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Neurology Clerkship > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Anatomic distribution of CNS infections?

A
  1. encephalitis
  2. meningitis
  3. myelitis
  4. plexitis/neuritis
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2
Q

Acute bacterial meningitis symptoms?

A
  1. 95% have at least 2 of:
    -fever
    -HA
    -stiff neck
    -altered mental status
    (only 44% have 3 of them)
  2. 20% coma
  3. 30% seizures
  4. Rash, otitis/sinusitis, cranial nerve palsies: increased ICP, infection, endarteritis of vasa nervorum.
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3
Q

What bug do you think of if acute bacterial meningitis is accompanied by a rash?

A

N. meningitis

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4
Q

LP findings in acute bacterial meningitis?

A
  1. Elevated opening pressure (>18cmH2O)
  2. Low Glucose (60%).
  3. CSF to serum glucose ration 220mg/dL
  4. Elevated Cell Count: >2000cells/uL
  5. PMNs >1180cells.uL or (>90% of total cell count).
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5
Q

Do Abx change LP results?

A

Not significantly

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6
Q

CSF studies?

A
  • culture/stain

- PCR: enterovirus, west nile, HSV1&2

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7
Q

Empiric treatment when suspect acute bacterial meningitis?

A

-Ampicillin
-Ceftriaxone
-Vanco-
-Acyclovir
Also: corticosterioids

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8
Q

Acute bacterial meningitis bugs and treatment in neonates?

A 
Bugs: 
1. Group B Strep
2. E.coli
3. Listeria
4. S. pneumoniae
Treatment: Ampicillin+Cefotaxime
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9
Q

Acute bacterial meningitis bugs and treatment in nosocomial infections?

A

Bugs:
1. Gram (-) Bacilli
2. Staph
Treatment: Vanco+Ceftazedime

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10
Q

Acute bacterial meningitis bugs and treatment if seizures?

A

Bug: HSV1
Treatment: Acyclovir

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11
Q

Acute bacterial meningitis due to S. Pneumoniae is associated with?

A
  1. Otitis media
  2. Skull fracture
  3. Alcohol
  4. Sickle Cell
  5. Pneumovax immunocompromised/asplenia
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12
Q

Acute bacterial meningitis due to N. meningitidis is associated with?

A
  1. Dorms
  2. Military
    - vaccinate students, military, complement deficient, asplenia ppl.
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13
Q

Acute bacterial meningitis due to L. monocytogens is associated with?

A
  1. Pregnancy

2. Transplant

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14
Q

Mortality of acute bacterial meningitis?

A

Kids: 9.4%
Adults: 20%

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15
Q

Viral meningoencephalitis symptoms?

A
  1. HA in both
  2. In encephalitis > meningitis:
    • Altered mental status,
    • Seizures, EEG abnormalities
    • CSF RBCs
    • focal signs
    • fever, malaise
  3. In meningitis> encephalitis
    • CSF pleocytosis (increased cell count)
    • Neck stiffness
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16
Q

Viral meningoencephalitis pathogens?

A
  1. Enterovirus: Echovirus, Coxsackievirus
  2. HSV1 - acute and severe encephalitis
  3. HSV2 - Mollaret Meningitis (benign recurrent lymphocytic meningitis)
  4. Arbovirus (West Nile)
  5. Rabies
  6. HIV
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17
Q

Viral meningoencephalitis pathogen most likely in summer?

A

Arbovirus - West Nile

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18
Q

Viral meningoencephalitis pathogens most likely in Fall?

A

Enterovirus:

  • echovirus
  • cocksavievirus
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19
Q

Viral meningoencephalitis pathogens most associated with animal exposure?

A

Rabies

Arbovirus - West Nile, St. Louis Encephalitis,….

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20
Q

Viral meningoencephalitis pathogens most associated with Aphasia or Temporal lobe seizures?

A

HSV1&raquo_space;> HSV2

21
Q

Viral meningoencephalitis pathogens most associated with LMN weakness?

A

Enterovirus

West Nile

22
Q

Viral meningoencephalitis pathogens most Temporal lobe hemmorhage?

A

HSV

23
Q

Viral meningoencephalitis pathogens most Basal Ganglia on imaging?

A

West Nile

24
Q

HSV1 encephalitis symptoms?

A 
10% of encephalitis in US
70% mort if untreated
97% permanent neurologic deficit
Symptoms: 
Seizures, Aphasia, Hemiparesis/Motor weakness
Audtory/Olfactory/Visual Hallucinations
25
Q

HSV1 encephalitis workup?

A
  1. EEG - temporal sharp waves
  2. MRI - normal early, then edema/hemorrhage into temporal/orbitofrontal lobes
  3. CSF/PCR: 5% false negative
26
Q

Treatment of HSV1 encephalitis?

A

High dose Acyclovir for 21 days

27
Q

HSV2 commonly causes meningitis. What are symptoms?

A

Parathesias
Urinary retention
Transverse Myelitis
Genital lesions predating the CNS symptoms by 1wk.

28
Q

HSV2 diagnosis? Treatment?

