1
Q
Encephalitis
A
Inflammation of the brain
- usually viral
2
Q
What is a bacterial brain infection?
A
Cerebritis
3
Q
Primary vs secondary encephalitis
A
Primary: virus invades brain and spinal cord
Secondary: (post infectious) encephalitis
- virus infects another part of the body
- secondarily enters the brain
4
Q
Short list of common encephalitis viruses?
A
Herpes
- HSV
- VZV
Childhood
- MMR
Arboviruses
Rabies
Toxoplasmosis
5
Q
Herpes encephalitis spread by?
A
Reactivation
6
Q
Arbovirus is spread by?
A
Mosquitos
Ticks
7
Q
Rabies
A
Infected animal
8
Q
VZV Cytomegalovirus are more common in?
A
Immunocompromised
9
Q
Pathophysiology of encephalitis?
A
Crosses the BBB
- virus enters neural cells
- disruption in cell functioning
- perivascular congestion
- hemorrhage
- inflammatory response
- diffusely affects gray matter
- focal or diffuse pathology
10
Q
S/s of encephalitis?
A
Focal and diffuse presentation
- fever w HA
- N/V
- behavioral changes
- decreased LOC
- stiff neck
- photophobia
- lethargy
- gen/local seizures
- acute confusion
- amnestic states
- flaccid paralysis
11
Q
Physical signs of encephalitis
A
Altered mental Focal - hemiparesis - focal seizures - autonomic dysfunction Movement disorders Ataxia Cranial nerve defects Dysphagia Meningismus
12
Q
MC physical finding for encephalitis?
A
Altered mental status and or personality changes
13
Q
Diagnostics for encephalitis?
A
Head CT - w and w/o contrast - before LP MRI - most likely to show abnormals Electroencephalography CSF
14
Q
Which diagnostics are required?
A
Must do a CT first
- elevated ICP
- obstructive hydrocephalus
- mass effect
Then must do LP
- CSF analysis
15
Q
Tx for encephalitis?
A
Supportive
- airway
- fluids/electrolytes
- nutrition
- secondary infection
- hyperpyrexia
- manage ICP
16
Q
How do you manage ICP?
A
Head elevation
Diuresis
Mannitol
Seizures
17
Q
HSE is MC where?
A
Herpes eimplex encephalitis is MC in western countries
- still rare
18
Q
What causes HSE?
A
Reactivation of HSV
- lying dormant in the trigemianal ganglia
- acute onset of sever symptoms
- NOT associated with active diseases (cold sores)
- CNS spread from HSV spread through the olfactory tracts
19
Q
Mortality rate for HSE?
A
50-75%
But 100% have long-term motor and mental disabilities
20
Q
HSE s/s?
A
Psychiatric symptoms
Anterior opercular syndrome
Global aphasia
Disease specific
- HSV-1 - brainsetm encephlitis
- HSV-2 - myelitis
21
Q
What is anterior opercular syndrome?
A
Benign recurrent meningitis
22
Q
Diagnostic studies from HSE?
A
PCR DNA for HSV
CT scan
- low density
23
Q
HSE tx?
A
Supportive
Acyclovir (zovirax)
Can actually treat this one!!
24
Q
Arbovirus means?
A
Arthropod-borne virus
25
Arboviruses require?
Vector
- mosquito
- tick (rare)
Birds infect the mosquitos
26
Common symptoms of arboviruses?
Usually few or no symptoms
27
2 MC arboviruses?
St louis encephalitis
- urban near Mississippi river
California virus
- N midewst and East
28
Less common arboviruses?
Eastern equine encephalitis (EEE)
- rare but high mortality
- found in new england
Western equine encephalitis (WEE)
- rural communities west of Mississippi river
29
S/S of arboviruses?
```
- Mimics encephalitis
Vary by virus
- Dysuria/pyuria
- Seizures
- Movement disorders
```
30
Dysuria and pyuria occur in?
St. Louis encephalitis
31
Generalized or localized seizures occur with?
California encephalitis
32
Movement disorders are common in?
St. Louis encephalitis
EEE
WEE
- Eastern equine encephalitis
- Western equine encephalitis
33
Labs/diagnostics for arboviruses?
Leukocytosis
| EEG changes
34
Tx for encephalitis
Supportive
35
Preventative for encephalitis?
Insect repellant
- Skin
- Homes
No water-holding containers around the home
36
West nile is a?
Arboviral - flavivirus
37
Transmission of west nile?
Birds
Mosquitos
Throughout the US
Mostly summer/fall but year round in the south
38
Old people are at an increased risk for (west nile)
Neuroinvasive infection
39
S/s of west nile?
- Mild/asymptomatic (vast majority)
- encephalitis
- lethargy (extreme)
- flaccid paralysis
40
Flaccid paralysis with WNE?
Only 10% of the time
41
Diagnostics for WNE?
Leukopenia
| Serologic testing
42
Tx for WNE?
Supportive
43
Major pathways for meningitis?
1. Invasion of the bloodstream
2. Retrograde neuronal pathway
3. Direct contagious spread
44
How does meningitis direct contiguous spread work?
Spreads to brain from
- Sinusitis
- Otitis media
45
Before HIB vaccine most bacterial meningitis included
- H. flu,
- N. Meningitis,
- S. Pneumoniae
Now its usually?
