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Neuro > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What is another name for a leptomeningeal inflammation?

A

meningitis

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2
Q

What are the types of penchymal inflammation?

A

encephalitis, cerebritis, myelitis

brain abscess

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3
Q

What is another name for subdural or epidural inflammation?

A

subdural/epidural empyemas

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4
Q

How does infection get into the brain?

A 
arterial spread
retrograde venous spread
local extension (air sinuses, infected tooth)
neural route (PNS--->CNS)
direct implantation (trauma, iatrogenic)
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5
Q

What does the word neurotropism mean?

A

having a special affinity for nervous tissue

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6
Q

What is the most common cause of meningitis?

A

strep pneumo

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7
Q

What are the clinical signs/symptoms of meningitis?

A

headache, photophobia, stiff neck (nuchal rigidity), clouded consciousness, fever

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8
Q

What are the 4 clinical types of meningitis?

A

hyperacute 1 wk

aseptic

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9
Q

What are the key features of hyperacute meningitis?

A 
meningococcal meningitis (n. gonorrhea)
sparse inflammation, numerous organisms, congestion
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10
Q

Waht are the key features of acute meningitis?

A

usually bacterial
from hematogenous spread
exudate present, numerous PMNs in subarachnoid space

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11
Q

What are the key features of subacute/chronic meningitis?

A

TB, syphillis
brain parenchyma commonly affected as well
lymphocytes, plasma cells, macrophages in exudate

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12
Q

What are the key features of aseptic meningitis?

A

usually viral
much less fulinant than bacerial meningitis and less severe sx
summer and early fall
lymphocytic infiltrate in meninges

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13
Q

What are come complications of bacterial meningitis?

A

brain infarcts
phlebitis (which may cause infarction of underlying brain tissue)
secondary vasculitis

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14
Q

What organisms commonly cause aseptic meningitis?

A

arboviruses

enterovirus (most common) [echovirus, coxsackie]

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15
Q

What are the clinical signs/sx of brain abscesses?

A

focal deficits, raised IC pressure

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16
Q

What are brain abscesses usually caused by in immunecompetent hosts?

A

strep

staph

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17
Q

How do brain abscesses like to spread?

A

toward the ventricles

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18
Q

What are some common abscess cuasing pathogens in immunocomprimised hosts?

A 
toxoplasma
nocardia
listeria
gram neg bacilli
mycobacteria
fungi
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19
Q

What is encephalitis?

A

inflammation of brain parenchyma
if in spinal cord-myelitis
if meninges and brain-meningoencephalitis

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20
Q

What are common causes of bacerial meningoencephalitis?

A

TB
syphilis
Lyme disease

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21
Q

What do you find in the CSF with TB meningoencephalitis?

A

elevated pressure and protein
decreased glucose
lymphocytic pleocytosis
cultures for AFB positive in 50%

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22
Q

What are signs and symptoms of TB in the CNS?

A

headache
lethargy
confusion
vomiting

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23
Q

What does TB in the CNS look like on gross examination?

A

mass lesion with central necrotic core or caseation, surrounded by fibroblasts, epitheliod histocytes, giant cells and lymphocytes

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24
Q

What is another name for TB osteomyelitis?

A

spondylitis/pott’s disease

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25
Q

What is TB osteomyelitis?

A

granulomatous process involving vertebral bodies and discs
causes epidural abscesses
can lead to cord compression & vertebral collapse

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26
Q

Describe neurosyphilis?

A

tertiary states

months-yrs after initial infection

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27
Q

What are the major forms of neurosyphilis?

A 
general paresis (paretic neurosyphilis)
meningovascular
tabes dorsalis
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28
Q

What are the key features of general paresis?

A

gradual impairment of cognition/attention
thickened meninges and atrophic brain
meningeal & parenchymal perivascular lymphocytes, plasma cells, microglia

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29
Q

What are the key features of meningovascular type neuropyphilis?

A

chronic meningitis and multifocal arteritis
severe at base of brain
causes infarcts and hydrocephalus
meningeal & arrterial/arteriolar lymphocytes and plasma cells with collagenous thickening of wall and eventual occlusion
focal neuro deficits due to vascular compromise 2ary to arteritis

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30
Q

What are the key features of tabes dorsalis?

A

chronic inflammation in dorsal roots and ganglia w/loss of neurons and assoc. deg of posterior columns
“lightening pains” or paraesthesias in affected roots, loss of position/vibratory sense, shuffling broad based gait

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31
Q

What are key general features of viral (meningo)encephalitis?

A

perivascular lymphocytes
microglial nodules
neurnophagia

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32
Q

What specific organisms commonly cause viral meningoencephalitis?

A

arobvirus
herpes virus
HIV
progressive multifocal leukoencephalopathy

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33
Q

Which virus is the most common cause of psoradic acute viral encephalitis in temperate climates?

A

HSV1

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34
Q

What are signs of HSV infection in the CNS?

A

headache, fever, modd, memory, behavior abnormalities, drowsiness, coma

35
Q

What is seen in HSV1 CNS infection on MRI?

A

focal abnormalities in frontal or temporal lobes

36
Q

What is seen in the CSF with a HSV1 CNS infection?

A

increased pressure
lymphocytic pleocytosis
elevated prtein
PCR for HSV1 DNA

37
Q

What are gross findings of acute HSV encephalitis?

A

congestion, swelling, hemorrhagic necrosis of temporal lobs, insula, cingulate gyri, orbital cortex

38
Q

What is the most common opportunist viral infection in AIDS patients? What does it cause?

A

CMV

subacute encephalitis

39
Q

What demographic most commonly gets HSV2 meningitis?

