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Neurology > Infection of the nervous system > Flashcards

Infection of the nervous system Flashcards

1
Q

What is encephalitis?

A

Encephalitis means acute inflammation of brain parenchyma, usually viral

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2
Q

What is the most common cause of encephalitis?

A

Viral

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3
Q

What are viral causes of encephalitis?

A
  • HSV 1 + 2
  • Arbovirus
  • CMV
  • EBV
  • VZV
  • HIV
  • Measles
  • Mumps
  • Rabies
  • West nile virus
  • Tick-borne encephalitis
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4
Q

What are non-viral causes of encephalitis?

A
  • Any bacterial meningitis
  • TB
  • Malaria
  • Listeria
  • Lyme disease
  • Legionella
  • Leptospirosis
  • Aspergillosis
  • Crytococcus
  • Schistosomiasis
  • Typhus
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5
Q

What would be your differential diagnosis for someone with features of encephalitis?

A

If no infectious prodrome, think encephalopathy

  • Hypoglycaemia
  • Hepatic encephalopathy
  • Diabetic ketoacidosis
  • Drugs
  • Hypoxic brain injury
  • Uraemia
  • SLE
  • Wernicke’s encephalopathy
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6
Q

What are autoimmune causes of encephalitis?

A

Limbic encephalites

  • Paraneoplastic limbic encephalitis
  • Voltage gated potassium channel limbic encephalitis
  • Anti-NMDA receptor antiobody panencephalitis
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7
Q

What are signs and symptoms of encephalitis?

A
  • Bizarre encephalopathic behaviour or confusion
  • Decreased GCS/Coma
  • Fever
  • Headache
  • Focal neurological signs
  • Seizures
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8
Q

When should you suspect encephalitis?

A

Whenever someone presents with odd behaviour, decreased consciousness focal neurology or seizure which was preceded by an infectious prodrome

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9
Q

What kind of infectious prodromes would you want to find out about in someone presenting with features of encephalitis?

A
  • Pyrexia
  • Rash
  • Lymphadenopathy
  • Cold sores
  • Conjunctivitis
  • Meningeal signs
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10
Q

What might cold sore indicate about the cause of a presentation of encephalitis?

A

Caused by Herpes Simplex virus

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11
Q

What might parotid gland swelling indicate as to the cause of encephalitis?

A

Caused by mumps

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12
Q

What might be the cause of someone presenting with features of encephalitis, hydrophobia, delusions, hallucinations and anxiety?

A

Rabies

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13
Q

What investigations would you consider doing in someone with features of encephalitis?

A
  • Bloods - Blood cultures, Viral PCR, Malaria film, Toxoplasma IgM titre, HIV test, Mantoux test
  • Contrast enhanced CT
  • LP
  • EEG
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14
Q

In someone with features of encephalitis, what would focal bilateral temproal lobe involvement on Contrast-enhanced CT indicate ?

A

HSV encephalitis

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15
Q

What would meningeal enhancement on contrast-enhanced CT suggest in someone with features of encephalitis?

A

Meningeal involvemnent

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16
Q

What should you do before doing an LP?

A

CT scan to rule out coning

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17
Q

What are features seen on LP in someone with encephalitis?

A
  • Increased CSF protein
  • Increased lymphocytes
  • Decreased glucose
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18
Q

What is important to remember when interpreting LP CSF results for someone with suspected encephalitis?

A

Normal CSF does not exclude ecnephalitis

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19
Q

How would you manage someone with encephalitis?

A
  • Start aciclovir within 30 mins arrival
  • Supportive therapy in HDU
  • Anticonvulsants for seizures
  • Dexamethaose - if raised ICP
20
Q

What is mortality rate in untreated encephalitis?

A

70%

21
Q

What is the mortality rate in treated encephalitis?

A

10-30%

22
Q

What are causes of a cerebral abscess?

A
  • Ear/Sinus/dental/peridontal infection
  • Skull fracture
  • Congenital heart disease
  • Endocarditis
  • Bronchiectasis
23
Q

What are the typical causative bacteria implicated in brain abscesses?

A
  • Staph. angiosus (sinus/teeth)
  • Bacteriodes (sinus/teeth)
  • Staphylococci (penetrating trauma)
24
Q

What are symptoms of a brain abscess?

