CNS infections

Question 1

subdural abscess

Answer 1

infection may spread to subdural space from air sinuses or middle ear
traversed by brr aa, but these will not deliver abx
must be drained
IV abx

Question 2

normal CSF pressure

Answer 2

<200mm

Question 3

normal CSF protein

Answer 3

14-45mg

Question 4

normal CSF glucose

Answer 4

50% of serum

Question 5

normal CSF WBCs

Answer 5

0-10

Question 6

CSF pressure with bacterial meningitis

Answer 6

high&raquo_space;200

Question 7

CSF protein with bacterial meningitis

Answer 7

high

45-200

Question 8

CSF glucose with bacterial meningitis

Answer 8

very low, maybe 0

Question 9

CSF WBCs with bacterial meningitis

Answer 9

polys in 1000s

Question 10

CSF pressure w/viral meningitis

Answer 10

normal-slightly high

Question 11

CSF protein w/viral meningitis

Answer 11

normal-slightly high

Question 12

CSF glucose w/viral meningitis

Answer 12

normal

Question 13

CSF WBCs w/viral meningitis

Answer 13

monos 10-100s

Question 14

most common infectious agent of CNS

Answer 14

leptomenigitis

Question 15

common cause of bacterial meningitis in birth-2months

Answer 15

E.coli
Grp B strep
listeria

Question 16

common cause of bacterial meningitis in 2months-5yrs

Answer 16

strep pneumoniae
meningococcus
H. influenza (before vaccine)

Question 17

common cause of bacterial meningitis in older child/adult

Answer 17

Strep pneumoniae

N. meningitdis (epidemics)

Question 18

common cause of bacterial meningitis in elderly

Answer 18

S. penumoniae
E. coli
group B strep
listeria

Question 19

common viruses which cause encephalitis

Answer 19

arboviruses
CMV
herpes
HIV

Question 20

rare viral causes of encephalitis

Answer 20

rabies
Progressive Multifocal Leukoencephalopathy
Subacutre Sclerosing Panencephalitis

Question 21

herpes encephalitis clinical

Answer 21

HA, fever, stiff neck, drowsy, coma, neuro symptoms
fatal w/o rapid Tx
25-50% fatal w/Tx
long term sequel in survivors common

Question 22

neonatal vs adult herpes encephalitis

Answer 22

adults show predilection for frontal and temporal lobes, neonatal global

Question 23

rabies

Answer 23

variable incubation 10days-year
centripetal axonal transport to CNS
HAs, fever, malaise, dysphagia , stupor, coma, death

Question 24

rabies histo

Answer 24

negri bodies

inclusions of proteins made by virus in cytoplasm

Question 25

progressive multifocal leukoencephalopathy (PML)

Answer 25

- caused by polyomavirus (JC and BK) - latent in kidneys and B-cells in tonsils of most adults and sometimes the brain - reactivation w/in CNS or in peripheral tissues -> white matter damage - infects/destroys oligodendrocytes

Question 26

PML clinical

Answer 26

- infection in humans in generally asymptomatic - focal neurologic deficits that progress to cognitive impairment - fatal - Tx immunosuppression can lead to remission

Question 27

subacute sclerosing panencephalitis (SSPE)

Answer 27

rare in kids and adolescents several years after measles which usually occurs before 2 yrs of age present with school and behavioral issues -> seizures and motor problems -> to coma and death CSF increased IgG affects grey and white matter

Question 28

cryptococcosis

Answer 28

``` hematogenous dissemination from lung usually immunosupressed pts menigitis w/or w/o parenchymal cysts abscesses India ink CSF bird droppings ```

Question 29

TB

Answer 29

``` meningeal signs and cranial nn palsies basal meningitis granular meningeal surface granulomas in 10% vasculitis like herpes inflammatory response more common in base of brain ```

Question 30

bacterial cerebral abscesses

Answer 30

``` pts with infective endocarditis wound infection (post-op) ```

Question 31

cerebral absesses

Answer 31

HA, fever, seizures, focal signs mortality 10-30% w/Tx 50% have sequele

Question 32

aspergillosis

Answer 32

``` one of more common mycotic infections of nervous system spores, pulmonary entry hematogeneous spread immunosuppressed hemorrhagic infarcts and abscesses very high mortality even w/Tx ```

Question 33

neurocysticercosis

Answer 33

commonest parasitic infection of CNS leading cause of epilepsy worldwide pork meat can be asymptomatic become calcified

Question 34

toxoplasmosis in AIDs

Answer 34

CD4 <100 form abscesses usually subacute variable presentation Dx with imaging, CSF PCR

Question 35

cryptococcus in AIDs

Answer 35

CD4 <50 spreads from lungs chronic HA, fever, malaise Dx with CSF- increased ICP, culture, Ag+

Question 36

primary lymphoma in AIDs

Answer 36

``` CD4<100 DLBCL chronic decreased mental status HA, no fever, localizing signs Dx: imaging, Bx ```

Question 37

PML in AIDs

Answer 37

CD4 demyelination progession of multifocal symptoms in wks Dx with CT

Question 38

HIV dementia

Answer 38

CD4 <200 infection of neural cells w/direct and immune damage broad neuropsychiatric and motor deficits clinical Dx, imaging supportive

Question 39

CJD

Answer 39

subacute progressive dementia with EEG changes and CSF finding (increased protein 14-3-3) very long latent period no Tx- fatal can be sporadic, familial, iatrogenic, or variant Dx- western blot

Question 40

prions

Answer 40

porteinaceous infectious agents no nucleic acid not inactivated by typical steralization procedures

Question 41

PrPc

Answer 41

normal protein | alpha pleated sheet

Question 42

PrPsc

Answer 42

abnormal beta pleated sheet EXTREMELY protease resistant

Question 43

CJD histo

Answer 43

spongioform degeneration with axonal and neuronal death | gliosis

Question 44

Kuru histo

Answer 44

PAS stain | plaque formation

Question 45

autoimmune encepalitis

Answer 45

anti-NMDA R encephalitis | usually pts have tumor elsewhere that produces neural tissue -> Ab generation -> cross BBB attack self