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Neuro Med > Acute and subacute encephalitis > Flashcards

Acute and subacute encephalitis Flashcards

1
Q

What are symptoms of encephalitis?

A

Altered level of consciousness, focal neurologic deficits (hemiparesis, aphasia, hemispatial neglect, movement disorders), Seizures can occur, coma

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2
Q

Can meningitis and encephalitis coexist?

A

Yes, called “meningoencephalitis”

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3
Q

What are a significant proportion of encephalitis cases likely caused by?

A

autoimmune disorders and postinfectious encephalitis caused by aberrant immune response to primary infection

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4
Q

What is the proposed case definition for encephalitis?

A

encephalopathy for 24 hours, plus 2 of the following: Hisroy of fever, seizures/focal neurological deficits, CSF pleocytosis, electroencephalogram characteristics consistent with encephalitis, neuroimaging abnormalities

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5
Q

Is viral encephalitis higher in adults or children?

A

Children

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6
Q

What is most common cause of encephalitis?

A

Idiopathic

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7
Q

What are the most common causes of encephalitis (not idiopathic) in order?

A

HSV-1 and HSV-2 (11-22%), VZV (4-14%), Postinfections (measles, mumps, rubella, flu) (2-11%), TB (5-8%), Autoimmune (4-8%), Enterovirus (1-4%)

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8
Q

How do you diagnose HSV-1 or 2 encephalitis?

A

PCR of the CSF

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9
Q

What are minor causes of encephalitis?

A

Arboviruses, other herpesviruses (EBV, HHV-6, HCMV), JC virus, Respiratory viruses, Rabies, mumps and measles (direct, primary infection), Bacteria

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10
Q

What is the differential for encephalitis?

A

Alphaherpesviruses, Postinfection immune responses (acute disseminated encephalomyelitis), Tuberculosis, Autoimmune, Enteroviruses, rare causes

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11
Q

If a patient presents with altered state of consciousness and unexplained seizure, fever or new focal neurological deficits, what should you be concerned about?

A

Encephalitis

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12
Q

What are the 3 things to do when diagnosing encephalitis?

A

CT scan, lumbar puncture, EMPIRIC THERAPY PRIOR TO CSF RESULTS: ACYCOLOVIR

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13
Q

What happens to glucose and protein levels in bacterial encephalitis?

A

Protein goes up, glucose down

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14
Q

What happens to glucose and protein levels in viral encephalitis?

A

Protein goes up, glucose stays the same

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15
Q

What should happen to a CSF sample in someone suspected to have viral encephalitis?

A

PCR for HSV, HSV-2, VZV and enteroviruses. Will cover 90% of everything

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16
Q

What lobe under an MRI would be affected in an HSV infection causing encephalitis?

A

Temporal lobe, it’s where the trigeminal nerve ends

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17
Q

What area of the brain do flaviviruses typically infect for encephalitis?

A

Basal ganglia and thalamus

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18
Q

What happens to the level of lymphocytes and neutrophils upon viral encephalitis?

A

Neutrophils are increased initially, decrease later and lymphocytes increase dramatically

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19
Q

What are the WBC counts of autoimmune causes of encephalitis?

A

Very low

20
Q

What WBC is increased in West Nile Virus encephalitis?

A

neutrophils

21
Q

What WBC is increased in ADEM (acute disseminated encephalomyelitis) encephalitis?

A

neutrophils in CSF (sometimes)

22
Q

What causes of encephalitis will most likely have an abnormal MRI?

A

HSV (temporal lobe), ADEM (supra tentorial)

23
Q

What is the tree of HSV-1 and -2?

A

DNA vrus, icosahedral nucleocapsid, enveloped, dsDNA linear genome (class 1)

24
Q

What is the major target of antiviral therapy against herpesviruses?

A

proteins that are required to promote DNA replication

25
Q

Are babies more likely to get encephalitis caused by HSV-1 or HSV-2?

A

HSV-2

26
Q

What is the most common cause of encephalitis among immunocompromised patients?

A

VZV

27
Q

How does acyclovir affect viruses?

A

guanine nucleoside analogue that has a high affinity for viral DNA pol and inhibits viral DNA replication. Has lower affinity for human DNA pol

28
Q

Can treating patients with acyclovir/antiviral agents clear the body of the virus?

A

No, only works to decrease the spread of the disease, will not clear a latent infection

29
Q

What is most common causes of postinfectious encephalitis?

A

measles, mumps, rubella, VZV, influenza

30
Q

What is the most common form of postinfectious encephalitis?

A

Acute disseminated encephalomyelitis (ADEM)

31
Q

Describe ADEM. When does it occur?

A

inflammatory demyelinating condition that occurs anywhere from days to 4 weeks post-viral infection (caused by type 2 hypersensitivity reaction)

32
Q

What usually causes ADEM? (what kind of hypersensitivity)

A

type 2 hypersensitivity

33
Q

What is the tree of measles virus?

A

Virus, ssRNA (-) group V, nonsegmented, helical nucleocapsid, enveloped, paramyxoviridae, morbillovirus

34
Q

What form of encephalitis can measles complicate to?

A

subacute sclerosing panencephalitis (SSPE), acute postinfectious encephalomyelitis, primary measles encephalytis

35
Q

What is the treatment of primary measles encephalitis?

A

Supportive

36
Q

How does primary measles encephalitis establish itself?

A

invades and replicates within brain cells, injuring neurons and triggering lymphocytic infiltration.

37
Q

What is the treatment of measles-induced acute disseminated encephalomyelitis?

A

Corticosteroids to dampen the immune response

38
Q

How does measles-induced acute disseminated encephalomyelitis occur? What are some basic markers in CSF?

A

Can be seen with recent history of measles (last several weeks to months), coupled with myelin basic protein found in CSF with absence of infectious virus.

39
Q

What are symptoms of measles-induced acute disseminated encephalomyelitis?

A

motor and sensory defects, ataxia, mental status change, myelin basic protein found in CSF.

40
Q

What age of contraction of measles puts children at greater risk for contracting subacute sclerosing panencephalitis?

A

Before 2 years old

41
Q

Describe subacute sclerosing panencephalitis disease process?

A

Measles virus infects neurons and spreads slowly between other neurons causing them to fuse. Symptoms don’t show up until 10-15 years later, and by that time the patient only has 1-3 years of life

42
Q

What are the different kinds of picornaviruses?

A

poliovirus, coxsackievirus A and B, echovirus, enterovirus

43
Q

What kind of viruses are picornaviruses (poliovirus, coxsackie, echo, entero)

A

ssRNA (+) group IV

44
Q

What kind of viruses spread from arthropod vectors?

A

Arboviruses

45
Q

What kind of arboviruses cause encephalitis?

A

West nile, La Crosse encephalitis virus, St. Louis Encephalitis virus, Powassan Virus

Neuro Med (39 decks)

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