60. Neuroborreliosis. Neurosyphilis. Affection of the nervous system in AIDS. Flashcards
what is another word for neuroborreliosis ?
lyme disease
what causes lyme disease or nueroborreliosis ?
spirochete borrelia burgdorferi - from tick bites
what is the pathophysiology of neuroborrelsiosis ?
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
is nueroborelliosis curable ?
all stages of neuroborrleisois is curable with antibiotic therapy
in stage 2 early dissemination what are the symptoms in neuroborrelsiosi ?
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
what is stage 3 of lyme disease as signs and symtpoms ?
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
what is the diagnosis for lyme disease ?
CSF pleocytosis (abnoral large number of lymphocytes)
bb specific antibodies produced intrathecally
neruological symtpks
less significant - microscope baed assays
what is the DD for lyme disease ?
alzheimer disease
acute disseminated encephalomyelitis
viral meningitis
what is the treatment for neuroborreliosis ?
IV - penicillinG , ceftriaxone , doxycycline - cross the BBB
amoxicillin in pregnancy
what causes neurosphyphilis?
sexually transmitted disease - trepanoma palladium
for untreated syphillus
what are the 6 diagnostic categories of neurosyphilis ?
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
what are the symptoms of neurospyphilus ?
congentive and behavioural impariment ataxia stroke ophthalmic - blurred vision , color perception urinary symtoms - bladder incontinence
what are the signs of neurosphylus ?
hyporeflexia
decreased proprioception , loss of vibratory sense
anisocoria
dimentia , paranoia
romberg sign - closing eyes and increased loss of balance
neursphylus is divided into 2 categories ?
early involvement of cns limited to meninges
parenchymal involvement
early neurosphyilus affects mesodermal structures - meninges and vessels
late neurosphylus - brain , spinal cord and parenchyma
what are the 6 clinical form of neurosphyllus ?
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
what is the pathophysiology of HIV ?
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
what are the pathophysiological manifestation of hiv infection on the brain ?
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
what are the complication of HIV infections ?
CNS lymphoma by secondary EBV kaposki sarcoma progressive multifocal leukoencepahlopathy crytptococcal meningitis - fungal tuberculos meningitis CMV enecphalitis
how many stages of AIDS dementia complex are there and what are they ?
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
what is the diagnosis of HIV affecting the brain ?
csf - hiv antibodies , pleocytosis
ct - diffuse atrophy and ventricular enlargement , attenuation of periventricular white matter
