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MDCN 450: Course 5 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

T/F you can do a lumbar puncture when they have a raised ICP

A

false. Do a ct head and fundoscopy first. if a mass or papilledema is present–> do not puncture

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2
Q

T/F you can do a LP when the INR is >1.4

A

false.

Lumbar Punctures

When NOT to:

  • Raised ICP: do a CT head and fundoscopy first. If a mass or papilledema is present→ DO NOT PUNCTURE!!
  • Bleeding risk: INR>1.4, or platelets <50.
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3
Q

T/F meningitis causes a focal neuro deficit

A

false. it is an infection of the meninges as a whole.

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4
Q

Fever, neck stiffness, change in mental status, focal neurological signs, seizures, petechial rash

A

Bacterial meningitis–> should isolate patient immediately

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5
Q

key infections that cause meningitis

A

Neonates: group B strep, E Coli, listeria monocytogenes

infants/children: strep pneumo, N. meningitis, Hib

adolescents/young adults: strep pneumo, N. meningitidis

Older adults: strep pneumo, N. meningitidis, listeria monocytogenes.

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6
Q

Risk factors of meningitis

A

patients with a splenectomy, sickle cell anemia, CSF leak, cochlear implants, those who are immunocompromised

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7
Q

these two MSK signs can help diagnose bacterial meningitis

A

Brudzinski’s sign: hip flex in response to knee flexion

Kernigs sign: pain in hamstring with knee extension

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8
Q

When to skip the lumbar puncture and start treatment for bacterial meningitis (PIGCSF)

A

P: papilledema

I: Immunocompromised

G: GSC ov 10 or lower

CNS seizures

S: seizures

F: focal neuro deficit.

immediately start ceftriaxone, vancomycin and steorids.

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9
Q

if a patient is over 65, what should you add to the meningitis ABX treatment?

A

add ampicillin in addition to the ceftriaxone, steroids and vanco

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10
Q

vaccination that can prevent against meningitis

A

pneumococcal conjugate vaccine

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11
Q

Tubercular Meningitis management (RIPE)

A

rifampin

isoniazid

pyrazinamide

ethambutol

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12
Q

outline how tubercular meningitis CBC profile changes upon duration of the disease

A

Investigations: MRI: cavitation lesions in the brain. LP: TB features, shifts from PMN dominant (day 1-21), and thne switches to lymphocytes

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13
Q

Identify the cerebrospinal fluid (CSF) profiles associated with bacterial, viral, fungal, syphilitic, and tuberculous neurological infections

Elevated WBC: lymphocytes suggest __ or __. ___ suggest bacterial

Elevated RBCs/xanothochromia: __ tap, __

Glucose: if low, __ infection. If normal, __/__ infections

Protein: __= viral, fungal, if __– bacterial

A

Elevated WBC: lymphocytes suggest viral or fungal. Neutrophils suggest bacterial

Elevated RBCs/xanothochromia: Traumatic tap, HSV

Glucose: if low, bacterial infection. If normal, viral/fungal infections

Protein: normal= viral, fungal, if elevated– bacterial

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14
Q

LP tap profile in someone with HIV

A

LP would be normal. Management is with HAART

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15
Q

PNS and CNS symptomsof HIV

A

PNS: myositis, distal sensory polyneuropathy, muscle pain. Autonomic involvement. Acute/chronic inflammatory demyelinating polyradiculopathy:lymphocytes+protein in CSF

CNS: motor neuron disease-like illness9 mix of UMN and LMN),

HIV-associated vacuolar myelopathy: in 50% of HIV patient on autopsy. UMN signs, autonomic signs (ED, urinary incontinence), progressive sensory deficits in the legs

  • Dementia
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16
Q

Herpes Zoster (shingles)

Definition: reactivation of latent ___ __ virus

Symptoms: sharp burning itch with __→ very painful

Management:

Prevention: __ (over 50), Zostivax (over 60)

During the infection: __.

A

Herpes Zoster (shingles)

Definition: reactivation of latent varicella zoster virus

Symptoms: sharp burning itch with allodynia→ very painful

Management:

Prevention: Shingrix (over 50), Zostivax (over 60)

During the infection: acyclovir.

