60. Neuroborreliosis. Neurosyphilis. Affection of the nervous system in AIDS.

Question 1

what is another word for neuroborreliosis ?

Answer 1

lyme disease

Question 2

what causes lyme disease or nueroborreliosis ?

Answer 2

spirochete borrelia burgdorferi - from tick bites

Question 3

what is the pathophysiology of neuroborrelsiosis ?

Answer 3

entering the circulation - distinct tropism for skin , heart , cns , joints and eyes

progression of disease
early localised - body may clear it without any manifestations - asymptomatic but seroporisitve

early disseminated

chronic disseminated

Question 4

is nueroborelliosis curable ?

Answer 4

all stages of neuroborrleisois is curable with antibiotic therapy

Question 5

in stage 2 early dissemination what are the symptoms in neuroborrelsiosi ?

Answer 5

spreads through out the body produces symptoms by direct invasion - erythema migrants
flue like symptoms - fever and muscle pain

signs and symptoms lasting less than 6 months

Question 6

what is stage 3 of lyme disease as signs and symtpoms ?

Answer 6

persistent survival of the bacteria in nervous tissue

painful meningoradicultis - radicular pain , paresis and eadache
cranial nerve abnormalitis
altered mental status

later on - mononeuropathy 
polyneuropathy 
radiculopathy
acrodermatitis chronica atrophicans 
cerebral vascultisi 
spastic ataxia 
gait diroer
micturation disroder

Question 7

what is the diagnosis for lyme disease ?

Answer 7

CSF pleocytosis (abnoral large number of lymphocytes)

bb specific antibodies produced intrathecally

neruological symtpks

less significant - microscope baed assays

Question 8

what is the DD for lyme disease ?

Answer 8

alzheimer disease
acute disseminated encephalomyelitis
viral meningitis

Question 9

what is the treatment for neuroborreliosis ?

Answer 9

IV - penicillinG , ceftriaxone , doxycycline - cross the BBB

amoxicillin in pregnancy

Question 10

what causes neurosphyphilis?

Answer 10

sexually transmitted disease - trepanoma palladium

for untreated syphillus

Question 11

what are the 6 diagnostic categories of neurosyphilis ?

Answer 11

1- neuropsychiatric -psychosis , dimentia

2 - cerebrovascular

3 - occular - uveitis , visual loss , optic nerve dysfunction

4 - myelopathy - dysfunction of spinal cord

5 - seizures

6- brainstem and cranial nerves

Question 12

what are the symptoms of neurospyphilus ?

Answer 12

congentive and behavioural impariment 
ataxia 
stroke 
ophthalmic - blurred vision , color perception 
urinary symtoms - bladder incontinence

Question 13

what are the signs of neurosphylus ?

Answer 13

hyporeflexia
decreased proprioception , loss of vibratory sense
anisocoria
dimentia , paranoia
romberg sign - closing eyes and increased loss of balance

Question 14

neursphylus is divided into 2 categories ?

Answer 14

early involvement of cns limited to meninges
parenchymal involvement

early neurosphyilus affects mesodermal structures - meninges and vessels

late neurosphylus - brain , spinal cord and parenchyma

Question 15

what are the 6 clinical form of neurosphyllus ?

Answer 15

asymptomatic

acute syphilitic meningitis - stiff neck and headache

meningovascular syphillus- andarteritis , perivascular inflammtion
luminal narrowing - predisposing to cerebrovascular thrombosis - middle cerebral artery
or branches of basally artery

tabes dorsalis - preataxia, ataxia and paralysis-loss of sensation
lancinating pain
loss of peripheral reflexes

general paresis - occurs after 20-30 years after initial exposure to trepanoma palladium
frontotemporal meningoencaphalitis

optic atrophy - photophobia and dimming of vision
anterioir uveitis panuveitis

Question 16

what is the pathophysiology of HIV ?

Answer 16

enter the brain by monocytes and other infected CD4+ cells
virus replicates in these cells and infect other cells such as the microglia and oligodendrocytes , astrocytes and neurones

virus is then densely located in the basal ganglia and subcortical area and frontal cortex

Question 17

what are the pathophysiological manifestation of hiv infection on the brain ?

Answer 17

HIV -1 associated cognitive/ motor complex or AIDS dementia complex
poor concentration
mental slowness
dimentia

HIV associated progressive enceaphlopathy - cognitive motor and behavioural changes seen in children

polymyositis

chronic neuropathy

Question 18

what are the complication of HIV infections ?

Answer 18

CNS lymphoma by secondary EBV 
kaposki sarcoma 
progressive multifocal leukoencepahlopathy 
crytptococcal meningitis - fungal 
tuberculos meningitis 
CMV enecphalitis

Question 19

how many stages of AIDS dementia complex are there and what are they ?

Answer 19

stag 0 - normal mental and motor function

stage 0.5 - gait and strength normal
symptoms may be minimal - no impairment of work

stage1 - evidence of functional , intellectual ad motor impairment
diminshed performance of neuropsychological testing
but walk without assistance and can perform all aspects of work

stage 2 - perform basic activities of self care
but cannot work

stage 3 - major intellectual incapacity
motor diasbility
walking slowed , clumsiness of arms

stage 4 - vegetative state

Question 20

what is the diagnosis of HIV affecting the brain ?

Answer 20

csf - hiv antibodies , pleocytosis

ct - diffuse atrophy and ventricular enlargement , attenuation of periventricular white matter