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Flashcards in CNS infections Deck (65)
1

What, technically, is meningitis?

Inflammation of the pia or arachnoid mater

2

What are the three major, noninfectious causes of meningitis?

Blood
Carcinoma
Sarcoid

3

What is encephalitis?

Inflammation of the brain parenchyma

4

What is meningoencephalitis?

Inflammation of meninges and the brain

5

What is myelitis?

Inflammation of the spinal cord

6

What is the classic triad for meningitis?

fever
HA
Stiff neck

7

Rash + meningitis = ?

Neisseria meningitidis

8

What is Kernig's sign?

Resistance to passive extension at the knee

9

What is Brudzinski's sign?

Spontaneous flexion of the knees and hips when the neck is passively flexed

10

What are the age ranges for Neisseria meningitidis caused meningitis?

Young adults

11

What are the age ranges for Strep pneumo caused meningitis?

Adults over 18

12

What are the four conditions where imaging should precede LP?

-New onset sz
-Immunocompromised state
-Focal findings
-Decreased LOC

13

Where is the needle inserted with an LP?

L3/L4 interspace

14

What is the normal value for opening pressure with an LP?

60-180

15

What is the normal value of glucose in CSF?

45-80

16

What is the normal protein in CSF?

15-45

17

What is the normal WBC count in CSF?

Less than 5

18

What is the definition of hypoglycorrhachia?

CSF [glucose] is less than 60% of blood

19

What happens to the following with bacterial meningitis:
-Opening pressure
-WBCs
-CSF:BG ratio
-Protein

-Opening pressure = more than 180
-WBCs More than 10 (PMNs)
-CSF:BG ratio Less than 0.31
-Protein More than 50

20

What is the treatment for strep pneumonia caused meningitis?

Third or fourth generation cephalosporin

21

Why are steroids used in the treatment of meningitis?

To relieve the side effects of the inflammation on the brain

22

What is the steroid of choice for meningitis?

Decadron

23

What is the most common cause of meningitis: bacterial, fungal, viral, or parasitic?

Viral

24

Unless (___) occurs, viral meningitis is usually self limited.

Meningoencephalitis

25

What are the CSF findings of aseptic meningitis?

Pleocytosis
Hypoglycrorrachia
Protein elevation

26

What are the usual viral causes of aseptic meningitis?

-Enterovirus
-arboviruses
-HIV
-HSV

27

What is the treatment for aseptic meningitis?

Supportive

28

How does meningitis lead to seizures in the long term?

Scarring in the brain leads to an epileptic focus

29

What are the two bugs that more commonly cause meningitis in immunosuppressed patients?

-Listeria
-Strep monocytogenes

30

Are PCRs done with aseptic meningitis? Why or why not?

No--does not change treatment plan

31

Treatment for viral meningitis is supportive except for infections with which virus?

HSV

32

What usually causes HSV encephalitis?

Reactivation from a trigeminal ganglion

33

What is the presentation of HSV encephalitis?

-Fever
-HA
-Changes in LOC
-Bizzare CNS s/sx

34

Why can there be RBCs in the CSF of pts with HSV encephalitis?

Hemorrhagic changes in the brain 2/2 infx

35

What are the CT/MRI findings of HSV encephalitis?

Focal area of high attenuation

36

What is the treatment for HSV encephalitis?

IV acyclovir

37

What are the CSF findings of HSV encephalitis?

5-500 WBCs
-Decreased glucose

38

How are the s/sx of HIV caused meningitis, as opposed to other viral causes of meningitis?

No real difference, but may progress to dementia

39

What are the two focuses of lyme disease?

-Minnesota/wisconsin
-Northeast

40

What is the classic neurological findings of lyme disease?

Bell's palsy

41

What is chronic lyme disease?

Nonspecific s/sx of unknown cause

42

What is the definition of acute meningitis?

Less than a 4 week duration

43

What are the protein findings of aseptic, septic, and chronic meningitis?

Aseptic = mild increase
Septic = High protein
Chronic = High protein

44

What are the WBCs that characterize chronic meningitis?

Moderate monocytic pleocytosis

45

What are the usual causes of chronic meningitis?

Fungal
TB
Sarcoidosis

46

How does the clinical presentation of chronic meningitis compare to acute?

Usually more subtle

47

How do you diagnose chronic meningitis?

MRI with contrast
CSF

48

Why is gadolinium used with MRIs in diagnosing meningitis?

Breakdown of the BBB leads to uptake of the Gd by the meninges

49

What causes TB meningitis?

Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space

50

True or false: TB encephalitis is usually caused by hematogenous spread of bacilli

False--Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space

51

What causes CN involvement with TB meningitis?

Thick, gelatinous exudate

52

What causes hydrocephalus with CNS TB?

Blockage of CSF flow from exudate

53

How does TB meningitis usually present, relative to usual meningitis?

Slower onset, with cranial neuropathies, and hemiparesis

54

What are the CSF findings of TB, in terms of:
-WBCs
-Protein
-Glucose

-Increase lymphocytes
-Normalish protein
-Decreased Glucose

55

What is the treatment for TB meningitis? Duration?

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

6-18 months

56

What is the major challenge in treating TB meningitis?

BBB

57

What is the prognosis of TB meningitis?

25%, with worse outcomes at age extremes

58

Who usually gets Progressive multifocal leukoencephalopathy?

Immunosuppressed patients

59

What is the infectious agent that causes PML?

JC papovavirus

60

What is the presentation of PML?

Insidious progression of dementia with focal findings

61

What are the MRI findings of PML?

Non-enhancing multifocal white matter lesions

62

What are the CSF findings of PML?

Protein elevation

63

What is the presentation of Prion diseases?

Progressive dementia

64

Who gets Kuru?

South sea islanders who participate in eating the dead

65

What, besides progressive dementia, does Creutzfeldt-Jakob disease present with?

-Hemianopsia
-Ataxia/focal weakness
-Myoclonus