All of the following are diffuse CNS infections, EXCEPT:
a. meningitis
b. encephalitis
c. brain abscess
d. meningoencephalitis
c. brain abscess - focal infection
- meningitis - involves meninges and CSF
- encephalitis - involves brain matter and parenchyma
- meningoencephalitis - both CSF and brain involved (ex. Tuberculous CNS infection)
- Examples of focal are: abscesses, subdural empyema & herpes simplex encephalitis (can be both focal and diffuse)
TB meningitis preferentially affects the
a. CSF
b. Dura
c. Meninges
d. Basal Brain
d. Basal Brain
The most common site of infection in the meninges.
subarachnoid space
Arrange the following layers from top to bottom: arachnoid mater dura mater pia mater subarachnoid space
“Doreen Apor Sucks Penis”
Dura mater - Arachnoid mater - Subarachnoid Space - Pia mater
Usually the route of entry of bacteria/viruses into the CNS.
Hematogenous (bloodstream)
The virulence factor that helps most bacteria to invade the CNS.
Bacterial capsule
H. influenzae, N. meningitides, S. pneumoniae, E. coli
The most common cause of encephalitis
Infection by ENTEROVIRUSES
Rising rates of HIV infection was correlated with rising incidence of infection by:
a. Cryptococcus
b. Streptococcus
c. Staphylococcus
d. Ihavabigcoccus
a. Cryptococcus
* According to a 2015 research
The three primary cardinal manifestations of CNS infection.
HAF
Headache, Alteration of Sensorium, Fever
A CNS infection from eating raw/uncooked meat
Cysticercosis
Syndrome characterized by ascending paralysis. First there is weakness in the feet and then the hands, then the cranial
nerves. The ascending paralysis happens after the patient has recovered from an infection.
Guillain-Barre Syndrome
Infectious organisms that aren’t composed of DNA but protein. They are transmitted through infected, altered protein material.
prions
Post-infection immune reaction to measles or mumps which occurred months or years earlier.
Subacute Sclerosing Panencephalitis (SSPE)
A condition that usually occurs in cannibals that develop a degenerative disease after eating infected brain matter.
kuru
The most common etiologic agent for CNS infections in patients aged >60 years old.
a. S. pneumoniae
b. N. meningitides
c. Grp B Strep
d. S. aureus
a. S. pneumonia
1-23 mos -> S. pneumoniae
2-18 y/o -> N. menigitides
19-59 y/o -> S. pneumonia
>60 y/o -> S. pneumonia > Listeria monocytogenes
Most common fungal infection of the CNS.
a. Mucormycosis
b. Cryptococcosis
c. Histoplasmosis
d. Candidiasis
b. Cyptococcosis
TRUE or FALSE: An infected dura mater becomes opaque, with clearing of the meninges.
FALSE. An infected dura mater is opaque, with DIFFUSE CLOUDING of the meninges.
TRUE or FALSE: Infiltration by lymphocytes indicate an acute CNS infection.
FALSE. Infiltration of PMNs during acute and lymphocytes during chronic infection.
A patient presents with severe rashes and petechiae with cigarette-like burns. These signs are pathognomonic of?
meningococcemia
Prophylaxis for meninggococcemia:
Rifampicin, Ceftriaxone, Tetracyclines
Why does TB meningitis usually affect the base of the brain?
TB is an aerobic bacterium, so it will stay at a location with the highest oxygen saturation, which is at the base of the brain, where all the blood vessels are.
The gold-standard for diagnosis of cryptococcal meningitis:
India ink stain
TRUE or FALSE: A negative result after imaging studies does not rule out the presence of a brain abscess.
TRUE.
At the first 1-3 days of brain abscess formation, early cerebritis (gray matter inflammation) does not show up on imaging studies. Lesions show up on the 7th day.
Early capsule formation of a brain abscess occurs at:
10-13 days
The Gold Standard in the diagnosis of CNS infections.
CSF Analysis
Quantitative parameters of CSF Analysis include the following, EXCEPT:
a. WBC
b. RBC
c. Sugar
d. Turbidity
d. Turbidity
TRUE or FALSE: Do a lumbar puncture for CSF analysis in a patient with focal/lateralizing signs.
FALSE. This may lead to herniation due to pressure difference between the subarachnoid space and the atmosphere.
Recommended drug for treatment of fungal meningitis.
Amphotericin B
Shot gun therapy for highly toxic patients include all of the following, EXCEPT:
a. Cephalosporins (3rd gen)
b. anti-Koch’s
c. antivirals
d. Human diploid cell line vaccine for rabies.
d. Human diploid cell line vaccine for rabies
The adjuvant therapy used for Cryptococcus infection in addition to amphotericin B.
flucytosine
