Brain infections

Question 1

How can you distinguish a traumatic tap from a bloody tap?

Answer 1

expect only 1 WBC per 700 RBC in a traumatic tap

Question 2

What is on the differential for acute lymphocytic predominant meningitis?

Answer 2

enterovirus, HSV, VZV, HIV, Lyme, VDRL, EBV

Question 3

How can you distinguish enterovirus from lyme meningitis?

Answer 3

enterovirus is more common, EBV has a shorter prodrome (1 day); facial palsy occurs in lyme

Question 4

What are causes of lymphocytic meningitis you should especially consider in immunocompromised hosts?

Answer 4

VZV, cryptococcus, T gondii, NSAIDs

Question 5

A patient treated for cryptococcal meningitis returns one month later with severe headache, seizures and an LP showing 230 WBC. What should you give?

Answer 5

steroids for immune reconstitution syndrome

Question 6

A patient with HIV presents with a large area of white matter enhancement and tests positive for JC virus.. this is..

Answer 6

PML

Question 7

A patient with HIV presents with a ring enhancing lesion. First test?

Answer 7

toxo blood test

Question 8

What is the best tx for bells palsy?

Answer 8

steroids

Question 9

What are the most common culprits in bacterial meningitis?

Answer 9

strep pneumo, neisseria, listeria - tx with steroids and then antibiotics

Question 10

The roommate of a patient who had meningitis should receive what form of prophy?

Answer 10

rifampin or cipro

Question 11

A young patient presents with psychotic features and smell hallucinations. Suspect..

Answer 11

HSV1

Question 12

A patient who travels a lot presents with low grade myalgias and fever and presents areflexic in both legs, mild bilateral weakness, mild facial weakness. MRI shows inflammatory changes in the anterior horns. This is…

Answer 12

west nile encephalitis

Question 13

A patient who was previous well presents unsteady, forgetful with enlarged ventricles, rapid deterioration. She becomes nonverbal and has an occasional myoclonic jerk. This is..

Answer 13

cjd

Question 14

What is the typical presentation for TB meningitis?

Answer 14

brain stem infarcts due to basal meningeal involvement

often hydrocephalus

Question 15

What are some of the symptoms of late neuro lyme?

Answer 15

early - aseptic meningitis

cranial nerve palsies, polyneuropathy, polyradiculopathy, encephalopathy

Question 16

A patient presents with complex partial seizures of the temporal lobe, olfactory hallucinations and a CSF count that shows an elevated RBC. Think

Answer 16

HSV1

Question 17

What is the treatment for HSV1 encephalitis?

Answer 17

acyclovir

Question 18

A patient presents with seizures, heaache and increased ICP with imaging showing enhancing cysts. Treatment?

Answer 18

neurocystericosis - treat with albendazole

Question 19

A patient with HIV develops loss of vibration and joint position sens, sensory ataxia. This is…

Answer 19

vacuolar myelopathy due to severe immunosuppression

Question 20

A 27 year old patinet comes in with tingling in his limbs and weakness after completed Hep B vaccinations. LP shows no whites and a protein of 450. This is..

Answer 20

GBS

Question 21

A young girl develops is treated for a CNS infection with antbiotics and has bilateral sensorineural hearing loss. What would her LP show?

Answer 21

elevated polys, elevated protein, low glucose

Question 22

A man who emigrated from Mumbai has double vision, stiff neck and a 6th nerve palsy. What would LP show?

Answer 22

low glucose, high protein, high WC - Tb meningitis

Question 23

A young boy on chemo develops ear pain, inability to close left eye, flattening of nasolabial fold. His external auditory canal shows red lesions. This is..

Answer 23

VZV - Ramsay Hunt

Question 24

A young woman on steroids has a headache and stiff neck. Her OP is very high and she has elevated lymphocytes with neg. gram stain. this is..

Answer 24

crypto

Question 25

What are the consequences of congenital CMV?

Answer 25

bilateral hearing loss, spasticity, hyperintensities on MRI margins

Question 26

What antibiotic should be added to cover for listeria?

Answer 26

ampicillin