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CNS Flashcards

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1
Q

RF for pneumococcal meningitis

A

**tends to be a/w other foci of infection (septic arthritis, PNA, IE)

  • asplenia
  • EtOH
  • CKD/CLD
  • DM
  • malignancy
  • basilar skull rx (w/ persistent CSF leak)
  • cochlear implants
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2
Q

manifestations of listeria CNS infections

A
  1. meningoencephalitis (the most common)
    1. neonates, IC, elderly
    2. increased risk seizures/focal neuro signs
  2. cerebritis (from direct hematogenous spread)
    1. F/HA, stroke-like hemiplegia
  3. rhomboencephalitis (a/w food outbreaks)
    1. IC
    2. biphasic; late = ataxia, nystagmus, CN palsies
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3
Q

meningitis +

rash, diarrhea

A

think of enterovirus

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4
Q

meningitis +

malaise, LAD, pharyngitis, maculopapular rash (in right epi group)

A

think HIV

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5
Q

common causes of recurrent meningitis

A

consider HSV-2

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6
Q

meningitis in:

lab personnel, pet owners, rodent-infested living conditions

A

consider LCMV

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7
Q

meningitis +

parotitis

A

mumps

(common cause of meningitis in unimmunized populations)

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8
Q

main causes of chronic meningitis

(e.g. 4+ wks of sx + pleocytosis)

A
  • TB
  • fungal
  • lyme
  • syphilis
  • malignancy
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9
Q

Predictive variables for diagnosis of TB meningitis

A

TBM results from rupture of tubercle into meninges

  1. >36yo (+2)
  2. blood WCC >5x106 (+4)
  3. number of days of illness _>_6 (-5)
  4. CSF WCC _>_900x103 (+3)
  5. CSF %PMNs _>_75 (+4)

Total score < 4 → TBM
Total score >4 → bacterial meningitis

Thwaites Index

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10
Q

undulant fever

CN palsy (esp blurred vision/hearing loss)

behavior changes/confusion

Mediterranean, Middle East
unpasteurized dair products/infected animals

Dx and Tx

A

Brucella

Tx w/ any of the two: doxy, CRP, rifampin

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11
Q

Cognitive impairment, ataxia, ophthalmoplegia, supranuclear gaze palsy
F, wt loss, peripheral LNs, myalgias

GI symptoms

A

think tropheryma whipplei

Tx: CRO, then TMP/SMX

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12
Q

excrutiating HA
rash + pruritus
paresthesias

peripheral/CSF eos

Asia, S Pacific

ingestion of shellfish, snails

A

think angiostrongylus cantonensis

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13
Q

etiologic agents of post-neurosurgical meningitis

A

most = enterobacterales, PSAR

also S aureus, CoNS

Candida in 5%

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14
Q

Common causes of encephalitis in…

  • US/UK
  • internationally
  • endemic areas
A
  • HSV, VZV, enterovirus
  • rabies, JEV
  • WNV, tickborne encephalitis virus, St Louis encephalitis virus
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15
Q

encephalitis + imaging with…

arteritis and infarctions

A
  • VZV
  • nipah virus
  • rickettsia rickettsia
  • syphilis
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16
Q

encephalitis + imaging with…

calcifications

A
  • CMV (if cortical lesions)
  • toxo (if periventricular lesions)
  • Taenia solium
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17
Q

encephalitis + imaging with…

cerebellar lesions

A
  • VZV
  • EBV
  • M pneumoniae
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18
Q

encephalitis + imaging with…

focal lesions in basal ganglia, thalamus, and/or brain stem

A
  • EBV
  • EEE
  • SLEV
  • JEV
  • WNV
  • enterovirus
  • influenza (acute necrotizing encephalopathy)
  • tropheryma whipplei
  • listeria
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19
Q

encephalitis + imaging with…

hydrocephalus

A
  • TBM
  • crypto
  • cocci
  • histo
  • balamuthia mandrillaris
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20
Q

encephalitis + imaging with…

space-occupying lesions

A
  • toxo
  • acanthamoeba
  • taenia solium
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21
Q

encephalitis + imaging with…

temporal/frontal lobe involvement

A
  • HSV, VZV
  • HHV-6
  • WNV
  • enteroviruses
  • syphilis (if medial lobes)
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22
Q

vesicles at site of inoculation + regional LAD
flu-like illness
paresthesias at inoculation site

invades CNS: diplopia, ataxia, agitation, seizures, asc paralysis

lab workers

Study These Flashcards
A

Herpes B Virus

23
Q

Asia, Western Pacific

pig, wading birds = reservoir, transmitted by mosquito

Parkinson-like syndrome

Study These Flashcards
A

Japanese Encephalitis Virus

24
Q

initial viremia: flu-like illness + arthralgias 7-14 days after tick bite

remission of 1 week

then CNS: meningitis, encephalitis, myelitis, radiculitis

Study These Flashcards
A

Tickborne encephalitis virus

transmitted rapidly after attachment (early removal may not prevent)