Its a disease of adults
| - penicillin-resistant S. pneumonia
46
The HIB vaccine...
Decreased HIB meningitis by 90%
| - got to be alive to have autism, just saying
47
Classic presentation of meningitis?
```
Fever
Ha
Neck stiffness
Photophobia
N/V
Papilledema
Rash
Hepatosplenomegaly
Cerebral dysfunction
```
48
Meningitis cerebral dysfunction symptoms?
Lethargy
Confusion
Coma
49
Triad of meningitis?
Only 2/3 of pts
- Fever
- nuchal rigidity
- mental status change
50
Kernig sign?
Hip at 90*
Cant extend Knee
- hamstring pain
Indicates meningeal irritation
51
Brudzinski sign?
Chin Bent to chest
| Hips flexion
52
Atypical presentation of meningitis?
HIV
Elderly
- May be subtle
- May be mostly lethargy
Neutropenia pt’s
- subtle symptoms of meningeal irritation
53
Cornerstone for meningitis diagnosis?
CSF
54
Meningitis CT/MRI
| ?
DO NOT aid in diagnosis of meningitis
55
CSF finding chart?
Youve seen it before, its on slide 33
56
MC bacterial meningitis pathogens?
S. Pneumonia
N. Meningitidis
H. Influenzae
57
MC meningitis in neonates?
GBS
E. Coli
Listeria monocytogenes
58
MC bacterial meningitis in US?
Streptococcus pneumonia
59
Tx for s. Pneumoniae meningitis?
Cefotaximine
Or
Ceftriaxone
And
Vancomycin + dexamethasone
60
S. Pneumonia findings on CSF?
Fulminant illness with
CSF
- PMNs > 1000
- low glucose (<25%)
61
Neisseria meningitis is a?
Gram-neg diplococcus
Seen in epidemics
62
N. Meningitis risk?
High mortality
High risk in
- asplenics
- Terminal complement deficiency
63
Tx for M. Meningitidis?
Cefotaximine /Ceftriaxone
+
Vancomycin + dexamethasone
64
N. Meningitis is found in?
Africa
College students (dorms)
Military recruits
65
Prevention for N. Meningitis?
Vaccine for:
- asplenic pts
- HIV
- college students
- recruits
- the Hajj
66
The N. Meningitis vaccine is?
New tetravalent conjugate vaccine
| - recommended for young adolescents
67
listeria monocytogenes is common in?
Setting of cell-mediated immune deficiency
Rare in healthy adults
- age >50
- pregnancy
- alcoholics
- steroids
68
Tx for listeria monocytogenes?
Ampicillin + gentamicin
- empiric abx
- pending CSF results
Droplet isolation x 24-48hrs
69
Who needs Post exposure prophylaxis for N. Meningitidis?
Close contacts
- prolonged contact >8hrs
- close proximity <3 feet
- directly exposed to secretions
- w/in 1 week before onset of symptoms
Medical personnel - airwary
70
Prophylaxis meds for N. Meningitis?
Ceftrixone - 250mg
Or
Rifampin 600mg
Cipro 500mg
71
The big menigitis bugs?
Viral
- enterovirus (coxsackie)
- herpesvirus
- arthropod-borne
- HIV
Parasitic
- free living amoebas
Fungal
- C. Neoformans
- C. Immitis
- B. Dermatidis
- candida
- H. Capsulatum
Special
- TP
- syphilis
72
Tx of viral mengitis?
Only require supportive care
- self limited
Antivirals may be used if needed
73
Fungal meningitis tx?
Antifungals as needed
74
TB meningitis tx?
Isoniazid (INH)
| Pyrazinaminde (PZA)
75
Syphilitic meningitis tx?
Aqueous crystalline Pen G
| Benzathine Pen G
76
Differential for meningitis?
```
Brain abscess
Noninfectious meningitis
Meningeal carcinomatosis
CNS vasculitis
Stroke
```
77
What is a prion-related disease
Proteinaceous infectous particles
| - affects humans and animals (humans are animals... just saying)
78
Examples of prion-related diseases?
Kuru
Creutzfeld-jakob diease
Bovine spongiform encephalopathy
79
Prion related diseases fun facts?
Strangely unique
- inheritied/ sporadically/ infectious
Long incubation periods
80
Prion disease tx and mortality?
All are fatal
No treatment
81
S/s of prion-related diseases?
- 6-7th decade of life
- Dementia (progresses)
- Multifocal neurological dysfunction
- myoclonic fasciculations
- ataxia
- somnolence
- progressive cognitive impairment
82
Diagnosis of prion-related diseases?
Lab - developing PCR
MRI - bilateral areas of increased intensity
CSF - increased protein (CSF)
83
Infections tissue with prion-related diseases
Brain/eye tissue
Cerebral electrodes
Infected instruments
84
Prion-related diseases medical equipment?
Special autoclaving and treatment for known cases
85
Differential for prion-related diseases?
- Alzheimer disease
- Dementia in motor neuron disease
- HIV-1 encephalopathy
- AIDS dementia complex
- herpes simplex encephalitis
- hydrocephalus
- inherited metabolic diseases
- multiinfarct dementia
86
I dont care what people think of me
At least mosquitos find me attractive
Senior - ID 3
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