Brain infections Flashcards
How can you distinguish a traumatic tap from a bloody tap?
expect only 1 WBC per 700 RBC in a traumatic tap
What is on the differential for acute lymphocytic predominant meningitis?
enterovirus, HSV, VZV, HIV, Lyme, VDRL, EBV
How can you distinguish enterovirus from lyme meningitis?
enterovirus is more common, EBV has a shorter prodrome (1 day); facial palsy occurs in lyme
What are causes of lymphocytic meningitis you should especially consider in immunocompromised hosts?
VZV, cryptococcus, T gondii, NSAIDs
A patient treated for cryptococcal meningitis returns one month later with severe headache, seizures and an LP showing 230 WBC. What should you give?
steroids for immune reconstitution syndrome
A patient with HIV presents with a large area of white matter enhancement and tests positive for JC virus.. this is..
PML
A patient with HIV presents with a ring enhancing lesion. First test?
toxo blood test
What is the best tx for bells palsy?
steroids
What are the most common culprits in bacterial meningitis?
strep pneumo, neisseria, listeria - tx with steroids and then antibiotics
The roommate of a patient who had meningitis should receive what form of prophy?
rifampin or cipro
A young patient presents with psychotic features and smell hallucinations. Suspect..
HSV1
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…
west nile encephalitis
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..
cjd
What is the typical presentation for TB meningitis?
brain stem infarcts due to basal meningeal involvement
often hydrocephalus
What are some of the symptoms of late neuro lyme?
early - aseptic meningitis
cranial nerve palsies, polyneuropathy, polyradiculopathy, encephalopathy
A patient presents with complex partial seizures of the temporal lobe, olfactory hallucinations and a CSF count that shows an elevated RBC. Think
HSV1
What is the treatment for HSV1 encephalitis?
acyclovir
A patient presents with seizures, heaache and increased ICP with imaging showing enhancing cysts. Treatment?
neurocystericosis - treat with albendazole
A patient with HIV develops loss of vibration and joint position sens, sensory ataxia. This is…
vacuolar myelopathy due to severe immunosuppression
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..
GBS
A young girl develops is treated for a CNS infection with antbiotics and has bilateral sensorineural hearing loss. What would her LP show?
elevated polys, elevated protein, low glucose
A man who emigrated from Mumbai has double vision, stiff neck and a 6th nerve palsy. What would LP show?
low glucose, high protein, high WC - Tb meningitis
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..
VZV - Ramsay Hunt
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..
crypto
What are the consequences of congenital CMV?
bilateral hearing loss, spasticity, hyperintensities on MRI margins
What antibiotic should be added to cover for listeria?
ampicillin