A

CSF-PCR: 95% sensitivity, 100% specificity.

Acyclovir shortens course.

29
Q

Benign Recurrent “Aseptic” Meningitis?

A

= Mollarett Meningitis

-Female, 3-9 attacks/yr, 23% history of genital herpes.

30
Q

Arboviruses?

A

Arthropod born:

  • West Nile
  • St. Louis Encephalitis
  • California Encephalitis
  • Eastern Equine Viruses.
31
Q

West Nile Virus anatomically? Risk Factors? CSF? Treatment? Symptoms?

A
  1. Acute Flaccid Paralysis: Poliomyelitis like, Asymmetric weakness
  2. Myelitis
  3. Meningoencephalitis: brainstem, movement disorder
    Risk Factors:
    >50yo, summer
    CSF- prolonged PMN predominance
    Treatment: supportive
    Symptoms: 80% assymp, 50% rash, 10% flu, 1% have CNS infection.
32
Q

Rabies Encephalitis

A

Hallucinations, agitation, paralysis, hypersalivation, hydrophobia.
Path: Negri Bodies: cytoplasmic eosinophilic inclusions.

33
Q

HIV Associated Dementia

A

Minimal imaging changes - hypodense T1 white matter changes.
Risks: Low CD4, high HIV RNA, anemia, HCV.
Responds to anti-retrovirals.
Can cause meningitis, rarely encephalitis.

34
Q

Lyme disease

A

Borrelia burgdorferi
Early: lyphocytic meningitis, erythema migrans, facial diplegia, painful radiculitis, optic nneuritis, mononeuritis multiplex, GBS.
Late: encephalomyelitis, - mimics MS, peripheral neuropathy, polyarthritis, cardiac conduction block Type III.
Dx: cerum and CSF Ab.

35
Q

Fungal meningitis CSF findings:

A

Low glucose

High Protein

36
Q

Found in soil and bird excrement and causes fungal meningitis with what symptoms:
CSF finding? Dx with? Tx with?

A 
Cryptococcys neoformans. 
Elevates ICP -> HA. 
CSF: mononuclear pleocytosis
Dx: India Ink
Tx: Amphotericin B
37
Q

Causes fungal meningitis and focal infections. CSF is significant for lymphocytic pleocytosis:
Dx?

A

Aspergillosis.

Dx: CSF-PCR

38
Q

Found in Mississippi and Ohio River Valleys, causes fungal meningitis:
CSF findings? Dx?

A

Histoplasmosis, Blastomycosis.
CSF: Histoplasmosis: mononuclear pleocytosis.
Blastomycosis: Early PMN–> lymphocytic
Dx: urine polysaccharide Ag

39
Q

Found in Southwest US, causes fungal meningitis:

CSF findings? Dx?

A

Coccidiomycosis.
CSF: Early - PMN –> lymphocitic.
Dx: compliment-fixation Ab testing.

40
Q

Mycobacteria TB:

A

1% with neuro dz.
Parameningeal infection. Hematogenous spread via lungs, tumbercle formation.
Pott Disease: TB osteomyelitis with paravertebral abscess.
TB meningitis: AFB smear of CSF - low sensitivity. CSF culture - takes weeks. Clinical Dx.

41
Q

Treponema pallidum

A 
Syphilis. spirochete. 
Primary - active
Secondary - rash
Latent
Tertiary - gummas, neuro, cardiac. years after primary and 1/3 cases without treatment get tertiary.

Nuero: meningitis, encephalitis, tabes dorsalis, Argyll Robertson pupil

42
Q

Organisms in abscess for immunocompetent ppl:

A

S. aureus

Enterobacteriaceae

43
Q

Organisms in abscess for immunocompromised ppl:

A

Listeria monocytogenes
Nocardia
Toxoplasma gondii

44
Q

Abcess on imaging? Tx?

A

Multiple ring enhanving lesions with surrounding edema.
Tx: Metronidazole and Penicillin
Cephalosporin
Surgery

45
Q

Most common cause of epilepsy world wide?

A

Neurocystercosis. Taenia solium. Ingested eggs excreted in animal feces, larvae travels to brain and muscles. From eating raw pork too.

46
Q

Most common neuroinfections in transplant patinents:

A
  1. Aspergillus - septate hyphae branched at 45 degress.
  2. CMV
  3. Cryptococcus
  4. Nocardia asteroides
  5. Toxoplasmosis
47
Q

Trearing neurocystercercosis

A

Calcified cysts are inactive - treat seizures with anticonvulsants.
Active infection: albedazle, praziquantel

48
Q

CNS Malaria?

A

Plasmodium falciparum.

Symptoms: HA, maylgia, seizures, later get cerebral edema –>stupor, coma. Mortality 20-50%

49
Q

3 prion diseases? Symptoms?

A
  1. Creutzfeldt-Jakob Disease
  2. Fatal Familial Insomnia
  3. Kuru
    Psychiatric, rapid onset dementia, ataxia, myoclonus, insomnia

Neurology Clerkship (21 decks)

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