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Infections & HIV Flashcards

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1
Q

Meningitis is usually caused by

A

Spread of an infectious agent via bloodstream from an infective focus elsewhere in the body

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2
Q

Clinical manifestations of meningitis

A

Rapid onset over several days; generalized HA, fever, vomiting, lethargy, stiff neck, confusion

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3
Q

Neurologic complications of meningitis

A

Seizures, focal cerebral signs, acute cerebral edema, CN dysfx (3, 4, 6, 7), hearing loss, HP, dysphagia, hemianopsia

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4
Q

Brain abscess can be caused by

A

Infection spread from middle ear or sinus
In assoc. w/ congenital heart disease
Spread of infection from distant site
Direct intro of bacteria following PHI

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5
Q

Cardinal symptom of brain abscess

A

Relentless & progressive HA, usually followed by focal neurological signs

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6
Q

Pott’s disease

A

TB in spinal column

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7
Q

Early symptoms of neurosyphilis

A

Fatigue, irritability, personality changes, forgetfulness, tremor

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8
Q

Symptoms of late stage neurosyphilis

A

Impaired memory & judgment, confusion, disorientation, seizures, dysarthria, myoclonus, poor motor control

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9
Q

General paresis

A

Accumulation of neurosyphilis lesions causes dementia, behavioral changes, delusions of grandeur, psychosis, & diffuse UMN-type weakness

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10
Q

Tabes dorsalis

A

In neurosyphilis, there is involvement of the spinal cord dorsal roots resulting in degeneration of dorsal columns

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11
Q

Lyme disease

A

Neuro manifestations after a delay of several weeks; untreated cases eventually show WM abnormalities; may involve memory impairment & difficulty with complex cognitive fx, irritability, depressed mood

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12
Q

Tetanus

A

Affects the motor unit of the PNS

Tonic contractions eventually appear secondary to continuous activity of multiple muscle groups

Also see nuchal rigidity, lockjaw, risus sardonicus, dysphagia

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13
Q

Herpes simplex affects which area of the brain most?

A

Limbic cortex/temporal lobe

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14
Q

Presentation of CNS involvement of herpes simplex

A

Bizarre psychotic behavior, confusion, lethargy, HA, fever, meningeal signs, seizures, focal signs

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15
Q

Subacute sclerosing panencephalitis is caused by

A

persistent infection of genetically mutated forms of the measles virus that escape immune clearance; latent period of 6-8 yrs

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16
Q

Initial symptoms of subacute sclerosing panencephalitis

A

mild mental deterioration followed by myoclonic jerks, seizures, vision loss

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17
Q

Advanced state of subacute sclerosing panencephalitis

A

muscle spasms/rigidity, progressive deterioration to comatose & then persistent vegetative state

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18
Q

Progressive multifocal leukoencephalopathy

A

Demyelination of CNS due to destruction of oligodendrocytes by the JC polyoma virus (JCV)

Mostly seen in immunocompromised individuals

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19
Q

How does toxoplasmosis present on neuroimaging?

A

Ring-enhancing lesions

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20
Q

Common presenting features of toxoplasmosis

A

seizures, HA, fever, lymphocytic predominant meningitis, focal signs; general subacute encephalopathy & language impairment

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21
Q

Varicella-zoster

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A

Herpes virus that causes chickenpox, becomes latent in CN & dorsal-root ganglia, & frequently reactivates decades later to produce shingles & postherpetic neuralgia

22
Q

Varicella-zoster affects which cranial nerves?

23
Q

Neurological complications of rabies

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A

Delirium, seizures, nuchal rigidity, paralysis, excitabilty

24
Q

Cysticercosis

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A

Caused by ingestion of eggs of pork tapeworm, forms multiple cysts in muscles, eyes, & CNS

