Infectious Nervous Flashcards

1
Q

West Nile Virus Encephalitis

A

fever, headaches, and altered mental status. A prominent finding in WNE is muscular weakness (30 to 50 percent of patients with encephalitis), often with lower motor neuron symptoms, flaccid paralysis, and hyporeflexia with no sensory abnormalities. Rare form.

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2
Q

Most common causes of viral meningitis?

A

1) Enterococcus (coxsackie, poliovirus, rhinovirus)
2) HSV 2,
3) HSV 1, VZV, HIV, Lyme, VDRL, EBV, LCMV

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3
Q

West Nile Meningitis

A

Occurs in older, immunocompromised people. Rare form

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4
Q

What is the work up for a lymphocytic predominant meningitis in immunocompetent patient?

A

Blood: cultures, ESR, ANA, rheumatoid, Sjogren’s, SPEP, angiotensin converting enzyme,

CSF: cytology, antibodies to B. burgdorferi, Brucella, histoplasma, coccidioides, PCR M. tuberculosis.

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5
Q

Enterovirus v. Lyme

A

EV 6x as frequent as lyme

Median pediatric age 10 Lyme v 5 EV

Prodrome duration 12 d Lyme, 1 day EV

Lyme has facial palsy

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6
Q

fever, HA, nuchal rigidity, facial palsy

A

Lyme meningitis

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7
Q

fever, HA, nuchal rigidity, sacral pain

A

HSV 2 meningitis
But most hsv2 meningitis occurs without genital herpes.

Chronic prophylaxis
Acyclovir, valacyclovir

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8
Q

lymphocytic predominant meningitis in HIV patient differential diagnosis?

A

Virus: enterovirus, HSV 1, 2, 6, 7 VZV, CMV, EBV, HIV, WNV

Bacteria: endocarditis, parameningeal infection, mycoplasma, M tuberculosis, T pallidum

Fungi: Cryptococcus neoformans, H capsulatum, C immitis

Parasites: T. gondii

Noninfectious: carcinomatosis, posttransplant lymphoproliferative d/o, CNS vasculitis, ADEM (Acute disseminated encephalomyelitis)

Drug Reactions: NSAIDS, Cox-2 I, azathioprine, Bactrim, isoniazid, IVIG, OKT-3, intrathecal chemo.

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9
Q

When do you need to do a CT before an LP?

A

Yale criteria:

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10
Q

Cryptococcal meningitis CD4 count?

A

100

If WBC

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11
Q

What is IRIS syndrome

A

Immune reconsitition inflammatory syndrome

esp concerning in aids patient treated for cryptococcus meningitis
weeks after appropriate tx, worsening of sx or new neuro sx.

prevent by delaying HAART therapy.

+CRP with sterile tap

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12
Q

Inflammatory PML:

A

MS sx: weakness, changes in vision, personality, movement

Fast progressive

caused by JC virus and MS treated with Natulizamab

Multifocal non contrast enhancing lesions on MRI

Prognosis: 1/3-1/2 die in first month

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13
Q

multiple lesions in brain in AIDS patients

A

Multiple enhancing brain lesions. Usually brain abscesses (rarely encephalitis).

Dx: Serology
If congenital: periventricular calcifications

Rx: pyrimethamine/sulfadiazine and folinic acid

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14
Q

right ear pain followed by weakness of lid closure, eyebrow lifting, and lower face weakness.
No hearing loss, tip of tongue is numb

A

Bell’s palsy
Most common cause: 2/3 of are VZV, median ag 40, equal gender, recurrance rare

20-30% may have permanent disfiguring facial weakness &/or synkinesis, hyperacusis, loss of taste/tearing.

Tx with prednisone in first 48hr and valacyclovir.

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15
Q

Causes of one time Bell’s palsy

A

diabetes, HTN, HIV, Lyme, Ramsay Hunt (zoster), sarcoidosis, parotid disorders, Sjogren’s, pregnancy, amyloidosis, intranasal flue vaccine, WNV

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16
Q

Recurrent/Bilateral Facial N. Palsy

A

lymphoma, sarcoid, Lyme, pontine lesion, m. gravis.

