Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro Behavioral Med I > 6 - Neuro Manifestations of Infections > Flashcards

6 - Neuro Manifestations of Infections Flashcards

1
Q

What is a CNS infection?

A
  • Brain parenchyma, meninges, blood vessels can be invaded by any pathologic microorganism
  • CNS infections classified by site of involvement (Meningitis, Encephalitis, Myelitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is meningitis?

A

An infection of the meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is encephalitis?

A

An infection of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is myelitis?

A

An infection of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the time period of a CNS infection?

A

Disease processes may be

  • Acute
  • Subacute
  • Chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe meningitis

A
  • Invasion of meninges by pathologic microorganism
  • Infection / inflammatory response mostly involves the pia mater, arachnoid mater, subarachnoid space (CSF)
  • Secondary involvement blood vessels and brain parenchyma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the causes of meningitis

A

Aseptic Meningitis
- Unknown pathogen

Viral organisms

  • Enteroviruses most common
  • Usually self limiting / not life threatening

May be a complication of systemic viral infection
- Mumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe bacterial meningitis

A
  • Brain not the primary site of infection
  • Pathogen gains access to brain (hematologic or direct extension via ear, sinus, bone, etc.)
  • Sporadic or Epidemic (Meningococcus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs and symptoms of meningitis?

A
  • Chills, Fever, Headache
  • Neck pain / stiffness –> “nuchal rigidity”
  • Altered mental state
  • Seizures
  • Petechial rash (with meningococcus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which organisms typically cause meningitis?

A

Neonate

  • Group B streptococcus
  • Escherichia coli

Children
- H. influenza ( decreased incidence with vaccine)

Adults

  • Streptococcus pneumoniae (pneumococcus)
  • Neisseria meningitidis (meningococcus)
  • Listeria monocytogenes (also neonates)

1/3 - no organism cultured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the outcome of bacterial meningitis

A
  • Fatality rate is still rather high

- Incidence is 1-2/100,000 so not that infrequent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the sequelae (consequences) of meningitis

A
  • Focal neurologic deficits
  • Cognitive loss
  • Cranial nerve palsies (blindness, deafness, facial palsy)
  • Seizures
  • Hydrocephalous
  • Myelopathy, radiculopathy
  • Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you diagnose meningitis?

A
  • Suspected on history and physical exam
  • Confirmed on CSF analysis
  • Get spinal tap before antibiotics
  • Other tests (WBC, CT/MRI of brain, sinus x-ray, blood culture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What patients would you not want to do a spinal tap on?

A

Don’t do a spinal tap on an anticoagulated patient (warfarin) - they will bleed into the spinal canal and clot and then spinal deficits result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do you do a spinal tap?

A

L2-3, L3-4 or L4-5

It is a very benign procedure - minimal risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe what you will see in the CSF in CNS infections

A

slide 19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for bacterial meningitis?

A

Antibiotics

  • Cephalosporins – Ceftriaxone, Cefotaxime
  • Vancomycin

Supportive

  • Hydration / metabolic support / CSF edema
  • Ventilation
  • Anticoagulation for DIC

Steroids / Anticonvulsants

Rehabilitation

Prophylaxis (Rifampin, Cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe tuberculous meningitis

A
  • Generally subacute / secondary
  • Rupture of tubercle into CSF
  • Present with headaches, cognitive dysfunction, weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you diagnose tuberculous meningitis?

A
  • Brain scan, CSF

- Brain / meningeal biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe a CNS abscess

A
  • Can be found in the Brain, Spinal Cord, Epidural space
  • Typically occur secondary to blood metastasis, direct extension from skin, sinus, etc. or a perforating wounds
  • May contain anaerobic organisms
  • May be aseptic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is myelitis again?

A

A direct infection of the spinal cord itself

22
Q

Describe leprosy

A
  • Not a disease that has gone away
  • Chronic infection of skin and peripheral nerves
  • Granulomatous nerve deterioration occurs
  • Caused by the pathogen mycobacterium leprae
23
Q

What are the signs and symptoms of leprosy?

A

Cutaneous and peripheral nerve manifestation

  • Anesthesia
  • Motor loss
  • Joint, bone limb deformities
24
Q

How do you treat leprosy?

A
  • Treated with Dapsone, Rifampin, Clofazimine

Chance of spreading from person to person is very small, so you do not need to seclude patients

25
Q

What is encephalitis?

A
  • Infection of brain parenchyma

- Often secondary to viral infection

26
Q

What do we call encephalitis with spinal cord involvement?

A

With spinal cord involvement – encephalo-myelitis

27
Q

What do we call encephalitis with meningeal involvement?

A

With meningeal involvement – meningo-encephalitis (aseptic meningitis)

28
Q

How do you diagnose encephalitis?

A
  • Diagnosis suspected clinically

- Confirmed with virus isolation in CSF / tissue

29
Q

What is poliomyelitis?