Seizures, HA, nausea, vomiting, lymphocytic meningitis, focal deficits

25
Kuru
Chronic, rapidly progressing, fatal nervous system disease caused by prions & characterized by prominent ataxia, dysarthria, tremulousness, dementia in late stages Shows severe cerebellar loss, spongiform changes, & prion-amyloid plaques
26
Guillain-Barre syndrome
Post-infectious disease of peripheral myelin assoc. w/ paresthesias in the distal extremities & leg weakness
27
How does sarcoidosis affect the CNS?
takes form of a granulomatous infiltration of the meninges & underlying parenchyma, most frequent at base of brain Lesions - focal collections of epithelioid cells surrounded by rim of lymphocytes
28
Retrovirus
Stores genetic info as RNA, releases RNA & an enzyme, making DNA using the viral RNA as a pattern; viral DNA is incorporated into host cell DNA
29
CDC classification of HIV/AIDS
Category A: pts who have remained medically asymptomatic or have had only a transient illness Category B: pts w/ more serious HIV-related conditions Category C: pts who have more serious AIDS-defining illnesses AIDS is diagnosed in those w/ CD4<200 and/or a category C complication
30
What is the most common cause of CNS mass lesions in AIDS patients?
Toxoplasmosis
31
Common opportunistic infections in HIV/AIDS patients
Yeast infections, crytococcal meningitis, mycobacterium avium complex, cryptosporidium, PML, cytomegalovirus encephalitis, Kaposi's sarcoma, lymphomas, toxoplasmosis
32
What percentage of AIDS patients may develop some form of CNS disease?
50-66%
33
HIV-related mild neurocognitive disorder/minor cognitive motor disorder
- Difficulty in concentrating, unusual fatigability, subjectively slowed down, mild memory - May be seen as anxiety, depression, or hypochondriasis - Difficulties w/ info processing speed, divided attention, sustained effortful processing, deficiencies in learning & recalling new info - Verbal skills less affected
34
Diagnostic criteria for HIV-Associated dementia (HAD)
- Acquired impairment in 2 domains of cognitive fx, w/ focus in learning, slowed info processing, distractibility/inattention - Verified by neurological, NP, or clinical eval - Marked interference w/ daily fx - Present for 1 mo or more - No alteration in consciousness - Ruling out other causative etiology
35
AIDS dementia complex staging scheme (Sidtis & Price)
- Stage 0 (normal) - Stage 0.5 (equivocal/subclinical): no impairment of work or ADL performance - Stage 1 (mild): able to perform all but more demanding asepcts of work or ADLs, can walk w/o assistance - Stage 2 (moderate): cannot work or maintain more demanding aspects of daily life, can perform basic self-care - Stage 3 (severe): major intellectual incapacity or motor disability - Stage 4 (end stage): nearly vegetative
36
What are some psychosocial factors that should be considered with HIV/AIDS patients?
Stigmatism, may affect immediate social support, adjustment d/o, anxiety d/o, mood disorders, psychosis, substance use disorders (may/may not be pre-existing)
37
Asceptic meningitis
Nonbacterial meningitis, can be inflammatory, idiopathic, or viral infection
38
Cryptococcal meningitis
Meningitis caused by cryptococcus (yeast) infection; often result of opportunistic infection Often presents with headache, CN involvement, & CSF obstruction
39
Mollaret meningitis
Recurrent asceptic meningitis of unclear origin
40
Mental status changes are more often associated with bacterial or viral meningitis?
Bacterial
41
Meningismus
Meningeal irritation often caused by meningitis or SAH, carcinomatous meningitis, or chemical sensitivity
42
6 common signs of meningismus
HA, lethargy, photo & phonophobia, fever, nuchal rigidity
43
Common symptoms of brain abscess
HA, lethargy, fever, nuchal rigidity, nausea, vomiting, seizures, focal signs
44
Where do epidural abcesses most often occur?
Spinal canal
45
Neurological symptoms of Lyme disease
Often delayed by weeks; meningeal signs, emotional changes, impaired memory & cognition
46
What is the most common cause of viral encephalitis?
HIV-1
47
Cerebritis
Focal bacterial invasion of the brain parenchyma with no associated capsule or pus
48
Granuloma
Focal, more or less encapsulated, chronic inflammatory lesion (e.g., sarcoidosis, syphilis, TB, fungi, larvae of intestinal parasites)
49
Progressive multifocal leukoencephalopathy
Demyelinating viral infection of the brain
50
Kaposi's sarcoma
Tumor that appears as painless, red to purple, raised patches on skin
51
Lymphomas
Tumors of the immune system which may 1st appear in brain or other internal organs; pts typically present with slowly progressive neuro deterioration & may die within 3 months
52
The most common neurologic manifestation of HIV is
Emotional lability & delirium associated with HIV-associated dementia

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