A
  • Dull persistent headache
  • Symptoms of raised intracranial pressure (e.g., vomiting, papilledema, altered mental status)
  • Focal neurological deficits
  • Fever
  • Generalized or focal seizures
25
Q

What are signs seen in someone with a cerebral abscess?

A
  • Decreased GCS/Coma
  • Signs of sepsis elsewhere
  • Fever
  • Focal neruology
  • Signs of increased ICP
  • Meningism may be present
26
Q

What investigations might you consider doing in someone with a cerebral abscess?

A
  • CT/MRI
  • Bloods - FBC, ESR
  • Biopsy
27
Q

What might you see on FBC in someone with a cerebral abscess?

A

Increased WCC

28
Q

What might you see on investigation of ESR in someone with a cerebral abscess?

A

Raised ESR

29
Q

How would you manage someone with a cerebral abscess?

A

Urgent neurosurgical referral

  • Treat ICP
  • High dose ABx - 6-8 weeks
  • Surgical resection/decompression
30
Q

What dose of aciclovir would you start someone on if they presented with encephalitis?

A

IV acicolvir 10mg/kg 8 hrly for 14-21 days

31
Q

What antibiotics would you use to treat a cerebral abscess?

A
  • Penicillin/ceftraixone - cover streps
  • Metranidazole - anaerobes
32
Q

What is the morality rate in those with a cerebral abscess?

A

Treated - 25%

33
Q

What cerebral problems can occur in those with HIV infection?

A
  • Cerebral toxoplasmosis
  • Aseptic meningitis/encephalitis
  • Primary cerebral lymphoma
  • Cerebral abscess
  • Cryptococcal meningitis
  • SOL of unkown cause
  • Dementia
  • Leucoencephalopathy
34
Q

What infectious organisms can infect the CNS in those with chronic HIV infection?

A
  • Cryptococcus neoformans
  • Toxoplasma gondii
  • Cytomegalovirus
35
Q

What is acute disseminated encephalomyelitis?

A

A rare autoimmune disease marked by a sudden, widespread attack of inflammation in the brain and spinal cord that often follows many types of infection (measles, mycoplasma, mumps, rubella). As well as causing the brain and spinal cord to become inflamed, ADEM also attacks the nerves of the central nervous system and damages their myelin insulation, which, as a result, destroys the white matter.

36
Q

What are neurological manifestations of lyme disease?

A
  • Mononeuropathy
  • Mononeuritis multiplex
  • Painful radiculopathy
  • Cranial neuropathy
  • Myelitis
  • Meningoencephalitis
  • Encephalomyelitis
37
Q

What are the main forms of neurosyphillis?

A
  • Asymptomatic neurosyphillis
  • Meningovascular syphillis
  • Tabes dorsalis
  • General paralysis of the insane
38
Q

What is Meningovascular Neurosyphillis?

A

Syphillitic infection which causes:

  • Subacute meningitis with cranial nerve palsies and papilloedema
  • A gumma – a chronic expanding intracranial mass
  • Paraparesis – a spinal meningovasculitis.
39
Q

What is asymptomatic neurosyphillis?

A

Neurosyphillis with positive CSF but no neurological signs

40
Q

What is tabes dorslis?

A

Demyelination in dorsal roots causes a complex deafferentation syndrome. The elements of tabes:

  • Lightning pains
  • Ataxia, stamping gait, reflex/sensory loss, wasting
  • Neuropathic (Charcot) joints
  • Argyll Robertson pupils
  • Ptosis and optic atrophy
41
Q

What is general paralysis of the insane?

A

Dementia and weakness associated with neurosyphillis, in addition to:

  • Seizures
  • Brisk reflexes
  • Extensor plantar reflexes
  • Tremor
  • Argyll-Robertson pupils
42
Q

How would you manage someone with neurosyphillis?

A

Benzylpenicillin

43
Q

What are features of Sporadic/Variant CJD?

A
  • Rapidly progressive dementia with early behavioural abnormalities
  • Myoclonus
  • Cerebellar ataxia
  • Extrapyramidal and pyramidal signs
  • Cortical blindness
  • Seizures
44
Q

What is variant CJD linked to?

A

Bovine spungiform encephalopathy

45
Q

What is the following?

A

Cerebral abscess

Neurology (34 decks)

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