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Neurology > 1(E): Encephalitis, Cerebral Abscess, Toxoplasmosis > Flashcards

1(E): Encephalitis, Cerebral Abscess, Toxoplasmosis Flashcards

1
Q

Define encephalitis

A

Inflammation brain parenchyma

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2
Q

What regions of the brain are more commonly affected by encephalitis

A
  • Inferior Frontal

- Medial Temporal

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3
Q

What is the age distribution of encephalitis

A

<20 years-old and >50 years-old

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4
Q

What are the two types of encpehalitis

A

Viral

Autoimmune

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5
Q

What causes 90% of viral encephalitis in adults

A

HSV1

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6
Q

What can cause viral encephalitis in neonates

A

HSV2

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7
Q

What can cause viral encephalitis in immunocompromised

A

CMV

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8
Q

What are the two types of autoimmune encephalitis

A

NMDA encephalitis

Pareneoplastic encephalitis

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9
Q

What are the symptoms of encephalitis

A
  • Strange behaviour: hyper-sexual, hypomanic
  • Psychiatric
  • Decrease GCS
  • Fever, Vomitting, Headache
  • Focal Neurological signs
  • Seizures
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10
Q

What bloods should be taken in suspected encephalitis

A

PCR
Blood Culture
Toxoplasmosis IgM

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11
Q

What imaging is taken for encephalitis

A

CT

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12
Q

What will be seen on CT imaging

A

Petechial haemorrhages in middle-temporal and inferior-frontal lobe

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13
Q

What will be seen on LP in encephalitis

A

Lymphocytosis

Raised Protein

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14
Q

What will be seen on EEG in encephalitis

A

periodic 2Hz discharges

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15
Q

What is used to manage encephalitis

A

acyclovir

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16
Q

How quickly should acyclovir be started for suspected encephalitis

A

30-minutes

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17
Q

What is a cerebral abscess

A

Suppurative collection of pus within brain parecchyma

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18
Q

What typically causes cerebral abscess

A

Secondary to infections:

  • Otogenic
  • Oral
  • Sinusitus
  • Meningeal
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19
Q

What are rare causes of cerebral abscess

A

Skull Fracture
Septic Foci
Neurosurgery

20
Q

What pathogen is most common cause of cerebral abscess

A

S. Viridian’s (50%)

Others:
- Staph. Aureus (15%)

21
Q

What does strep viridian’s cause prior to cerebral abscess

A

Sinusitis

22
Q

What can cause cerebral abscess if immunocompromised

A

Toxoplasmosis

23
Q

What is the triad of signs/symptoms in cerebral abscess

A
  • Raised WCC
  • Fever
  • Raised ICP
24
Q

What headache is present in cerebral abscess

A

Dull persistent headache

25
Q

What does rupture of cerebral abscess cause

A

If abscess ruptures, headache suddenly worsens and is associated with meningism

26
Q

What are symptoms of raised ICP

A
  • Vomitting
  • Papilloedema
  • Altered mental state
27
Q

What are focal neurological deficits associated with cerebral abscess

A

CN3 palsy
CN6 palsy

= occur due to raised ICP

28
Q

Apart from raised ICP, what other neurological feature may be present

A

Seizures

29
Q

What is a systemic feature of cerebral abscess

A

Fever

30
Q

Explain spread of pathogen in cerebral abscess

A

Pathogen can either spread via direct contamination (eg. skull fracture) or haematogenously

31
Q

What happens 3-5 after pathogen infiltration

A

Early cerebritis - infiltration of neutrophils and oedema

32
Q

What happens in late cerebritis (2-3W)

A

necrosis, liquefaction and macrophage infiltration. Then eventually a fibrotic capsule will form around the lesion

33
Q

What are 3 blood tests for cerebral abscess

A
  • FBC
  • Blood Culture
  • CRP
34
Q

What will be seen on CT or MRI in cerebral abscess

A

Ring-enhancing lesions in peripheries

35
Q

What is difference between cerebral abscess on CT/MRI and in toxoplasmosis gondii

A

Toxoplasmosis gondii = ring-enhancing lesions in basal ganglia. Cerebral abscess = ring-enhancing lesions in periphery

36
Q

How is cerebral abscess managed

A
  • Refer to neurosurgery for urgent drainage and biopsy
  • IV Antibiotics
  • Some recommend dexamethasone to reduce ICP (Controversial)
37
Q

What causes cerebral toxoplasmosis

A

Toxoplasmosis Gondii

38
Q

What is the most common neurological disorder associated with HIV

A

Cerebral toxoplasmosis

39
Q

What causes cerebral toxoplasmosis

A

Infection toxoplasmosis Gondii

40
Q

How is toxoplasmosis gondii usually transmitted

A

Cat faeces
Unpasteurised milk
Insufficiently cooked meat

41
Q

What does CD4 count have to be in HIV to enable cerebral toxoplasmosis

A

<100

42
Q

How does cerebral toxoplasmosis present clinically

A

Headache
Focal neurological deficit
Seizure
Change in mental status

43
Q

What is first-line investigation for toxoplasmosis gondii

A

Sabin-Feldman Dye Test

Looks for amount IgG toxoplasmosis gondii that can bind to methylene blue

44
Q

What other investigation is ordered in cerebral toxoplasmosis

A

CT/MRI

45
Q

What does CT/MRI in toxoplasmosis gondii show

A

Ring-enhancing lesions in basal ganglia

46
Q

Why type of organism is toxoplasmosis gondii

A

Protazoan

47
Q

How is cerebral toxoplasmosis managed

A

Pyrimidine and Sulphadiazine for 6-Weeks

Neurology (26 decks)

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