosurgery for urgent drainage and biopsy - IV Antibiotics - Some recommend dexamethasone to reduce ICP (Controversial)
37
What causes cerebral toxoplasmosis
Toxoplasmosis Gondii
38
What is the most common neurological disorder associated with HIV
Cerebral toxoplasmosis
39
What causes cerebral toxoplasmosis
Infection toxoplasmosis Gondii
40
How is toxoplasmosis gondii usually transmitted
Cat faeces Unpasteurised milk Insufficiently cooked meat
41
What does CD4 count have to be in HIV to enable cerebral toxoplasmosis
<100
42
How does cerebral toxoplasmosis present clinically
Headache Focal neurological deficit Seizure Change in mental status
43
What is first-line investigation for toxoplasmosis gondii
Sabin-Feldman Dye Test | Looks for amount IgG toxoplasmosis gondii that can bind to methylene blue
44
What other investigation is ordered in cerebral toxoplasmosis
CT/MRI
45
What does CT/MRI in toxoplasmosis gondii show
Ring-enhancing lesions in basal ganglia
46
Why type of organism is toxoplasmosis gondii
Protazoan
47
How is cerebral toxoplasmosis managed
Pyrimidine and Sulphadiazine for 6-Weeks

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