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ADAMS > Viral infections of the Nervous System > Flashcards

Viral infections of the Nervous System Flashcards

1
Q

natural host of LCM virus (lymphocytic choriomeningitis)

A

Mus musculus

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2
Q

causes fifth disease in young children characterized by high fever and markedly flushed cheeks, irritability and sometimes febrile seizures

in adult may cause brachial neuritis

A

Parvovirus

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3
Q

may be associated with cauda equina neuritis

A

HSV and HIV

HVS- with preceding genital infection with the virus

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4
Q

causes encephalitis in immunocompromised patients

HIV, chemo for neoplasm, organ transplantation or hematologic or lymphoid malignancy

A

HHV-6
CMV
VZV

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5
Q

Vogt-kayanagi-Harada syndrome

A

iridocyclitis
depigmentation of a thick swath of hair and of skin
vitiligo aorund eyes, loss of eyelashes, dyacusis, deafness

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6
Q

Most serious among the arbovirus infections In the US

A

eastern equine encephalitis (EEE)

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7
Q

predilection of lesions in Herpes Simplex Encephalitis

A

inferomedial or lateral portions of the frontal and temporal lobes, and insula

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8
Q

T/F Lesions in HSE are usually bilateral and always symmetrical.

A

False
usually bilateral but not symmetrical
p751

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9
Q

T/F
In the acute stages of HS encephalitis, intranuclear eosinophilic inclusions are found in neurons and glia cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis.

A

True

p751

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10
Q

EEG findings in Herpes Simplex Encephalitis

A

lateralized periodic high-voltage sharp waves in the temporal regions and slow-wave complexes at regular 2-3/s intervals

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11
Q

T/F

In HSE, False-negative tests for HSV PCR are most likely to occur in the first 72 hrs of febrile infection.

A

False
48 hrs
p752

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12
Q

Dose and duration of Acyclovir in HSE

A

30mg/kg/d

10-14 days

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13
Q

Main cause of relapses in HSE in adults

A

treatment with low doses for a brief period

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14
Q

prognosis in Herpes Simplex Encephalitis

A

if treatment begun 4 days of onset of illness, survival is greater than 90%

in an evaluation after 2 yrs, 53% were dead or severely impaired

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15
Q

Neurologic sequelae in HSE

A

korsakoff amnesic defect or global dementia
seizures
aphasia

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16
Q

causative agent in roseola

exanthemia subitum

A

HHV-6

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17
Q

viral agents that appear as causes of encephalitis with some regularity in stem-cell and organ transplants pts

A 
parvovirus
CMV
EBV
adenovirus
HSV
VZ virus
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18
Q

incubation period for Rabies

A

10-20 days, as short as 14 days

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19
Q

main neurologic symptoms for rabies include apprehension, dysrathria, psychomotor overactivity, followed by dysphagia, spasms of throat muscles, dysarthria, numbness of the face, diplopia, spasma of facial muscles indicate involvement of

A

tegmental medullary nuclei

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20
Q

Rabies is distinguished by the presence of cytoplasmic eosinophilic inclusions called

A

Negri bodies

most prominent in the pyramidal cells of hippocampus and Purkinje cells

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21
Q

Focal collections of microglia in Rabies are called

A

Babes nodules

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22
Q

Dose of Human Rabies immune globulin HRIG for postexposure prophylaxis

A

20 U/kg

provides passive immunnization for 10-20 days

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23
Q

Acute ataxia of childhood is most often associated with

A

chickenpox

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24
Q

most common causative organisms to cause acute ataxia in adults

A

varicella, EBV, mycoplasma

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25
Q

characterized clinically by radicular pain, vesicular cutaneous eruption, segmental sensory and delayed motor loss

A

Herpes Zoster

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26
Q

VZV DNA is localized primarily in which ganglia

A

trigeminal

thoracic

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27
Q

Lipschutz inclusion bodies are seen in

A

herpez zoster

multiplication of virus in epidermal cells causes swelling, vacuolization, lysis of cell boundaries, leading to the formation of vesicles

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28
Q

how long does pain and dysesthesia usually last in Herpes Zoster

A

1-4 weeks

in others - pain persists for months or years

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29
Q

what to look for in Tzanck smear

A

multinucleated giant cells in scrapings from the base of an early vesicle

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30
Q

thoracic dermatomes frequently involved in herpes zoster

A

T5 - T10

followed by craniocervical regions

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31
Q

complication of VZV
2-10 weeks after onset of ophthalmic zoster, patient develops an acute hemiparesis, hemimanesthesia, aphasia or other focal neurologic or retinal deficits associated with mononuclear pleocytosis in the spinal fluid and elevated IgG in CSF

A

cerebral angiitis

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32
Q

in Zoster angiitis
Acyclovir shortens the duration of acute pain and speeds the healing of vesicles provided that treatment started within approximately how many hrs?