17
Q

Post Herpetic Neuralgia (PHN)

Definition: pain ___+ after ___

Management:

1st line: ___ + capsaicin skin patches

2nd line: ___ and __

3rd line: notriptiline, __, venlafaxine

4th line: __

A

Post Herpetic Neuralgia (PHN)

Definition: pain 2mo+ after shingles

Management:

1st line: lidocain + capsaicin skin patches

2nd line: lyrica and gabapentin

3rd line: notriptiline, amitriptylin, venlafaxine

4th line: opioids

18
Q

person comes in with fever, headache, back pain, fatigue, pharyngitis, conjunctivitis, and a tremor and confusion.

CSF shows lymphocyte pleocytosis, elevated protein and normal glucose

Dx?

A

elevated protein - more likely to be viral, normal glucose = less likely to be bacterial.

tremor and pharyngitis is key for WEST NILE VIRUS

19
Q

West Nile Virus

Symptoms: fever, headache, back pain, fatigue, __, __

Neurological: __ IN 94% of patients, myoclonus, parkinsonism, confusion.

Direct infection of __ horn cells causes __-like __ __ paralysis

Labs:

CSF: lymphocytic pleocytosis (<1000cells, median 170), normal or elevated __,normal __.

Viral serology: diagnostic standard

Imaging: meningeal, __, __ abnormalities

Management: supportive

A

West Nile Virus

Symptoms: fever, headache, back pain, fatigue, pharyngitis, conjunctivitis

Neurological: TREMOR IN 94% of patients, myoclonus, parkinsonism, confusion.

Direct infection of anterior horn cells causes poliomyelitis-like acute flaccid paralysis

Labs:

CSF: lymphocytic pleocytosis (<1000cells, median 170), normal or elevated protein,normal glucose.

Viral serology: diagnostic standard

Imaging: meningeal, thalamic, BG abnormalities

Management: supportive

20
Q

Brain Abscess:

Definition: inflammation and collection of infected material, coming from local (ear infection, dental abscess, infection of paranasal sinuses, infection of the mastoid air cells of the temporal bone, epidural abscess) or remote (lung, heart, kidney). Infectious sources, within the brain tissue

Symptoms? Etiology? Management?

A

Symptoms: headache, confusion, slurred speech, weakness, numbness, +/- LOC, +/-twitching of arm or leg

Etiology: usually polymicrobial

S.viridans, S.milleri, S.aureus, S.pneumo, B.fragilis commonly found - Nocardiosis to be considered

Natural Course:

  • Day 1-2: cerebritis
  • Day 2-7: Central Necrosis
  • Day 5-14: Early encapsulation
  • Day 14+: late encapsulation

Management: vanco+penicillin + flagyl + ceftriaxone + dexamethasone + surgical drainage

Complications: Meningitis, ventriculitis

21
Q

Classic triad for spinal epidural abscess

A

Symptoms: Classic Triad= back pain + fever + neurological deficit

Etiology: staph from IVDU, endocarditis, UTI, lung infections→ STAPH AUREUS #1

Risk factors: immunocompromised, alcoholic, diabetes

Investigations: STAT MRI with contrast or CT with contrast, blood cultures, urinalysis + culture, sputum cultures

Management:

Empiric ABX: Vancomycin + ceftriaxone

Neurosurgery decompression stat.

22
Q

1 cause of adult-onset seizures in the world

A

Neurocysticercosis

Etiology: pork/pig tapeworm

Epi: #1 cause of adult-onset seizures in the world

Time from infection → symptomatic can be 6 months to 30 years (average 5 years)

Signs and Sx: seizures, long term muscle pain. Symptoms can take years to occur after infection. Will see cyst with dot inside.

Treatment: albendazole.

*Order an X-ray of thighs.

23
Q

Outline the stages of lyme disease. Maangement?

A

3 stages:

Erythema Migrans (2-30 days)

Weeks to months later: 2nd stage→ systemic features

  • Cardiac: arrhythmias, myopericarditis, ventricular dysfunction
  • Neurologic; viral meningitis (headache, stiff neck, mildly wrong CSF), cranial neuropathy, polyneuropathy, radiculopathy, polyradiculopathy, polyradiculoneuropathy
  • Pain, numbness, paraesthesias, weakness, decreased DTRS in a specific pattern
  • Brachial plexopathy, lumbosacral.

3rd stage: months to years

  • Cardiac: carditis
  • Large joint arthritis
  • Neurologic: chronic encephalomyelopathy: memory dysfunction, mild cognitive changes, psychiatric symptoms.

