CNS Flashcards
Methods for HSV Encephalitis diagnosis
EEG
MRI
Brain biopsy
CSF analysis with PCR
EEG findings in HSV encephalitis
periodic lateralizing epileptiform discharges
Diagnosis of VZV encephalitis
send CSF PCR and antibodies
PCR has low sensitivity
MR findings in VZV encephalitis
large vessel vasculitis and ischemia
Steroid indication with VZV encephalitis
if there is evidence of vasculopathy
HHV-6 encephalitis treatment
Ganciclovir or Foscarnet
MR findings in CMV encephalitis
subependymal gadolinium enchancement and non specific white matter changes
CMV encephalitis treatment
Ganciclovir and foscarnet
Three features of severe WNV
meningitis
encephalitis/meningoencephalitis
poliomyelitis with flaccid paralysis
Diagnosis of WNV
serum IgM antibody
CSF IgM
PCR CSF sensitivity less than 60%
Unique presenting feature of St Louis Encephalitis Virus
urinary symptoms, SIADH
Diagnosis of SLEV
Serology, CSF IgM
Clinical features of Japanese Encephalitis Virus
Seizures and parkinsonian features, poliomyelitis like flaccid paralysis
Classic patient population for JEV
children, rice field association
powassan virus vector
ixodes scapularis tick
clinical features of powassan virus
Parkinsonism, involvement of basal ganglia and thalamus
Tick borne encephalitis virus location
eastern Russia, central Europe
Tickborne encephalitis virus risks
unpasteurized milk or cheeses, SOT, rituximab
Tickborne encephalitis presentation
poliomyelitis like paralysis
PEP for Tickborne encephalitis
anti-TBE Immune globulin
eastern equine encephalitis virus feature of CSF
high WBC count >1000 with neutrophilic predominance
incubation period of rabies
20-90 days
rabies clinical presentation
encephalitic form
paralytic form
features off encephalitic rabies
agitation with alternating lucidity
hyper salivation
hydrophobia
bizarre behavior
progression to coma, death
features of rabies paralytic form
ascending paralysis, early muscle weakness
later cerebral involvement
association with NMDAR encephalitis
OVarian teratoma
check TVUS
association with NMDAR encephalitis
HSV encephalitis and later development of NMDAR antibodies
therapy for NMDAR encephalitis
Steroids, IVIG, PLEX
Rituximab or cyclophosphamide
possible presentation of enterovirus 71
rhomboencephalitis
ataxia, myoclonus, CN deficits
suppressive therapy role in recurrent HSV 2 meningitis
not indicated, associated with higher frequency of meningitis after cessation of drug
animals that transmit lymphocytic choriomeningitis virus
rats, rodents, mice, hamsters
more common in winter
association with enteric GN meningitis
disseminated strongyloidiasis in hyper infection syndrome
empiric therapy < 1 month
ampicillin, gentamicin, cefotaxime or cefepime
empiric therapy of meningitis 1-23 months
vancomycin plus 3rd gen ceph
empiric therapy 2-50
vanc plus 3rd gen ceph
older than 50
vanc, ampicillin, 3rd gen ceph
basilar skull fracture empiric therapy
vanc and 3rd gen ceph
head trauma, neurosurgery, CSF shunt empiric therapy
vancomycin plus cefepime/ceftazidime/meropenem
MIC cut off to use penicillin for pneumococcus
< or equal to .06
PCN MIC < 1 pneumococcus therapy
3rd generation ceph
PCN MIC 1 or greater pneumococcus therapy
vanc and 3rd generation ceph
Neisseria PCM MIC <1
penicillin or ampicillin
Neisseria MIC .1 to 1
3rd generation cephalosporin
H flu B lactase negative
ampicillin
H flu B lactamase positive
3rd generation cephalosporin
clinical feature of listeria meningitis
increased risk of seizures and focal neurologic signs
possible clinical presentation of listeria
rhombencephalitis
late development of ataxia, nystagmus and cranial nerve palsies
patient presenting with Gram Negative Meningitis. what is a possible risk for this
seen with strongyloides hyper infection syndrome
duration of treatment for listeria meningitis
21 days
duration of treatment for Neisseria meningitis
7 d
duration of treatment for E coli meningitis
21 d
what is the most common cause of viral meningitis
enterovirus
lymphocytic choriomeningitis virus risk factors
rodent infested houses
lab personnel
pet owners