A

48 hrs

some say 72

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33
Q

Zoster angiitis

for immunocompromised patients, what is the treatment

A

intravenous acyclovir given for 10 days

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34
Q

Treatment for Toxoplasmosis in AIDS

A

pyrimethamine 100mg initially then 25 mg daily

sulfonamide 4-6g daily

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35
Q

Nonfocal complication in AIDS
presenting with retinitis, acute confusional state or delirium combined in a small proportion of cases with cranial nerve signs including ophthalmoparesis, nystagmus, ptosis, facial nerve palsy or deafness

A

Cytomegalovirus

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36
Q

Early histopathologic changes in poliomyelitis

A

anterior horn cells - central chromatolysis of the nerve cells
along with an inflammatory reaction

37
Q

Prion encephalopathy or all types has now been firmly associated with the conversion of a normal cellular protein PrPc to

A

an abnormal isoform, PrPsc

38
Q

True or False

in prion encephalopathy
The transformation involves a change in which its helical proportion diminishes and the proportion of Beta pleated sheet increases.

A

True

p770

39
Q

In CJD

Several competing classification systems have been devised that are based on both the presence of what two amino acids at codon 129 of the prion protein

A

methionine

valine

40
Q

which of the ffg is the most common variant in spongiform enceph

a. MM1
b. MM2
c. MV1
d. VV1

A

MM1

41
Q

rapidly or subacutely progressive and profound dementia is associated with diffuse myoclonic jerks

early stages of neurologic disease are characterized by a great variety of clinical manifestations, changes in behavior, emotional response, intellectual function followed by ataxia and abnormalities of vision such as distortions of shape and alignment of objects or impairment of visual acuity

early phase: confusion, hallucinations, delusion, agitation

A

CJD

42
Q

EEG pattern in CJD

A

distinctive and changing over the course of disease from diffuse and nonspecific slowing to one of stereotyped high-voltage slow 1-2Hz and sharp-wave complexes on an increasingly slow and low-voltage background

43
Q

In CJD EEG

the high-voltage sharp waves which give the appearance of periodicity are synchronous with

A

myoclonus but the pattern may persists even without myoclonus

44
Q

MRI findings in CJD

A

hyperintensity of lenticular nuclei on T2 and DWI when disease is fully established

long contiguous segments of cortex as well as various parts of BG also show these alterations

45
Q

what parts of the brain are mostly affected in CJD

major neuropathologic changes are found in:

A

cerebral and cerebellar cortices

46
Q

in CJD

the microscopic vacuoles, which gives the brain tissue the typical sponge appearance are found in

A

cytoplasmic processes of glia cells and dendrites of nerve cells

47
Q

how viruses gain entrance to the body
VZV, measles and mumps -
polioviruses, enteroviruses -
HSV -

A

VZV, measles and mumps - respiratory
polioviruses, enteroviruses - oral-intestinal
HSV - oral or genital mucosal route

48
Q

intermediate step to seeding in the brain/CSF

A

viremia

49
Q

viruses which utilize the peripheral nerve pathway

A

VZV
rabies
HSV

50
Q

In Progressive multifocal leukoencephalopathy, there is a selective lysis of

A

oligodendrocytes

51
Q

clinical syndrome of aseptic meningitis

A

fever, headache, signs of meningeal irritation

predominantly lymphocytic pleocytosis in the spinal fluid with normal glucose

52
Q

mild depression of CSF glucose (nerve below 25mg/dL) occurs with meningitis caused by

A

mumps
HSV-2
lymmphocytic choriomeningitis
VZV

53
Q

most common cause of aseptic meningitis

A

viral

mostly enteroviruses - mainly echovirus and Coxsackie virus

54
Q

Elsberg syndrome

A

associated with HSV2
aseptic meningitis
bladder failure
vaginal or vulvar pain after a bout of genital herpes

55
Q

Most common sporadic cause of encephalitis and has no seasonal or geographic predilections

A

HSV

56
Q

primary infection with EBV, complicated by meningitis, encephalitis, facial palsy, or polyneuritis of the GBS

A

infectious mononucleosis

57
Q

T/F

Status epilepticus in Herpes Seimplex Encephalitis is common.

A

False

rare
p751

58
Q

pathologic lesions in Herpes Simplex Encephalitis

A

intense hemorrhagic necrosis of the inferior and medial temporal lobes and the mediorbital parts of the frontal lobes
region of necrosis may extend upward along the cingulate gyri and sometimes the insula or the lateral parts of teh temporla lobes or caudally into the midbrain but always contiguous with areas of mediotemporal lobe necrosis

59
Q

route of entry of HSV into the CNS

A

latent in trigeminal ganglia and with reactivation may infect the nose and then the olfactory tract

may also soread along nerve fibers that innervate the leptomeninges of the anterior and middle fosaee

60
Q

imaging findings in Herpes Simplex Enceph

A

CT - hypodensity of the affected temporal lobe areas in 2/3 of cases
MRI - increased signal in T2 weighted images

T1- low signal intensity with surrounding edema and sometimes scattered areas of hemorrhage occupying the inferior parts of the frontal and temporal lobes

ehancement to some degree with contrast: indicates cortical and pial abnormalities of BBB

61
Q

T/F

Antiviral treatment seems to affect PCR assay results in cases of herpes simplex encephalitis.

