CNS Infections

Question 1

Focal, intracerebral infection that begins as a localized area of cerebritis and develops into collection of pus surrounded by a well vascularized capsule

Answer 1

Brain Abscess

Question 2

One of most serious complications of head and neck infections

Answer 2

Brain Abscess

Question 3

What is the most common location for sinusitis?

Answer 3

Frontla lobe

Question 4

We also see sphenoid sinusitis in the

Answer 4

Temporal lobe or sella turcica

Question 5

Otitis media infections can spread to the

Answer 5

Temporal lobe or cerebellum

Question 6

Dental infections can spread to the

Answer 6

Frontal lobe

Question 7

60-70% of brain abscesses are caused by

Answer 7

Streptococci

Question 8

Make up around 20-40% of brain abscess infections?

Answer 8

Anaerobes

Question 9

Enteric gram negatives account for

Answer 9

23-33% of brain abscesses

Question 10

Clinical manifestations usually depend on size and location of space occupying lesion and virulence of organism

Answer 10

Brain abscesses

Question 11

Brain abscesses can be classified as either

Answer 11

Indolent or Fulminant

Question 12

The most common presenting symptom of a brian abscess is

Answer 12

Headache

Question 13

Uncommon in cases of brain abscess

Answer 13

Nuchal Rigidity

Question 14

The diagnostic procedure of choice for detecting a brain abscess is

Answer 14

MRI

Question 15

Brain abscess shows as a hypodense center with peripheral ring enhancement after contrast, can be surrounded by edema (hypodense) in a

Answer 15

CT with contrast

Question 16

Contraindicated in patients with a brain abscess

-Risk of Herniation

Answer 16

Lumbar Puncture

Question 17

To manage a brain abscess, we need antibiotics with good

Answer 17

CNS penetration

Question 18

The most common protozoal cause of brain abscess

Answer 18

Toxoplasma Gondii

Question 19

Transmission mainly by ingestion of tissue cysts in contaminated meat or food or oocysts in food/water contaminated from cat feces

Answer 19

Toxoplasma gondii

Question 20

Transmission mainly by ingestion of tissue cysts in contaminated meat or food or oocysts in food/water contaminated from cat feces

Answer 20

Toxoplasmosis

Question 21

Toxoplasmosis has a prediliction for the

Answer 21

Basal ganglia or brainstem

Question 22

Shows rounded isodense or hypodense lesions with ring enhancment-usually multiple lesions

Answer 22

Toxoplasmosis

Question 23

Collection of pus between dura and arachanoid

Answer 23

Subdural Empyema

Question 24

Localized collection of pus between dura and overlying skull or vertebral column

Answer 24

Epidural Abscess

Question 25

Most common predisposing condition is ear and sinus infections for a

Answer 25

Cranial Subdural Empyema

Question 26

Signs and symptoms secondary to increased intracranial pressure, meningeal irritation, or focal cortical inflammation

Answer 26

Cranial Subdural Empyema

Question 27

The predominant complaint in a patient with a cranial subdural empyema is a

Answer 27

Headache

Question 28

Presents with focal neurologic signs (hemiparesis, hemiplegia, ocular palsies, dilated pupils, homonoymous hemaniopsia, cerebellar signs

Answer 28

Cranial Subdural Empyema

Question 29

Rare condition usually occurs secondary to metastatic infection from another site

Answer 29

Spinal Subdural Empyema

Question 30

Spinal Subdural Empyema is most frequently caused by

Answer 30

Staph areus

Question 31

Clinical presentation: radicular pain and symptoms of cord compression (can occur at multiple levels)

Answer 31

Spinal Subdural Empyema

Question 32

Can be difficult to distinguish from epidural abscess and can occur simultaneously

Answer 32

Spinal Subdural Empyema

Question 33

Signs and symptoms include headache, fever, seizures, focal neurologic signs, altered mental status but may be overshadowed by symptoms/signs from primary source of infection -More indolent course

