Clinical Approach to Headache Flashcards
Most common cause of meningitis in adults, infants and young children is…
S. pneumoniae
What used to be the most common cause of meningitis in kids? Why has that changed?
Used to be H. flu but vacciation has decreased incidence.
What is a cause of bacterial meningitis in the elderly only?
Listeria
What is the most common cause of fungal meningitis?
Which patients does it infect most?
Cryptococcus
DM and immunocompromised patients.
What is given for meningitis acutely? (3)
1st - dexamethasone steroid
3rd generation cephalosporins - ceftriaxone
Vancomycin
*all given IV
What is infectious encephalitis?
What is the most common cause?
Presence of inflammation in the brain in addition to clinical evidence of neurological dysfunction.
Viruses, but most cases remain unknown.
What are viral causes of infectious encephalitis in adults? (5)
HSV-1, -2 HIV West Nile Varicella Zoster Treponema pallidum
What is the presentation of HSV-1 encephalitis?
What is seen on MRI and EEG?
What is the treatment?
About 1/4 of patients treated for HSV-1 can develop…
Rapidly progressive neurologically devastating illlness with fever, HA, impaired consciousness, SZ and focal neurological signs/symptoms.
-can be similar presentation to bacterial meningitis.
Focal abnormalities in temporal lobes.
Acyclovir
Recurrent neuropsychiatric symptoms, sometimes w/ associated autoantibodies with secondary autoimmune encephalitis.
What is autoimmune encephalitis?
What is a large association?
At what point should this diagnosis be considered?
What is hard about making this diagnosis?
How is it treated geneally?
A cause of autoimmune encephalitis that mimics infectious encephalitis.
SZ - some are well-known causes of epilepsy.
In patients with progressive (< 6 wks.) encephalopathy or psychiatric disturbance, especially is SZ are present. Some entities may overlap with paraneoplastic syndromes and may be associated with tumors.
It takes a long time get test results from serum/CSF autoantibodies.Prompt identification and treatment is vital.
High-dose steroids, IVIg, plasma exchange, Rituximab, Cyclophosphamide or other immunosuppressants.
What are the 2 most well-known causes of autoimmune encephalitis?
NMDA encephalitis
LGI-1 encephalitis
Which patients are most common affected by NMDA encephalitis?
How is it diagnosed?
What lab studies are needed?
What is a common association?
What is the progression?
Young or middle-aged women.
Rapid onset (< 3 mo.) of 4 of the following 6 symptoms:
- Abnormal psychiatric behavior or cognitive dysfunction.
- Speech dysfunction
- SZ
- Movement disorder, dyskinesias, rigidity, etc.
- Decreased level of consciousness
- ANS dysfunction or central hypotension
At least 1 of:
Abnormal EEG (extreme delta brush)
CSF with pleocytosis and oligoclonal bands and/or NMDA-receptor antibodies.
Teratoma
Many will improve w/ treatment, but it may take a long time (1 year or more).
Which patients are more likely to get LGI-1 encephalitis?
What are the symptoms?
How is it treated?
What is a feature in 50% of patients?
What abnormality is seen acutely in these patients? What is the consequence of not treating thee patients?
What is a difficult part of treating it?
2x more common in men.
Faciobrachial dystonic SZ - brief SZ involving one side of the face and arm that occur very freuently (100s of times/day).
They are NOT responsive to antiepileptic drugs alone and may need immunotherapy as well.
Sleep disturbance is in 50% of patients.
Temporal lobe (hippocampal) abnormality. Failure to treat may result in permanent long-term brain injury (long-term cognitive effects, short-term memory problems).
Up to 1/3 may relapse after treatment.
“Extreme delta brush” think:
NMDA encephalitis