A

False

antiviral treatment did not appear to affect the results.

p752

62
Q

establishes cause of a medial temporal lobe (limbic) encephalitis in adult patients following allogenic hematopoeietic stem cell bone marrow transplants

A

HHV-6

63
Q

T/F

One attack of zoster provides lifelong immunity.

A

False

p755

64
Q

hazard in ophthalmic herpes

A

herpetic involvement of cornea and conjunctiva resulting in corneal anesthesia and residual scarring

65
Q

syndrome

facial palsy in combination with a herpetic eruption of the external auditory meatus

A

Ramsay Hunt Syndrome

66
Q

takes the form of a slowly or subacutely progressive dementia accompanied variably by abnormalities of motor function
treatment with antiretroviral drugs can result in cognitive improvement

A

AIDS Dementia Complex

67
Q 
sensitive tools in the early stages of AIDS dementia complex except
trail making 
CDT
pegboard
symbol-digit testing
A

except CDT

test of psychomotor speed seem to be most sensitive in the early stages of dementia

68
Q

pathologic basis of dementia

A

diffuse and multifocal rarefaction of teh cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, multinucleated giant cells

69
Q

pathologic description of HIV myelopathy

A

vacuolar degeneration

with pathologic resemblance to subacute combined degeneration because of vitamin B12 deficiency

70
Q

antiretroviral drug that can cause myopathy

A

zidovudine

because of its effect on the mitochondria
p760

71
Q

MRI findings in CMV in AIDS

A

T2 hyperintesities in the periventricular regions may extend more diffusely in the white matter and be accompanied by meningeal enhancement by gadolinum

72
Q

Shingles involving several contiguous dermatomes is known to occur in AIDS with CD4 counts

A

below 500

73
Q

T/F
Poliomyelitis
Inclusion bodies can be seen in the spinal cord.

A

False

p764
No inclusion bodies

74
Q

T/F

Acyclovir or famciclovir can be given to patients with poliomyelitis.

A

False

p764
The authors know of no systemic study of the potency of antiviral agents in this disease.

75
Q

mortality from acute paralytic poliomyelitis

A

5-10%

76
Q

in polio, the return of muscle strength occurs mainly in the first ___ months

A

3-4 months
p765
probably the result of morphologic restitution of partially damaged nerve cells

77
Q

history of primary measles infection at a very early age, before 2 years
followed by a 6-8 year asymptomatic period
initially, decline in proficiency at school, temper outbursts, changes in personality, difficulty with language, loss of interests in usual activities

progressive intellectual deterioration, focal or generalized seizures, widespread myoclonus, ataxia, visual disturbances, progressive chrorioretinitis

A

Subacute sclerosing panencephalitis

78
Q

EEG in SSPE

A

periodic (every 5-8s) bursts of 2 to 3/s high voltage waves, followed by a relatively flat pattern

79
Q

T/F

Cerebellum is usually affected in SSPE.

A

false

usually spared
p766

80
Q

develops several days to weeks
personality changes, intellectual impairment
combination of hemiparesis progressing to quadriparesis
visual field defects, cortical blindness, aphasia, ataxia, dysarthria, , dementia, confusional states, coma
seizures are infrequent
develops in patient with a neoplasm or chronic immunodeficiency state
CSF - normal
CT and MRI - nonenhancing demyelinating lesions

A

Progressive Multifocal Leukoencephalopathy

81
Q

Prognosis in PML

A

death occurs in 3-6 months

82
Q

causative agent in PML

A

JC virus

human polyomavirus

83
Q

a CD4 count of _______ is a poor prognostic sign for recovery from PML

A

100 cells /uL

84
Q

ophthalmoplegia and pronounced somnolence
1/3/ bradykinesia, catalepsy, mutism, chorea, myoclonus
20% died within a few weeks, survivors have varying degrees of impairment of mental function

most extraordinary feature: parkinsonian syndrome after an interval of weeks or months

A

Encephalitis Lethargica

von Economo Disease, Sleeping Sickness

85
Q

T/F

Prion diseases may be both genetic and infectious.

A

True

p769

86
Q

outstanding neuropathologic changes in CJD

A

widespread neuronal loss and gliosis accompanied by a striking vacuolation or spongy state of the affected regions
subacute spongiform encephalopathy

87
Q

Prion encephalopathy has now been firmly associated with the conversion of a normal cellular protein PrPc to an abnormal isoform PrPsc - the transformation involves a change in conformation of the protein - describe the change in number of helical and beta pleated sheets

A

the helical proportion diminishes and the proportion of beta pleated sheets increases

88
Q

test of CSF in CJD - finding by immunoassay of peptide fragments of normal brain proteins termed

A

14-3-3

ADAMS (29 decks)

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