Epi: European, Far Eastern, Siberian

25
summertime encephalitis or acute flaccid paralysis 50% w/ persistent neuropsych impairment
think WNV
26
MCC brain abscess
* Strep (incl milleri group and VGS) * SA * anaerobes (from ENT source) * if neurosurg, trauma, ear infection: consider Enterobacterales, PSAR as well * SE Asia (esp w/ liver abscess): consider hypermucoviscous Kleb pneumoniae
27
Management of cavernous sinus thrombosis
* culture/drainage of infected sinuses if possible * vanc + metro + 3/4 gen ceph * anticoagulation
28
Clinical features of cavernous sinus thrombosis
* _signs_: periorbital edema, chemosis, papillitis, oculomotor palsies, proptosis * IC artery and multiple CNs in the cavernous sinus
29
Etiology of Septic Cavernous Sinus Thrombosis RF Etiologic Agents
* _RF_: **paranasal sinusitis (most important; remember NG tube causing sphenoid sinusitis)**, facial infection, dental infection * _Etiologic_: Staph (60-70%), Strep (~17%), GNR, pneumococcal, bacteroides (~2%)
30
Therapy of brain abscess w/: * Aspergillus * Candida * Mucorales * Scedosporium
* Vori * AMB * AMB * Vori (AMB resistant)
31
Therapy of brain abscess w/: * Nocardia * MTB
* TMP/SMX or sulfadiazine. Combo for IC pts or those failing standard therapy * INH + rifampin + pyrazinamide +/- ethambutol
32
Therapy of brain abscess w/: 1. Actinomyces 2. Bacteroides 3. Enterobacterales 4. Fusobacterium 5. PSAR 6. SA 7. Strep milleri, other strep
1. PCN G 2. metro 3. 3/4th gen ceph 4. metro 5. ceftaz, cefepime, meropenem 6. nafcillin, oxacillin, or vanc 7. PCN G
33
brain abscess w/ ring-enhancing lesion seen in IC pts resistant to AMB (may see persist/present despite tx w/ AMB in question stem)
* scedosporium * tx w/ vori
34
brain abscess in IVDU w/ basal ganglia infarct + rapid onset
think local cerebral mucormycosis non-septated hyphae w/ right angle branching
35
**_Empiric Abx Therapy of Brain Abscesses w/:_** 1. OM/mastoiditis 2. sinusitis 3. dental sepsis 4. penetrating trauma, neurosurgical 5. lung abscess, empyema, bronchiectasis 6. bacterial endocarditis 7. Unknown 8. Transplant Recipients 9. HIV-infected pts
1. aerobic/anaerobic strep, GNR, anaerobes - **metronidazole + 3rd gen ceph** 2. the above + staph - **metro + 3rd gen ceph + VANC** 3. aerobic/anaerobic strep, actinomyces - **metro + 3rd gen ceph** 4. staph, GNs, clostridium - **vanc + 3/4 gen ceph** 5. ? add nocardia coverage - **metro + 3/4 gen ceph + TMP/SMX** 6. staph/strep - **vancomycin** 7. **vanc + metro + 3/4 gen ceph** 8. + aspergillus, nocardia - **add vori, TMP/SMX or sulfadiazine** 9. + toxo, MTB - **add pyrimethamine/sulfadiazine; consider RIPE for TB**
36
Abx tx with * N meningitidis: * PCN MIC \<0.1 * PCN MIC 0.1-1 * H flu: * BLase negative * BLase positive
37
Abx for Strep pneumo w/ * PCN MIC * PCN MIC \>0.12 w/ CRO MIC \<1 vs CRO MIC \> 1
38
Empiric abx therapy * Immunocompromise: * Basilar skull fx: * Head trauma/neurosurgery: * CSF shunt or drain:
39
Empiric abx therapy for meningitis * \<1mo: * 1-23mo: * 2-50yo: * \>50yo:
40
meningitis w/ Vietnam, eating undercooked pig blood/intestine, pig exposure
Strep suis
41
meningitis w/ spinal anesthesia or myelogram
consider strep salivarius
42
meningitis w/ contiguous foci in head/neck
GNR, anaerobes
43
meningitis in pt with CSF shunts and drains
think staph epi or deiphtheroids (cutibacterium)
44
meningitis (MC in children) concurrent pharyngitis/OM (\>50% of cases) adults RF: sinusitis, OM, SCD, DM, head trauma w/ CSF leak, PNA, splenectomy, EtOH
H flu
45
epi RF for GNR meningitis
(kleb, E coli, serratia, PSAR, acinetobacter, salmonella) **\*infrequent cause of CA-meningitis - often a/w underlying comorbidities** * head trauma/neurosurgical pts * neonates, elderly * DM, liver dz * IC pts * pts w/ GNR BSI **(commonly a/w BSI!)** * \*\*\*strongy hyperinfection syndrome
46
epi RF for GBS meningitis
_**\*\*Neonates:**_ * Early-onset septicemia a/w prematurity/PROM/LBW * Late onset meningitis (\>7 days after birth) **_Adults_**: * DM, cardiac/renal/liver disease, collagen disease, HIV, malignancy, EtOH, steroids
47
children/young adults can be a/w outbreaks other RF: terminal **complement** deficiencies (C5-8), MSM with HIV, **eculizumab**
meningococcal meningitis
48
Risk groups for developing lymphocytic choriomeningitis virus
(rare) transmitted by rodents (no P2P) * lab workers * pet owners (hamsters, mice) * impoverished/unhygienic places * rodent breeding factory
49
few/at least 10 episodes of meningitis lasting 2-5 days followed by spontaneous recovery
Recurrent benign lymphocytic meningitis (Mollaret) MCC = HSV-2
50
meningitis in summer/fall w/: rhomboencephalitis
enterovirus 71
51
meningitis in summer/fall w/: pericarditis/pleuritis
coxsackievirus B
52
meningitis in summer/fall w/: Herpangina
coxsackievirus A
53
meningitis in summer/fall w/: scattered maculopapular rash
echovirus 9
54
leading cause of "aseptic" meningitis
**enteroviruses** (85-95% of cases w/ identified etiology) \*\*summer/fall seasonality outbreaks reported

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