Management: doxycycline or minocycline

24
Q

Rapidly progressive dementias:

A

Viruses: HSV encephalitis, HIV dementia, progressive multifocal leukoencephalopathy (PML

Fungal infections: parasites

Syphilis

creutzfeldt-Jakob disease (CJD)

25
Q

Neurosyphilis

Etiology: treponema pallidum

Symptoms: Rapidly progressive cognitive and personality changes and dementia, loss of __ ___ sensation, non-reactive pupils

Main form of treatment?

A

Neurosyphilis

Etiology: treponema pallidum

Symptoms: Rapidly progressive cognitive and personality changes and dementia, loss of dorsal column sensation, non-reactive pupils\

Stages of Syphilis:

  • Primary (3-90d): chancre (genital ulcer)
  • Secondary (4-10wk): fever, headache, rash, generalized lymphadenopathy, alopecia, hepatitis, GI/renal symptoms, wart-like lesions on genitalia
  • Tertiary (2-15yr): meningeal syphilis (headache, photophobia, N/V, cognitive changes, CN palsies, seizures), tabes dorsalis (loss of coordination of movement, sensory ataxia, shooting pains, loss of dorsal column function), meningovascular disease (inflammation of CNS vessels leading to thrombosis and infarction- usually MCA), chronic meningoencephalopathy (progressive dementia, neuropsych, personality changes, emotional lability, fatigue, sleep disturbances)
  • Latent: positive serology with no signs/symptoms

MANAGE WITH PENICILLIN G

Investigations:

  • CSF (send to venereal disease research lab)
  • Serum (send to rapid plasma regain) Management: penicillin G

Management: Penicillin G

26
Q

HSV Encephalitis

Symptoms: like bacterial meningitis (headache, photophobia, sore neck), seizures, confusion, behavioural changes, aphasia

Investigations:

  • LP (xanthochromia due to hemorrhage not just traumatic tap; PCR)
  • MRI
  • EEG

Management: IMMEDIATELY r____ ___

Complications: mortality rate is 20%

A

HSV Encephalitis

Symptoms: like bacterial meningitis (headache, photophobia, sore neck), seizures, confusion, behavioural changes, aphasia

Investigations:

  • LP (xanthochromia due to hemorrhage not just traumatic tap; PCR)
  • MRI
  • EEG

Management: IMMEDIATELY IV acyclovir

Complications: mortality rate is 20%

27
Q

An opportunistic infection seen in immunosuppressed patients, which is often laying dormant in the kidney. Tends to target oligodendrocytes and cause demyelination. There is no treatment.

A

Progressive Multifocal Leukoencephalopathy (PML)/ John Cunningham (JC) Virus

Definition: opportunistic infection seen in immunosuppressed patients (HIV, immunosuppressant meds)

Epi: most people have latent JC virus (in their kidney)

Mechanism: targets oligodendrocytes → demyelination

Symptoms: vary based on where in the brain infects. “Usual” symptoms are confusion, weakness, visual field cuts (homonymous hemianopia), sensory changes, gait impairment. New neuro symptoms in a immunosuppressed individuals

Investigations: MRI (multiple lesions) + CSF + PCR are needed for dx

Management: no treatment, treat underlying (treat HIV or stop immunosuppressants)

Prognosis: serious neurological deficits are common

28
Q

Definition: a prion disease leading to degeneration of brain

Symptoms: cognitive decline, myoclonus, weakness, ataxia, visual field deficits

A

Creutzfeldt Jakob disease CJD

29
Q

T.Gondii can cause encephalitis, lymph node/liver/spleen enlargement, pneumonitis, chorioretinitis. What is the prophylactic treatment and management for this?

A

Management:

  • Prophylaxis: septra
  • Treatment: pyrimethamine + sulfadiazine + folinic acid (to avoid bone marrow toxicity)
30
Q

A hippy in vancouver comes in with

headache, moody, arm weakness, bilateral tonic-clonic seizure.

What do you suspect and how do you treat?

A

Cryptococcus Gattii Meningitis:

Etiology: hotspot in Canada is Vancouver Island– spores found in nature

Treatment: sulfadiazine and pyrimethamine, folinic acid.

Symptoms: headache, moody, arm weakness, bilateral tonic-clonic seizure.

31
Q
A

MDCN 450: Course 5 (34 decks)

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