NeuroID

Question 1

Treatment for solitary CNS abscess

Answer 1

Surgical drainage + systemic Abx

Question 2

Treatment for multiple CNS abscesses

Answer 2

Long term systemic Abx

If no biopsy, empiric tx = penicillin or 3rd gen ceph + metronidazole

If biopsy = depends on bug

Question 3

Manifestations of neurosyphilis

Answer 3

1. Aseptic meningitis 1-2 years after initial syphilis infxn
2. Meningovascular syphilis 5-7 years after primary, characterized by diffuse meningeal infiltrates, inflammation and fibrosis of arteries –> brain and spinal cord lesions
3. General paresis, 10-30 years after primary, p/w diffuse cortical dysfunction –> dementia, UMN signs, myoclonus, seizures, dysarthria, pupillary abnormalities
4. Tabes dorsalis = posterior nerve root involvement –> loss of proprioception, ataxia, lightning-like pains, and urinary incontinence

Question 4

Diagnosis of neurosyphilis

Answer 4

Serologic studies (PCR or antibodies) and spinal fluid analysis. Check serum FTA or MHA-TP (negative –> excludes possibility of neurosyphilis), if positive –> LP –> if abnormal –> 10-14 days IV penicillin

Question 5

Most common neurologic manifestation of Lyme disease

Answer 5

Subacute or chronic meningitis beginning weeks to months after tick bite. Symptoms = stiff neck, mood changes, difficulty concentrating. Can have associated CN palsies and peripheral neuropathy

Question 6

Diagnosis of Lyme disease

Answer 6

ELISA indicates h/o exposure but not active infection

If ELISA positive –> western blot