Infections of the Nervous System Flashcards

Question

what is the management of brain abscess?

Answer 1

Surgical drainage if possible Penicillin or ceftriaxone to cover streps Metronidazole for anaerobes High doses required for penetration Culture and sensitivity tests on aspirate provide useful guide

Answer 2

``` Cerebral toxoplasmosis Aseptic meningitis /encephalitis Primary cerebral lymphoma Cerebral abscess Cryptococcal meningitis Space occupying lesion of unknown cause Dementia Leucoencephalopathy ```

Answer 3

``` india Ink, cryptococcal antigen Toxoplasmosis serology (IgG) JC virus PCR CMV PCR HIV PCR ```

Answer 4

``` Lyme Disease (Borrelia burgorferi) Syphilis (Trepomena pallidum) Leptospirosis (Leptospira interrogans) ```

Answer 5

Early localized infection (1-30d) Characteristic expanding rash at the site of the tick bite: erythema migrans 50% flu like symptoms (days – 1 week) Fatigue, myalgia, arthralgia, headache, fever, chills, neck stiffness

Answer 6

Early disseminated infection (weeks – months after initial infection) Haematologic or lymphatic spread Musculoskeletal and neurologic involvement Neurologic involvement (10-15%) untreated patients PNS > CNS Mononeuropathy Mononeuritis multiplex Painful radiculoneuropathy Cranial neuropathy

Answer 7

Chronic infection (months to years after period of latency) Musculoskeletal and neurologic involvement most common Neurologic involvement: As described for stage 2 Subacute encephalopathy Encephalomyelitis Does NOT cause a chronic fatigue syndrome

Answer 8

``` Complex range of serological tests CSF lymphocytosis PCR of CSF MRI brain / spine (if CNS involvement) Nerve conduction studies / EMG (if PNS involvement) ```

Answer 9

Prolonged antibiotic treatment intravenous ceftriaxone oral doxycycline

Answer 10

``` has a similar 3 stage presentation Tertiary disease (neurosyphilis) years/decades after primary disease - not common ```

Answer 11

Treponema specific and non-treponemal specific (VDRL) antibody tests CSF lymphocytes increased, evidence of intrathecal antibody production, PCR

Answer 12

High dose penicillin

Answer 13

Caused by poliovirus types 1, 2 or 3 - all enteroviruses asymptomatic Paralytic disease in ~1% infects anterior horn cells of lower motor neurones Asymmetric, flaccid paralysis, esp legs No sensory features Polio Immunisation

Answer 14

Acute infectious disease of CNS affecting almost all mammals Transmitted to human by bite or salivary contamination of open lesion Neurotropic - virus enters peripheral nerves and migrates to CNS Paraesthesiae at site of original lesion Ascending paralysis and encephalitis

Answer 15

pre-exposure: Active immunisation with killed vaccine post-exposure: Give active rabies immunisation Give human rabies immunoglobulin (passive immunisation) if high risk

Answer 16

``` infection with Clostridium tetani anaerobic Gram positive bacillus, spore forming wound may not be apparent toxin acts at neuro-muscular junction blocks inhibition of motor neurones rigidity and spasm ```

Answer 17

immunisation (toxoid) given combined with other antigens (DTaP} penicillin and immunoglobulin for high risk wounds/patients

Answer 18

Clostridium botulinum Anaerobic spore producing gram positive bacillus Neurotoxin: Toxin binding blocks acetylcholine release Naturally present in soil, dust and aquatic environments

Answer 19

``` Incubation period 4-14 days Descending symmetrical flaccid paralysis Pure motor Respiratory failure Autonomic dysfunction Usually pupil dilation ```

Answer 20

Nerve conduction studies Mouse neutralisation bioassay for toxin in blood Culture from debrided wound

Answer 21

Anti-toxin (A,B,E) Penicillin / Metronidazole (prolonged treatment) Radical wound debridement

Answer 22

Preceding infection (viral, bacterial) or immunization “Molecular mimicry” Latent interval between the precipitating infection and onset of neurological symptoms Autoimmune

Answer 23

Transmissible Proteinaceous particle – Prion

Answer 24

``` Sporadic CJD New variant CJD Familial CJD (10-15%) Acquired CJD (<5%) ( eg blood transfusion) ```

Answer 25

``` Consider in any rapidly progressive dementia Insidious onset (usually older than 60) Early behavioural abnormalities Myoclonus Progressing to global neurological decline Motor abnormalities Cortical blindness Seizures may occur Death often within 6 months ```

Answer 26

Alzheimer’s disease with myoclonus - Usually more prolonged Subacute sclerosing panencephalitis (SSPE) - Very rare, chronic infection with defective measles virus CNS vasculitis Inflammatory encephalopathies

Answer 27

Younger onset <40 Linked to Bovine Spongiform Encephalopathy in Cattle Early behavioural changes more prominent Longer course (average 13 months)

Answer 28

``` MRI: Pulvinar sign in variant CJD Often no specific changes in sporadic CJD EEG: Generalised periodic complexes typical Often normal in initial stages CSF: Normal or raised protein Immunoassay 14-3-3 brain protein (non-specific, but very helpful in correct clinical context) ```

Infections of the Nervous System Flashcards

(52 cards)