Chapter 46. Neurovirology

Question 1

Question 46-1: 
A 46-year-old man presents with fever, headache, confusion, and mild left-sided weakness. Which is the most likely diagnosis? 
A.  Bacterial meningitis 
B.  Bacterial brain abscess 
C.  Viral meningitis 
D.  Viral encephalitis

Answer 1

Answer 46-1: D.
The patient clearly has an infectious illness,
and all of the listed conditions can have
associated fever and headache. The confusion
and focal findings suggest encephalitis,
although brain abscess and secondary cerebral
dysfunction from bacterial meningitis has to
be considered as well. Of all of the viral
encephalitides, HSV encephalitis is the most
likely. (p833)

Question 2

Question 46-2: 
Which of the following clinical findings help to differentiate meningitis from encephalitis? 
A.  Nausea and vomiting 
B.  Headache 
C.  Focal neurologic findings 
D.  Lymphocytic pleocytosis of the CSF

Answer 2

Answer 46-2: C.
Focal neurologic signs suggest encephalitis
rather than meningitis. Other findings which
would suggest encephalitis include confusion
or seizures. The other listed symptoms can be
seen in either menmgitis or encephalitis.
(p833)

Question 3

Question 46-3:
All of the following statements are true regarding poliomyelitis EXCEPT which?
A. Poliomyelitis due to wild type poliovirus does not occur in the US
B. Patients with immunodeficiency can develop polio after vaccination
C. Vaccine-related polio does not occur in immunocompetent individuals
D. During polio epidemics, 90% of infected patients were asymptomatic

Answer 3

Answer 46-3: C.
Vaccine·related polio occurs in 10-20 patients
per year in the US, and is due to reversion to
virulence of the vaccine strains. This develops
even in patients without immune compromise,
although vaccination of immunodeficient
patients has an increased incidence of
development of neurologic complications.
(p835)

Question 4

Question 46-4:
A patient with known AIDS presents with fever, malaise, weakness, which is multifocal and is associated with pain in multiple regions. There are regions of sensory loss which are patchy. Which is the most likely diagnosis?
A. Polyradiculitis
B. Toxoplasmosis
C. Cryptococcal meningitis
D. Toxic neuropathy due to medications for HIV infection

Answer 4

Answer 46-4: A.
The patient has polyradiculitis which is a viral
infection of the nerve roots. CMV is the most
common agent. Treatment is with ganciclovir
or foscamet. Treatment of the CMV infection
arrests, but unfortunately usually does not
improve. the neuropathic symptoms. (p836)

Question 5

Question 46-5: 
Which of the following is the most common cause of viral meningitis? 
A  Arbovirus 
B.  Enterovirus 
C.  Herpesvirus 
D.  CMV

Answer 5

Answer 46-5: B.
Enteroviruses are the most common agents
causing viral meningitis, being responsible for
85-95% of cases. Other common pathogens
include arboviruses (including West Nile
among others), HSV, and HIV. (P831)

Question 6

Question 46—6 :
Which of the following is appropriate treatment for HSV meningitis? 
A.  Acyclovir 
B.  FamciclGvir 
C.  Valacyclovir 
D.  Any of these

Answer 6

Answer 46-6: D. Any of these agents can treat HSV infections, including meningitis. (P832)

Question 7

Question 46-7: 
West Nile virus (WNV) produces which of the following? 
A.  Encephalitis 
B.  Meningitis 
C.  Both 
D.  Neither

Answer 7

Answer 46-7: C. WNV encephalitis is best known from reports in the press and literature. However, WNV can also produce meningitis. (P832)

Question 8

Question 46-8: 
A patient presents with recurrent episodes of aseptic meningitis, separated by months and years. Which is the most likely pathogen? 
A.  HSV-I 
B.  HSV-2 
C.  CMV 
D.  HlV

Answer 8

A nswer 46-8: B.
Recurrent aseptic meningitis was first described by Mollaret. The course is typically
benign, with no residual neurologic deficit.
CSF PCR has shown that HSV -2 is the most
likely pathogen. (p833)

Question 9

Question 46-9: 
Which of the following cause myelitis? 
1.  ECHO 
2.  HIV 
3.  West Nile 
4.  Polio 
Select: A =  I. 2. 3. B = 1, 3. C = 2, 4. D = 4 only.  E = All

Answer 9

Answer 46-9: E

All of these are potential causes of myelitis

Question 10

Question 46-10:
Antiviral treatment is available for which of the fol1owing causes of encephalitis and meningitis?
I. HIV
2. CMV
3. HSV
4. WNV
Select: A = 1, 2. 3. B = 1. 3. C = 2, 4. D = 4 only. E = All

Answer 10

Answer 46-10: E
There is no effective antiviral treatment for WNV, whereas there are treatments for the other listed agents. HSV is commonly treated with ganciclovir. HIV is treated with combination antivirals (p832)