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
4) Seizure
5) Confusion

Question 6

What signs/symptoms of meningitis are seen on 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
3) Constant crying/irritability
4) High Fever

Question 7

What is the general antimicrobial therapy given for meningitis?

Answer 7

1) Vancomycin
2) Ceftriaxone
3) Dexamethasone (Bacterial meningitis)

Question 8

When examining the CSF in bacterial meningitis, what is the

1) Opening Pressure
2) WBC count
3) Cell Differential
4) Protein Level
5) Glucose Level

Answer 8

1) Elevated
2) Greater than 1,000 per mm^3
3) PMN mostly
4) Mild to marked elevated
5) Normal to decreased

Question 9

When examining the CSF in VIRAL meningitis, what is the

1) Opening Pressure
2) WBC count
3) Cell Differential
4) Protein Level
5) Glucose Level

Answer 9

1) Normal
2) <100 per mm3
3) Lymphocytes predominately
4) Normal to elevated
5) Normal

Question 10

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

Answer 10

Viruses

Question 11

What are common causes of infection encephalitis in an adult?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Temporal lobes

Question 14

What is the treatment for Herpes Simplex 1 encephalitis?

Answer 14

Acyclovir

Question 15

What occurs in autoimmune encephalitis?

Answer 15

Rapid Progressive (<6 weeks) Encephalopathy or Psychiatric disturbances, especially with seizures

Question 16

What are the two most common etiologies of autoimmune encephalitis?

What are the treatments?

Answer 16

1) NMDA Encephalitis
2) LGI1 Encephalitis

-Combination of Immune therapies (Steroids, IVIG, Rituximab)

Question 17

NMDA Encephalitis most commonly affects what population?

Answer 17

Young or middle-aged women

Question 18

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

Answer 18

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 19

What EEG finding is associated with NMDA Encephalitis?

What will CSF find?

Answer 19

Extreme delta brush

Pleocytosis or oligoclonal bands and/or NMDA receptor antibodies

Question 20

NMDA Encephalitis is commonly associated with presence of?

Answer 20

Teratoma

Question 21

LGI1 Encephalitis occurs more commonly in what population?

Answer 21

Men

Question 22

LGI1 Encephalitis typically involved what type of seizures?

Answer 22

Faciobrachial dystonic seizures

Question 23

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

Answer 23

Sleep disturbance

Question 24

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

Answer 24

Temporal lobe, especially hippocampus