10 06 2014 CNS Infections- encephalitis

Question 1

What bacteria can cause brain abscess?

Answer 1

1. Streptococci
2. Bacteroides (gut flora)
3. Enterobacteriaceae
4. S. aureus
5. Streptococcus pneumonia or H influenza ( more for meningitis)

Question 2

Clinical manifestations of brain abscess

Answer 2

1. may have a fever
2. headache
3. focal neurologic a finds/ seizures (stroke-like)
4. nausea, vomiting ( increased cranial pressure)

Question 3

Diagnostic test for brain abscess

Answer 3

1. MRI
2. CT Scan
3. Blood cultures
4. Biopsy (brain)

DO NOT USE LUMBAR PUNCTURE = cause herniation because if you decrease volume in ventricles it gives the abscess room to spread = midline shift / herniation

Question 4

Treatment of brain abscess

Answer 4

1. medically (antibiotic - cross BBB) or combined with surgical drainage

Question 5

Types of brain abscess

Answer 5

1. cranial epidural
2. cranial subdural
3. paraspinal abscess
4. spinal epidural
5. spina subdural

Question 6

Cranial Epidural abscess

Answer 6

related to frontal sinus disease AND osteomyelitis

Question 7

Cranial Subdural abscess

Answer 7

Neurologic emergency
Usually see bacteremia
- Headache and seizure are common

Question 8

Paraspinal Abscess

Answer 8

Most common seen in clinic
May be epi or subdural
- STAPH AUREUS is the most common infection

Clinically patient presents with fever and back pain

Question 9

Spinal subdural abscess

Answer 9

Clinically presents with radical pain, urinary retention, constipation, leg weakness, hyperreflexia

MRI with gadolinium or CT with myelogram

Treat with steroids, antibiotics, and surgical decompression ( can cause permanent paralysis if spinal cord is compressed)

Question 10

Spinal epidural abscess

Answer 10

Thoracic > lumbar > cervical – due to fat (infection prone)

Posterior-lateral to spinal cord
symptoms of cord compression
Blood cultures are (+)

CSF: small number of ploys with markedly elevated portion.
CSF culture usually negative (because bacteria has not yet infiltrated CSF)

Question 11

Causes of Infections Chronic Meningitis

Answer 11

• Tuberculosis
• Cryptococcus (fungus)
• Coccidioidomycosis
• Histoplasmosis
• Lyme
• Syphilis ***

Question 12

CSF in tuberculosis

Answer 12

high protein, low glucose, few hundred lymphocytes ( almost never see organism)

Question 13

Lyme meningitis– chronic meningitis

Answer 13

Can occur at any stage of lyme
- often accompanies BELL PALSY (But can also be caused by Herpes Simplex Virus 2.

CSF = more antibody relative to serum

Question 14

Spyhilitic Meningitis two types

Answer 14

1. Meningovascular syphilis

2. Parenchymatous Neurosyphilis

Question 15

Meningovascular syphilis

1. organism
2. presenation

Answer 15

Caused by Endarteritis Obliterans

-Stroke-like syndrome and seizures

Question 16

Paraenchymatous Neurosyphilis

1. two types of symptoms
2. go into acronyms or definition

Answer 16

PARESIS and TABES DORSALIS

Paresis: Peronality, Affect, Reflex, Eyes, Sensorium, Intelligence (decline) ,speech

Tabes Dorsalis

• shooting pain
• ataxia
• sphincter disturbance
• Peripheral Neuropathy
• Cranial neuropathy

Question 17

Non- infectious etiologies of meningitis

Answer 17

1. neoplasms/ Para-neoplastic syndromes
2. Sarcois
3. Vasculitis
4. Drug induced ( HSV2)

Question 18

Encephalitis vs. Meningitis

Answer 18

Meningitis = swelling of meninges (bacterial)
Encephalitis = swelling of brain (viral)

Question 19

CSF for viral encephalitis

Answer 19

Lymphocytic predominence, blood may be seen, glucose will not be low!! – glucose is normal.

Question 20

Causes of viral encephalitis

Answer 20

• HSV 1
• St. Louis Encephalitis
• Eastern Equine Encephalitis
• Western Equine Encephalitis
• California Encephalitis
• West Nile

Question 21

Post infections Encephalitis

Answer 21

Acute Disseminated Encephalomyelitis

• mutlifocal neurological symptoms
• CSF indicated inflammation
• Occurs after measles, mumps, rubella, mycoplasm, varicella, EBV, influenza… and more.

treat with glucocorticoids