17
Q

Neurologic signs suspicious for Lyme’s disease

A

Facial palsy, unilateral or bilateral. Meningeal signs with or without cranial neuritis, Radiculopathy, mononeuropathy multiplex, encephalomyelitis, encephalopathy

18
Q

Lyme Pearls

A

2.Diagnostic testing should be done if there
is likelihood of tick exposure
3.Lyme accounts for only 25% su mertime 7th nerve
palsies in endemic areas
4.Onset of headache and meningeal symptoms is
less acute than in viral meningitis
5.Many patients with erythema migrans do not
yet have measurable antibody response
6.ELISA does not provide measure of disease activity
or treatment response and can remain positive for years
7.Early increase B cells, IgG synthesis, bands, possibly
due to chemokineCXCL 13
8.Borrelia burgdorferi is very sensitive to beta-lactam s
and tetracyclines with no sig nificant resistance 9.Persistent symptoms with negative laboratory tests after appropriate treatment are not Lyme disease

19
Q

Old man with high temp, stiff neck, unrousable, generalized seizure, no papilledema or lateralizing abn.

A

Dexamethasone (to reduce hearing loss)
Abx: for S. penumo, gnr, listeria,
CT
LP

20
Q

If low sugar in CSF:

A
cancer, Bacterial , TB
Herpes simplex (sometimes) Fungal (sometimes) Neurosarcoidosis
21
Q

Necrotic encephalitis, psychiatric symptoms. Mixed poly, lymphocytic encephalitis, RBC 400

A

HSV encephalitis

Dx PCR`

22
Q

Left leg weakness over 1 day to 3/5 strength. Areflexic in both legs. Speech arrest. Mild bilateral facial weakness. Normal sensory exam. rapid obtundation. CSF: 125 WBC 50% polys, glucose 75, protein 104

A

Polio like
West Nile Virus
Dx: IgM
older, immunocompromised people.

facial nerve

23
Q

Acute confusional states with limbic features

A

Psychiatric diagnosis, Drugs, Wernicke’s, Seizures/status –ddx, Infection: HSV 1>2, HHV 6, Paraneoplastic syndromes

24
Q

Encephalitis Causes4

A

vira: St. Louis, Equine, WNV, Japanese

Bacterial: rocky mt spotted fever, ehrlichiosis, anaplasmosis, lyme, leptospirosis

Amebae: aegleria, acanthamoeba

Non seasonal:
HSV 1, 2, 6, VZV, EBV, CMV, Rabies, H1N1, Toxoplasmosis

25
Q

Earl neurologic manifestations of Lyme

A

aseptic meningitis, facial n palsy,

26
Q

HSV encephalitis

A

temporal lobes

seizures, olfactory hallucinations, memory disturbances, elevated reds in csf + leukocytosis.

27
Q

Toxoplasmosis

A

AIDS patient
presents with headache, mental status change, focal neurologic signs and symptoms
fever
Multiple ring-enhancing lesions in basal ganglia.

28
Q

Neurocysticercosis

A
Caused by Taenia Solium. 
Seizure, headache, increased ICIP. 
multiple cystic lesions which can be ring-enhancing or calcified!
Seen in s america/latin america.  
Tx with albendazole and steroids.
29
Q

HIV associated dementia

A

after prolonged immunosuppresion.

MRI: patchy T2 hyperintensity in white matter and cerebral atrophy.

30
Q

PML

A

Demyelinating of CNS caused by infection of oligodendrocytes by JC virus.

31
Q

Cryptococcus Meningitis

A

markedly elevated ICP! + imunocompromised

Tx with amphotericin B and flucytosine

32
Q

Bacterial Meningitis

A

associated with hearing loss and visual loss. Low sugar and elevated poly count and hallmarks.

33
Q

TB meningitis

A

basilar meningitis with multiple cranial neuropathies, raised ICP, hydrocephalus, low sugar

34
Q

basilar meningitis with multiple cranial neuropathies, raised ICP, hydrocephalus, low sugar

A

TB meningitis

35
Q

40 yo man with double vision on looking to left for 2 days. stiff neck. inattentive and lethargic. mildly enlarged ventricles

A

TB meningitis

36
Q

Neiserria meningitides

A

can also cause septicemia – purple rash on abd

proflylaxis with rifampin or cirpofloxacin.

37
Q

Acyclovir SE

A

Nephrotoxicity, ATN

38
Q

Posterior fossa syndrome

A

CSF pleocytosis without microbial growth after posterior fossa surgery

39
Q

Congenital CMV

A

hearing loss, spasticity, hyperintensities along ventricular margins on MRI