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Neurology Clerkship > CNS Infections > Flashcards

CNS Infections Flashcards

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1
Q

Anatomic distribution of CNS infections?

A
  1. encephalitis
  2. meningitis
  3. myelitis
  4. plexitis/neuritis
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2
Q

Acute bacterial meningitis symptoms?

A
  1. 95% have at least 2 of:
    -fever
    -HA
    -stiff neck
    -altered mental status
    (only 44% have 3 of them)
  2. 20% coma
  3. 30% seizures
  4. Rash, otitis/sinusitis, cranial nerve palsies: increased ICP, infection, endarteritis of vasa nervorum.
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3
Q

What bug do you think of if acute bacterial meningitis is accompanied by a rash?

A

N. meningitis

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4
Q

LP findings in acute bacterial meningitis?

A
  1. Elevated opening pressure (>18cmH2O)
  2. Low Glucose (60%).
  3. CSF to serum glucose ration 220mg/dL
  4. Elevated Cell Count: >2000cells/uL
  5. PMNs >1180cells.uL or (>90% of total cell count).
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5
Q

Do Abx change LP results?

A

Not significantly

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6
Q

CSF studies?

A
  • culture/stain

- PCR: enterovirus, west nile, HSV1&2

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7
Q

Empiric treatment when suspect acute bacterial meningitis?

A

-Ampicillin
-Ceftriaxone
-Vanco-
-Acyclovir
Also: corticosterioids

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8
Q

Acute bacterial meningitis bugs and treatment in neonates?

A 
Bugs: 
1. Group B Strep
2. E.coli
3. Listeria
4. S. pneumoniae
Treatment: Ampicillin+Cefotaxime
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9
Q

Acute bacterial meningitis bugs and treatment in nosocomial infections?

A

Bugs:
1. Gram (-) Bacilli
2. Staph
Treatment: Vanco+Ceftazedime

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10
Q

Acute bacterial meningitis bugs and treatment if seizures?

A

Bug: HSV1
Treatment: Acyclovir

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11
Q

Acute bacterial meningitis due to S. Pneumoniae is associated with?

A
  1. Otitis media
  2. Skull fracture
  3. Alcohol
  4. Sickle Cell
  5. Pneumovax immunocompromised/asplenia
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12
Q

Acute bacterial meningitis due to N. meningitidis is associated with?

A
  1. Dorms
  2. Military
    - vaccinate students, military, complement deficient, asplenia ppl.
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13
Q

Acute bacterial meningitis due to L. monocytogens is associated with?

A
  1. Pregnancy

2. Transplant

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14
Q

Mortality of acute bacterial meningitis?

A

Kids: 9.4%
Adults: 20%

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15
Q

Viral meningoencephalitis symptoms?

A
  1. HA in both
  2. In encephalitis > meningitis:
    • Altered mental status,
    • Seizures, EEG abnormalities
    • CSF RBCs
    • focal signs
    • fever, malaise
  3. In meningitis> encephalitis
    • CSF pleocytosis (increased cell count)
    • Neck stiffness
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16
Q

Viral meningoencephalitis pathogens?

A
  1. Enterovirus: Echovirus, Coxsackievirus
  2. HSV1 - acute and severe encephalitis
  3. HSV2 - Mollaret Meningitis (benign recurrent lymphocytic meningitis)
  4. Arbovirus (West Nile)
  5. Rabies
  6. HIV
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17
Q

Viral meningoencephalitis pathogen most likely in summer?

A

Arbovirus - West Nile

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18
Q

Viral meningoencephalitis pathogens most likely in Fall?

A

Enterovirus:

  • echovirus
  • cocksavievirus
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19
Q

Viral meningoencephalitis pathogens most associated with animal exposure?

A

Rabies

Arbovirus - West Nile, St. Louis Encephalitis,….

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20
Q

Viral meningoencephalitis pathogens most associated with Aphasia or Temporal lobe seizures?

Study These Flashcards
A

HSV1&raquo_space;> HSV2

21
Q

Viral meningoencephalitis pathogens most associated with LMN weakness?

Study These Flashcards
A

Enterovirus

West Nile

22
Q

Viral meningoencephalitis pathogens most Temporal lobe hemmorhage?

23
Q

Viral meningoencephalitis pathogens most Basal Ganglia on imaging?

24
Q

HSV1 encephalitis symptoms?