A

Polio

  • Starts out with a GI infection - Enterovirus (picovirus)
  • First presents as an acute infection
  • Later progresses to flaccid paralysis (due to attacks on α motor neurons)
  • Occasional brain involvement occurs (stupor, seizures)
  • Respiratory muscles or bulbar muscles (used to talk and swallow) dysfunciton can result
  • Post-polio syndrome 30 – 40 years later (after infection)
  • Not a reactivation of the virus, but a an effect on previously injured nerves
30
Q

What is the arbovirus infection?

A

Transmitted by arthropod vectors (mosquitoes)

  • Eastern Equine Encephalitis
  • Western Equine Encephalitis
  • St. Louis Encephalitis
  • West Nile Encephalitis

1st acute infection

2nd confusion, seizures, focal neuro deficits, myelitis

  • May progress to coma, death
  • Recovery may be incomplete
31
Q

Describe herpes simplex encephalitis

A
  • Most significant sporadic encephalitis
  • Endogenous reactivation of latent virus
  • Abrupt onset with fever, headache, malaise (cognitive dysfunction, focal neuro deficits or seizures)
  • Abnormal EEG/MRI scan
32
Q

How do you treat herpes simplex encephalitis?

A
  • Acyclovir
  • Steroids
  • Anticonvulsants
33
Q

Describe AIDS

A

Clinical syndrome of multiple infections

  • Secondary to HIV-I infection
  • Targets immune system

Categorized by degree of immune system involvement
- CD4 lymphocyte counts

Neurotropic virus
- 70% with neurologic disease

CNS also affected by opportunistic infections

34
Q

Describe HAART therapy

A

HAART therapy – highly active anti-retroviral

We don’t see CNS manifestations of AIDS anymore due to these drugs

35
Q

What is progressive multifocal leucoencephalopathy?

A
  • Slowly progressive infection
  • It is a demyelinating disease that leads to dementia
  • Caused by the JC virus (which most people have inside them - 90%)
  • It is typically benign until there are problems with the immune system
  • PML involves an activation of this latent virus
36
Q

What patient populations do we see PML in?

A

Seen in immuno-deficient states

  • Lymphoma, AIDS
  • ↑ case reports with Tysabri (Natalizumab)
37
Q

Describe the fungal infections in the CNS

A

Cryptococcosis most common

  • Subacute / Chronic
  • Meningeal / Cognitive symptoms, Headache

Coccidiomycosis in southwest
- Valley fever

Candida Albicans (yeast) in immuno-compromised patients

38
Q

Describe fungal meningitis secondary to contaminated steroid injections

A

CDC – 54 cases as of 10/22/12

  • Exserohilum rostratum in 52 pts. and in unopened steroid vials
  • About 14,000 patients exposed
  • 25 deaths

Treatment
- Voriconazole, amphotericin B

39
Q

What are two spirochete infections?

A
  • Lyme Neuroborreliosis

- Neurosyphilis

40
Q

Describe Lyme Neuroborreliosis

A
  • Secondary borrelia burgdorferi
  • Tick vector
  • Causes erythema migrans, facial nerve palsy, meningoencephalitis, neuropathy
41
Q

Describe neurosyphilis

A
  • Secondary to treponema pallidum
  • Sexually transmitted disease
  • Causes meningoencephalitis, tabes doralis (use Rhomberg sign to diagnose), general paresis
42
Q

Describe cerebral cysticercosis

A
  • Encystment with larvae of Taenia solium
  • Multiple cysts / calcified lesions in brain and meninges

Mostly comes from meat or fish - lives in the muscle of pork

If you eat uncooked pork, it can infest inside of you and eventually get to the brain

43
Q

How does cerebral cysticercosis present?

A
  • Headaches
  • Seizures
  • Focal deficits
44
Q

How do you treat cerebral cysticercosis?

A
  • Ventricular shunts, surgery
  • Anticonvulsants / steroids
  • Albendazole
45
Q

What are prion diseases?

A

Proteins that have the ability to get into an orgaism and use the DNA/RNA equiptment to reproduce themselves

Present with…

  • Dementia
  • Motor signs
  • Seizures
  • Death
46
Q

Describe prions

A

Prion

  • Protein units without nucleic acid
  • Infectious / resistant to heat and radiation
47
Q

Describe the transmission of prion diseases

A
  • 90% sporadic

- Can also be iatrogenic or familial forms

48
Q

What are the CNS forms of prion diseases?

A

Transmissible Spongiform Encephalopathy

  • Jakob-Creutzfeldt disease (and variant)
  • Bovine Spongiform Encephalopathy (BSE) which is “Mad Cow” disease from food
49
Q

Describe botulism

A
  • Does not invade the CNS
  • Works on the neuromuscular junction
  • It is from a toxin of Clostridium Botulinum
  • Typically acquired in food and wounds
50
Q

What happens to patients with botulism poisonin?

A

Paralysis of motor and autonomic nerves (prominent cranial nerve involvement)

51
Q

How do you diagnose botulism?

A

Confirmed with toxin / organism identification

52
Q

What is the treatment with botulism?

A

Antitoxin and supportive

You have to prove you have botulism toxin before the CDC will send you the drug

Neuro Behavioral Med I (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions