Clinical Approach to Meningitis, Encephalitis (Hon)

Question 1

What is the most common cause of bacterial meningitis?

What is a highly contagious cause in teenagers and young adults?

What is a potential cause in the elderly?

Answer 1

1) Streptococcus pneumoniae
2) Neisseria meningitidis
3) Listeria monocytogenes

Question 2

What are common causes of viral meningitis?

Answer 2

1) Enteroviruses
2) HSV
3) HIV
4) West Nile

Question 3

Which form of meningitis causes serious complications and could even result in death?

Answer 3

Bacterial meningitis

Question 4

What is the most common causes of fungal meningitis especially in diabetic or immunocompromised patients?

Answer 4

Cryptococcal

Question 5

What are signs/symptoms of meningitis in patients over age 2?

Answer 5

1) Sudden high fever
2) Stiff neck
3) Severe headache

Question 6

What signs/symptoms of meningitis are seen in newborns?

Answer 6

1) A bulge in the soft spot on top of a baby’s head (fontanel)
2) Stiffness in the whole body

Question 7

What is the general antimicrobial therapy given for meningitis?

Answer 7

1) Vancomycin

2) Ceftriaxone

Question 8

When examining the CSF in meningitis, what is the WBC if the cause is bacterial?

If the cause is viral?

Answer 8

1) Greater than 1,000 per mm^3

2) Less than 100 per m^3

Question 9

When examining the CSF in meningitis, what is the cell differential if the cause is bacterial?

If the cause is viral?

Answer 9

1) Predominance of PMNs

2) Predominance of Lymphocytes

Question 10

When examining the CSF in meningitis, what is the protein level if the cause is bacterial?

If the cause is viral?

Answer 10

1) Mild to marked elevation

2) Normal to elevated

Question 11

When examining the CSF in meningitis, what is the glucose level if the cause is bacterial?

If the cause is viral?

Answer 11

1) Normal to marked decrease

2) Normal

Question 12

Of the pathogens reported to cause encephalitis, the majority are?

Answer 12

Viruses

Question 13

What are common causes of infectious encephalitis in an adult?

Answer 13

1) HSV 1 or 2
2) HIV
3) West Nile
4) Varicella Zoster
5) Treponema pallidum

Question 14

Herpes Simplex 1 encephalitis typically presents as a rapidly progressive neurologically devastating illness with combination of?

Answer 14

1) Fever
2) Headache
3) Impaired consciousness
4) Seizures

Question 15

MRI and EEG of a patient with Herpes Simplex 1 encephalitis often demonstrates focal abnormalities in what area?

Answer 15

Temporal lobes

Question 16

What is the treatment for Herpes Simplex 1 encephalitis?

Answer 16

Acyclovir

Question 17

What should be considered in patients with rapidly progressive (usually < 6weeks) encephalopathy or psychiatric disturbance, especially if seizures also present?

Answer 17

Autoimmune encephalitis

Question 18

What are the two most common etiologies of autoimmune encephalitis?

Answer 18

1) NMDA Encephalitis

2) LGI1 Encephalitis

Question 19

NMDA Encephalitis most commonly affects what population?

Answer 19

Young or middle-aged women

Question 20

NMDA Encephalitis typically presents with rapid onset (less than 3 months) of what symptoms?

Answer 20

At least four of the six:

1) Cognitive dysfunction
2) Speech dysfunction
3) Seizures
4) Movement disorder
5) Decreased level of consciousness
6) Autonomic dysfunction

Question 21

What EEG finding is associated with NMDA Encephalitis?

Answer 21

Extreme delta brush

Question 22

NMDA Encephalitis is commonly associated with presence of?

Answer 22

Teratoma

Question 23

LGI1 Encephalitis occurs more commonly in what population?

Answer 23

Men

Question 24

LGI1 Encephalitis typically involves what type of seizures?

Answer 24

Faciobrachial dystonic seizures

Question 25

What complication is seen in 50% of LGI1 Encephalitis patients?

Answer 25

Sleep disturbance

Question 26

Abnormality of what area of the brain is seen in LGI1 Encephalitis patients?

Answer 26

Temporal lobe, especially hippocampus