Study These Flashcards
A 
10% of encephalitis in US
70% mort if untreated
97% permanent neurologic deficit
Symptoms: 
Seizures, Aphasia, Hemiparesis/Motor weakness
Audtory/Olfactory/Visual Hallucinations
25
HSV1 encephalitis workup?
1. EEG - temporal sharp waves 2. MRI - normal early, then edema/hemorrhage into temporal/orbitofrontal lobes 3. CSF/PCR: 5% false negative
26
Treatment of HSV1 encephalitis?
High dose Acyclovir for 21 days
27
HSV2 commonly causes meningitis. What are symptoms?
Parathesias Urinary retention Transverse Myelitis Genital lesions predating the CNS symptoms by 1wk.
28
HSV2 diagnosis? Treatment?
CSF-PCR: 95% sensitivity, 100% specificity. | Acyclovir shortens course.
29
Benign Recurrent "Aseptic" Meningitis?
= Mollarett Meningitis | -Female, 3-9 attacks/yr, 23% history of genital herpes.
30
Arboviruses?
Arthropod born: - West Nile - St. Louis Encephalitis - California Encephalitis - Eastern Equine Viruses.
31
West Nile Virus anatomically? Risk Factors? CSF? Treatment? Symptoms?
1. Acute Flaccid Paralysis: Poliomyelitis like, Asymmetric weakness 2. Myelitis 3. Meningoencephalitis: brainstem, movement disorder Risk Factors: >50yo, summer CSF- prolonged PMN predominance Treatment: supportive Symptoms: 80% assymp, 50% rash, 10% flu, 1% have CNS infection.
32
Rabies Encephalitis
Hallucinations, agitation, paralysis, hypersalivation, hydrophobia. Path: Negri Bodies: cytoplasmic eosinophilic inclusions.
33
HIV Associated Dementia
Minimal imaging changes - hypodense T1 white matter changes. Risks: Low CD4, high HIV RNA, anemia, HCV. Responds to anti-retrovirals. Can cause meningitis, rarely encephalitis.
34
Lyme disease
Borrelia burgdorferi Early: lyphocytic meningitis, erythema migrans, facial diplegia, painful radiculitis, optic nneuritis, mononeuritis multiplex, GBS. Late: encephalomyelitis, - mimics MS, peripheral neuropathy, polyarthritis, cardiac conduction block Type III. Dx: cerum and CSF Ab.
35
Fungal meningitis CSF findings:
Low glucose | High Protein
36
Found in soil and bird excrement and causes fungal meningitis with what symptoms: CSF finding? Dx with? Tx with?
``` Cryptococcys neoformans. Elevates ICP -> HA. CSF: mononuclear pleocytosis Dx: India Ink Tx: Amphotericin B ```
37
Causes fungal meningitis and focal infections. CSF is significant for lymphocytic pleocytosis: Dx?
Aspergillosis. | Dx: CSF-PCR
38
Found in Mississippi and Ohio River Valleys, causes fungal meningitis: CSF findings? Dx?
Histoplasmosis, Blastomycosis. CSF: Histoplasmosis: mononuclear pleocytosis. Blastomycosis: Early PMN--> lymphocytic Dx: urine polysaccharide Ag
39
Found in Southwest US, causes fungal meningitis: | CSF findings? Dx?
Coccidiomycosis. CSF: Early - PMN --> lymphocitic. Dx: compliment-fixation Ab testing.
40
Mycobacteria TB:
1% with neuro dz. Parameningeal infection. Hematogenous spread via lungs, tumbercle formation. Pott Disease: TB osteomyelitis with paravertebral abscess. TB meningitis: AFB smear of CSF - low sensitivity. CSF culture - takes weeks. Clinical Dx.
41
Treponema pallidum
``` Syphilis. spirochete. Primary - active Secondary - rash Latent Tertiary - gummas, neuro, cardiac. years after primary and 1/3 cases without treatment get tertiary. ``` Nuero: meningitis, encephalitis, tabes dorsalis, Argyll Robertson pupil
42
Organisms in abscess for immunocompetent ppl:
S. aureus | Enterobacteriaceae
43
Organisms in abscess for immunocompromised ppl:
Listeria monocytogenes Nocardia Toxoplasma gondii
44
Abcess on imaging? Tx?
Multiple ring enhanving lesions with surrounding edema. Tx: Metronidazole and Penicillin Cephalosporin Surgery
45
Most common cause of epilepsy world wide?
Neurocystercosis. Taenia solium. Ingested eggs excreted in animal feces, larvae travels to brain and muscles. From eating raw pork too.
46
Most common neuroinfections in transplant patinents:
1. Aspergillus - septate hyphae branched at 45 degress. 2. CMV 3. Cryptococcus 4. Nocardia asteroides 5. Toxoplasmosis
47
Trearing neurocystercercosis
Calcified cysts are inactive - treat seizures with anticonvulsants. Active infection: albedazle, praziquantel
48
CNS Malaria?
Plasmodium falciparum. | Symptoms: HA, maylgia, seizures, later get cerebral edema -->stupor, coma. Mortality 20-50%
49
3 prion diseases? Symptoms?
1. Creutzfeldt-Jakob Disease 2. Fatal Familial Insomnia 3. Kuru Psychiatric, rapid onset dementia, ataxia, myoclonus, insomnia

Neurology Clerkship (21 decks)

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