CNS Infection IV

Question 1

symptoms of brain abscesses

Answer 1

– Rapid

– Headache, Changes in mental status, Generalized seizure

Question 2

predisposing condition and organisms if brain abscess is at frontal site

Answer 2

• sinusitis and dental abscesses

- Streptococci, Bacteroides, S. aureus, Haemophilus spp.

Question 3

predisposing condition and organisms if brain abscess is at temporal site

Answer 3

• otitis media and mastoiditis

- Streptococci, Bacteroides, Enterobacteriacea

Question 4

predisposing condition and organisms if brain abscess is at frontal, temporal, and parietal site

Answer 4

• Trauma, Penetrating wound

- S. aureus, Clostridia

Question 5

predisposing condition and organisms if brain abscess is at multiple site

Answer 5

• Infective endocarditis, Congenital Heart Disease, Lung abscess
• S. aureus, Streptococci (viridans), Fusibacteria, Nocardia

Question 6

fungal brain abscesses

Answer 6

– Candida sp
– Aspergillus sp.
– Cryptococcus sp
– Histoplasma capsulatum 
– Blastomyces dermatitidis

Question 7

diagnosis of brain abscesses

Answer 7

– CT scan
– Hypodense centre
– Peripheral uniform ring
– Brain oedema

Question 8

clinical presentation of subdural and epidural empyema

Answer 8

headache

fever (higher than 39oC)

Question 9

etiology of subdural and epidural empyema

Answer 9

– Streptococci (25-45%)
– Staphylococci (10-15%)
– Enterobacteriacea (3-10%) 
– Anaerobic bacteria (33%) 
– Polymicrobial

Question 10

predisposing factor for subdural empyema

Answer 10

sinusitis (male to female: 3 to 1)

Question 11

how do you diagnose epidural empyema

Answer 11

MRI pachymeningeal enhancement, superficial area of diminished intensity

Question 12

what are prions

Answer 12

infectious proteins that are resistant to formaldehyde, dry heat, boiling, ethanol, and ionizing radiation

Question 13

disease of Prions

Answer 13

– Transmissible Spongiform Encephalopathies (TSE)

• Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, familial fatal insomnia, Kuru

Question 14

biology of prions

Answer 14

– Normal cellular glycoprotein: PrPc (↑ 􏰈 alpha helix, ↓ beta 􏰆􏰆􏰇􏰇helix)
– Infectious glycoprotein form: PrPsc (↓􏰈 alpha helix, ↑ 􏰆 beta helix)
– Aggregates in neurons (myeloid plaques)
– Spongy cerebrum (vacuoles in cortex & cerebellum)

Question 15

are most cases of prions sporadic or familial

Answer 15

sporadic

Question 16

how does on get prion diseases

Answer 16

eating undercooked beef

Question 17

clinical feature of prions

Answer 17

– Nonspecific prodromal symptoms (1/3 CJD patients): fatigue, sleep disturbance, weight loss, headache, malaise, and ill-defined pain

– Most higher cortical function deficits.
• Progress over weeks-months: profound dementia (memory loss, impaired judgment, 􏰅􏰅intellectual function

Question 18

how does one get Tania solium and what is a big symptom

Answer 18

uncooked pork

neurocystercosis

Question 19

what does negleria and acanthamoba lead to?

Answer 19

• Negleria
– primary amebic meningoencephalitis (PAM)
• Acanthamoba
– Granulomatous Amebic Encephalitis (GAE)

Question 20

what is the most common cause of brain abscess in immunocompromised people like AIDs patients

Answer 20

toxoplasmosis - toxoplasma gondii

multi ring lesions that involve the basal ganglia

Question 21

how long after exposure does it take to see symptoms to nagleria and how long till death?

Answer 21

• 1 day to 1 week week after exposure –> symptoms

- death at 7-14 days for 97% of those infected

Question 22

what are symptoms of nagleria

Answer 22

• Headache
• Fever
• Nausea, vomiting
• Confusion
• Rapidly worsen over 3‐7 days

Question 23

pathogenesis of nagleria

Answer 23

starts at the amoeba olfactory nerve –> migrates to olfactory bulbs –> feeds on nerve tissue –> necrosis and hemorrhaging –> migrates along nerve fibers –> enters the floor of the cranium via the cribriform plate and into the brain –> consume cells of the brain a amoebostome (a unique actin‐rich, sucking apparatus extended from its cell surface)

Question 24

treatment of nagleria

Answer 24

– Amphotercin B (only shown effective in vitro)

– Combined Miconozole, Sulfadiazine and Tetracycline shows “some” benefit

Question 25

who does acanthamoeba affect

Answer 25

people with compromised immune systems

Question 26

symptoms of acanthamoeba

Answer 26

• headache, confusion
• nausea, vomiting, fever
• lethargy, stiff neck
• focal neurologic deficits
• signs of increased intracranial pressure

Question 27

treatment of acathamoeba and how many survive

Answer 27

Combined Miconozole, 5‐ fluorocytocine “some” benefit

almost 100% dies

Question 28

causes cerebral malaria

Answer 28

Plasmodium falciparum

Question 29

symptoms of plasmodium falciparum

Answer 29

unarousable coma which leads to death if left untreated

Question 30

used to treat neurocystercosis

Answer 30

Albendazole and praziquantel