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Brain and Behavior Exam 3 > Lec 64 Nervous System Infections > Flashcards

Lec 64 Nervous System Infections Flashcards

1
Q

What is meningitis?

A

inflammation of meninges

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2
Q

What is presentation of meningitis?

A
  • preceded by 3-5 days of headache, malaise, vomiting
  • stiff neck on flexion, headache, altered mental status
  • fever [differentiates from migraine]
  • may have seizures, papilledema
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3
Q

What are common causes of bacterial meningitis in neonate?

A

group B strep = most common
also:
- e coli
- listeria

NOT N. meningitidis

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4
Q

What are common causes of bacterial meningitis in children?

A

strep pneumoniae = most common

also:
- N meningitidis
- H influenzae type B

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5
Q

What are common causes of bacterial meningitis in adults?

A

N. meningitidis = most common
also:
- s. pneumoniae
- H influenzae type B

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6
Q

What are common causes of bacterial meningitis in elderly?

A
  • s. pneumoniae
  • L monocytogenes
  • gram neg rods
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7
Q

What type of meningitis with:

  • high opening pressure
  • low glucose
  • really high protein
  • lots of PMNs
A

bacterial meningitis

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8
Q

What type of meningitis with:

  • normal opening pressure
  • normal glucose
  • high protein
  • lots of lymphocytes
A

viral meningitis

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9
Q

What type of meningitis with:

  • high opening pressure
  • low glucose
  • high protein
  • lots of PMNs
A

fungal meningitis

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10
Q

What type of meningitis with:

  • high opening pressure
  • low glucose
  • really high protein
  • mixed PMNs and lymphocytes
A

TB

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11
Q

Is meningitis usually caused by bacteria or virus?

A

bacteria

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12
Q

Is encephalitis usually caused by bacteria or virus?

A

virus

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13
Q

What is myelitis?

A

inflammation of spinal cord

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14
Q

What is encephalitis?

A

inflammation of brain itself

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15
Q

What are signs of menningococcal meningitis?

A
  • petechial rash
  • stiff neck on flexion, fever
  • sepsis: hypotension, organ failure, DIC, purpura fulminans
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16
Q

What is a feared complication of menningococcal meningitis?

A

waterhouse-friderichsen syndrome = due to bleeding into adrenal gland
get adrenal failure, hypotension

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17
Q

What are causes of viral meningitis?

A

enteroviruses [cocksaskie] = children or adults

HSV/HIV/west nile

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18
Q

How do you prevent meningitis?

A

vaccinate against H influenzae, N meningitidis, S. pneumoniae

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19
Q

How do you treat bacterial meningitis?

A
  • initiate 3-4 gen cephalosporin and ampicillin for infants/elderly OR PCN
  • in meningococcal add rifampin
  • initiate corticosteroids
  • antibiotic must cross BBB
  • treat ICP
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20
Q

What are causes of non-infectious [aseptic] meningitis?

A 
inflammatory
malignancy
chemical
medication
migraine
21
Q

What is neuro TB? tow forms?

A
  • secondary to TB from other site in body

tuberculous meningitis: thick pale yellow exudate over base of brain obstructs CSF flow

tuberculoma: growth of tubercles, enlarge in CNS parenchyma

22
Q

What are symptoms of brain abscess

A

abscess = brain tumor

have –> brain tumor headache, focal neuro signs, obtundation, herniation

23
Q

What should you consider when sinusitis with fever, headache, focal seizures, localized tenderness

cause? treat?

A

subdural empyema = collection of pus in subdural space

cause: nearby infection after thrombosis of venous sinus, trauma

do MRI NOT LP, treat with surgical drainage + antibiotic

24
Q

What are signs of neurosyphilis?

A

cranial nerve lesions, subacute-chronic meningitis, neurovascular syphilis, gummas [soft non-cancerious growths], argyll-robinson pupils, dementia, tabes dorsalis, stroke

25
Q

What is sign of primary syphilis?

A

chancre

26
Q

What is sign of secondary syphilis?

A

rash on soles of feet and palms

27
Q

What are signs of tertiary syphilis?

A

neuro!

  • argyll-robinson pupil
  • dementia
  • tabes dorsalis
  • stroke
28
Q

What does positive CSF VDRL mean?

A

pt has neurosyphilis

29
Q

what does negative CSF VDRL mean?

A

does not rule out neurosyphilis

30
Q

What does negative CSF FTA [fluorescent treponemal antibody] mean?

A

rules out neurosyphilis

31
Q

What does positive CSF FTA [fluorescent treponemal antibody] mean?

A

does not make diagnosis of neurosyphilis

32
Q

What causes lyme disease?

A

borrelia burgdorferi tick in place > 24 hrs

33
Q

What are early, early disseminated, and late signs of lyme disease?

A

early: erythema migrans

early disseminated: headache, stiff neck, myalgias, arthralgias, myocarditis with conduction blocks

late persistent: cognitive, arthritis

34
Q

Who usually gets cryptococcal meningitis? signs?

A

usually AIDS T Cell < 200

budding yeast

high OP, low gluc, high protein

35
Q

Who gets invasive aspergillosis?

A

pt with impaired immunity

36
Q

What is mucormycosis? characteristics?

A

aggressive fungal infection
often w/ diabetics
spread along arteries beyond nasal sinuses into brain, involve orbit/eye/bone/brain
frontal lobe abscess

37
Q

What are chracteristics of candidiasis?

A

typically cause microabscesses more than meningitis

pseudohyphae

38
Q

What is creutzfeldt-jakob disease [CJD]?

A

prion disease
progressive, rapid, fatal
abnormal folded proteins [prions] fill brain

present: rapid dementia, myoclonus, ataxia

39
Q

What are characteristics of toxoplasmosis?

A

multiple ring enhancing lesions
most immunocompetent individuals are asymptomatic

if HIV: treat

40
Q

What is encephalitis?

A

viral infection of encephalon

41
Q

What are signs of encephalitis?

A

confusion, personality change, altered mental status, fever, seizures

more likely altered consciousness, less likely headache

42
Q

What are common causes of encephalitis?

A

acute: polio, rabies

subacute/chronic: HIV, JC virus, subacute sclerosing panencephalitis [measles]

seasonal: enterovirus [autum], herpes/arbovirus [summer]

43
Q

Match virus and disease:

HSV-1
HSV-2

meningitis
encephalitis

A

HSV-1 encephalitis

HSV-2 meningitis

44
Q

What are signs of herpes simplex encephalitis?

A

high mortality/morbidity

aphasia, impaired memory, other limbic symptoms

45
Q

What is treatment for herpes simplex encephalitis?

A

acyclovir

46
Q

How do you diagnose herpes simplex encephalitis?

A

PCR for HSV virus
RBCs in CSF
temporal-lobe spikes on EEG

47
Q

What happens in polio?

A

loss of motor neurons from anterior horns

48
Q

What happens in rabies?

A

negri bodies = neuronal intracytoplasmic inclusions

49
Q

What causes subactue sclerosing panencephalitis? signs?

A

defective measles virus
symptoms 6-10 yrs after primary infection

signs: rapid progressive dementia, ataxia, myoclonic jerks

Brain and Behavior Exam 3 (32 decks)

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