Answer 33

Cranial Epidural Abscess

Question 34

Initial focus usually sinuses, ear, mastoid infections but can occur after trauma or surgical procedures

Answer 34

Cranial Epidural Abscess

Question 35

Fever and headache are most common complaint with a cranial epidural abscess and patient may feel well until it progresses to

Answer 35

Subdural empyema, meningitis, or brain abscess

Question 36

Unlike a subdural abscess, can cross the midline

Answer 36

Epidural abscess

Question 37

Usually occurs secondary to hematogenous spread -Blood cultures frequently positive-bacteremia

Answer 37

Spinal epidural abscess

Question 38

1/3 of spinal epidural abscess cases show

Answer 38

Contiguous foci

Question 39

Spinal epidural abscesses often occur with

Answer 39

Vertebral osteomyelitis

Question 40

Present in up to 50% of cases of spinal epidural abscess

Answer 40

Diabetes

Question 41

May develop within hours to days (after hematogenous seeding) or may be more chronic (weeks to months, usually with vertebral osteo or contigous focus), TB also more gradual

Answer 41

Spinal Epidural Abscess

Question 42

Pain is the most consistent symptom of a spinal epidural abscess, but there is a fever in

Answer 42

60-70% of patients

Question 43

With a spinal epidural abscess, empiric antibiotics should be given which include coverage for

Answer 43

S. aureus and gram negative bacilli

Question 44

Inflammatory process involving brain parenchyma with clinical or laboratory evidence of neurologic dysfunction

Answer 44

Encephalitis

Question 45

Differs from meningitis because of the region of inflammation and altered mental status (hallmark)

Answer 45

Encephalitis

Question 46

The hallmark of encephalitis is

Answer 46

Altered mental status

Question 47

In a CSF exam, the cell count is less than 500 in

Answer 47

90% of cases of encephalitis

Question 48

Usually lymphocytic predominance but can see more polys in Eastern equine or enterovirus or WNV

Answer 48

Encephalitis

Question 49

Consider an alternate diagnosis other than encephalitis if

Answer 49

Glucose is low

Question 50

Usually not useful for diagnosing encephalitis

Answer 50

Viral Culture

Question 51

Frequently abnormal in encephalitis patients, but does not not usually pinpoint cause of encephalitis

Answer 51

EEG

Question 52

Among most severe of all human viral infections of brain - >70% mortality with no or ineffective therapy

Answer 52

Herpes Simplex Encephalitis

Question 53

Clinical features: Fever, personality change, dysphasia, autonomic dysfunction -accounts for 10-20% of encephalitis viral infections

Answer 53

Herpes SImplex Encephalitis (HSE)

Question 54

Shows CSF findings of lymphocytic meningitis, presence of RBCs, and elevated protein

Answer 54

HS-Encephalitis

Question 55

In greater than 90% of HSE cases, MRI shows

Answer 55

Temporal lobe abnormalities

Question 56

Shows periodic lateralizing epileptiform discharges (PLEDs) on electroencephalography

Answer 56

HSE

Question 57

Treatment for HSE is high dose of

Answer 57

Acyclovir

Question 58

Birds are the main reservoirs and has the mosquito vector culex pipens

Answer 58

West Nile Virus

Question 59

80% of patients show no clinical illness or symptoms with

Answer 59

West nile virus

Question 60

To diagnose with west nile virus, we can test

Answer 60

Serum IgM antibody (8-14 days after illness onset)

Question 61

CSF reveals lymphocytic pleocytosis and elevated protein; glucose is normal with

Answer 61

West Nile Virus

Question 62

Positive in greater than 90% of paitents with west nile virus

Answer 62

CSF IgM

Question 63

Transmitted by bite of infected animal -dogs are principal vector

Answer 63

Rabies

Question 64

80% of rabies cases are an

Answer 64

Encephalitic (furious) form

Question 65

Immunofluorescent detection of viral antigens and RT-PCR in nuchal biopsy is diagnostic for

Answer 65

Rabies