A

neonates passing through birth canal in mother with active HSV2 infection

40
Q

What are the signs/symptoms of arboviral meningoencephalitis?

A

seizures, confusion, stupor, delirium, coma & focal signs

41
Q

What types of arboviral meningoencephalitis are common in the US?

A 
west nile
easter, western equine
venezuelan
st louis
california
42
Q

How does HIV infection enter the CNS?

A

by infecting microglia

43
Q

What are the types of HIV involvement in the CNS?

A

HIV meningitis
HIV encephalitis/leukoencephalopathy
vacuolar myelopathy

44
Q

When does HIV meningitis occur?

A

during acute flu-like illness at time of seroconversion

45
Q

What are the clinical signs and symptoms of HIV encephalitis/leukoencephalopathy?

A

AIDS demential complex-cognitive and behavioral deterioration, eventually dementia, ataxia and tremor

46
Q

What classic lesion is seen in HIV encephalitis/leukoencephalopathy?

A

microglial nodules containing multinucleated (giant) microglial cells (contain HIV virus)

47
Q

What are hte key features of progressive multifocal leukoencephalopathy?

A

immunosuppressed hosts
caused by JC virus, which infects oligodendrocytes
JC virus infection during adolescence, reactivated w/immunosuppression

48
Q

What are the histologic findings associated with PML?

A

enlarged oligodendrocyte nuclei immunostained for JC virus, at ege of area of early myeloin loss
oligodendrocyte inlcusion
irregular porrly defined areas of demyelination

49
Q

What gross examination findings are associated wiht PML?

A

small foci of gray discoloration in white matter

50
Q

What is seen on gross examination of cerebral toxoplasmosis?

A

mutliple localized necrotic lesions

51
Q

What histologic findings are seen with cerebral toxoplasmosis?

A

tissue necrosis
toxo organisms lying free in tissue
organisms within pseudo cytes

52
Q

Who gets cerebral toxoplasmosis?

A

fetus if infection occurs during pregnancy

immunocompromised hosts, esp AIDS pts

53
Q

What are common fungal pathogens that can cause meningoencephalitis in immunocompromised hosts?

A

candida, mucor, aspergillus, cryptococcus, histoplasma, coccidiodes, blastomyces

54
Q

Which fungi will most commonly cause secondary vasculitis?

A

aspergillus and murcor

55
Q

What does aspergillus brain infection look like?

A

multiple foci of hemorrhagic necrosis with brain necrosis with inflammation
may see vessel wall infiltration by fungal hyphae

56
Q

Where does cryptococcus spread to the brain from?

A

the lungs

57
Q

What are the main forms of cryptococcus in the CNS?

A

meningitis with or without brain parenchymal cysts (encephalitis)
abscesses (cryptococcomas)

58
Q

What CSF findings are present with fungal infection?

A

lymphocytes, hihg protein, normal or reduced glucose

59
Q

What does cryptococcus infection look like on gross exam?

A

thickened meninges, esp over the sulci

multiple intraparenchymal cysts “soap bubbles”

60
Q

What histologic findings are seen in cryptococcal meningitis?

A

organisms are single round year forms surrounded by capsule

minimal inflammatory reaction

61
Q

What parasites besides toxoplasma can cause CNS infection?

A

amoeba
plasmodium (malaria)
trypanosoma
cystercercus (taenia solium)

62
Q

What causes most epidural and subdural empyemas?

A

staph and strep

via: frontal or mastoid sinusitis, otitis media, trauma, osteomyelitis or surgery

63
Q

In what case can a CSF profile be misleading?

A

if tx already started

64
Q

Which organism that causes meningitis also casues skin pettechiae?

A

neisseriea menigitidis

65
Q

What populations does listeria monocytogenes cause menigitis in?

A

neonates, elderly, immunocomp.

also in alcoholics

66
Q

When is e. coli meningitis seen?

A

in neonates, nosocomial

67
Q

If a patient has AIDS and meningitis sx for a few weeks what organisms do you suspect?

A

1) crypto

2) TB

68
Q

If someone presents with a less severe form of meningitis in the summer what organisms do you think may be causing?

A

enterovirus/aseptic

69
Q

If you suspect meningitis what do you do?

A

LP

70
Q

If CSF has increased WBC count and left shift what do you suspect?

A

bacterial infection

71
Q

If CSF has high mononuclear count what do you suspect?

A

fungus or TB

72
Q

What do increased lymphocytes in the CSF usually indicate?

A

fungus

73
Q

If glucose in the CSF is normal what do you suspect?

A

viral cause

74
Q

Which type of Abx MUST you use for meningitis?

A

CIDAL!!

75
Q

What is the tx of choice for s. pneumo meningitis?

A

IV ceftriaxone

76
Q

What is a good initial therapy for bacterial meningitis?

A

IV ceftriaxone, vancomycin, corticosteroids

77
Q

What abx is added if listeria suspected?

A

ampicillin

78
Q

What immunizations are available to try to prevent bacterial meningitis?

A

for pneumococcus, meningococcus and h influenza

79
Q

If you suspect viral meningitis but patient presents in summer what do you have to think of?

A

arboviruses

80
Q

What bacterial meningitis more commonly presents in summer?

A

lyme disease

81
Q

What pathogens are at the top of your ddx in a patient with focal neurologic deficits?

A

JC

toxoplasma

82
Q

If a patient has menigitis symptoms have been slowly worsening over a few months what type of disease do you have to include on the ddx?

A

prion disease

83
Q

Does syphilis present with acute or chronic meningitis?

A

can present with either

Neuro (14 decks)

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