CNS Infections

Question 1

What pathogens are MC in adults, children, closed populations, immunosuppressed (including trauma and surgery), and neonates?

Answer 1

*

Question 2

What are the MC routes of CNS infections

Answer 2

• Vascular
  
  • MC via arteries
  • Venous
    
    • periocular
    • perinasal
• Direct Extension
  
  • Middle ear infx
  • Herpes in trigeminal ganglion
• Ascending neural
  
  • Rabies in peripheral axons

Question 3

Signs and symptoms of bacterial meningitis

Answer 3

*

Question 4

What is Kernig’s, Brudzinski’s, and Jolt accentuation?

Answer 4

*

Question 5

Causes of chronic meningitis

Answer 5

TFLS

Question 6

CSF findings in acute bacterial and chronic meningitis?

Answer 6

*

Question 7

Causes of viral meningitis

Answer 7

VE-AMMS-H (VEAMMSH)

Question 8

Treatment for meningitis

Answer 8

• Antibiotics
• Anti-Inflammatory
  
  • Dexamethasone

Question 9

How to counter effects of ICP

Answer 9

*

Question 10

Complications of meningitis

Answer 10

*

Question 11

Causes of viral encephalitis (where)

Answer 11

*

Question 12

Most important opportunistic iral infection in immunocompromised pt

Answer 12

CMV encephalitis

Question 13

CMV Encephalitis

Answer 13

• TORCH infxs
• Path: Hemorrhagic necrotizing encephalitits

Question 14

Poliomyelitis

Answer 14

• Viral Encephalitis**
• Oral/fecal route
  
  • starts with gastrointeritis
• Spreads to spinal cord via blood
  
  • anterior horn
• Flaccid paralysis**
• Severe cases: respiratory muscles
  
  • Iron lung**

Question 15

Rabies

Answer 15

• Single stranded RNA
• Ascending peripheral axons
• Negri bodies*
• Hippocampus*
• Purkinge cells*
• Brainstem*
• No inflammation
• Symptoms
  
  • Irritability
  • Seizures
  • Contracture of pharyngeal muscles
  • Delirium
• Tx
  
  • Vaccine
• If virus reaches brain –> DEATH**

Question 16

What part of the brain does herpes encephalitis affect?

Answer 16

Inferior and medial regions of temporal lobe

Question 17

Progressive Multifocal Leukoencephalopathy (PML)

Answer 17

• Oligodendrocyte infxn
• Myelin destruction
• Immunosuppressed pts
• Symptoms
  
  • Dementia
  • Ataxia
  • Abn speech and vision

Question 18

Cryptococcal Infection

Answer 18

• Inhalation of pigeon** stools (fungus)
• Opportunistic infxn
• Chronic meningitis**/meningoencephalitis
  
  • Fibrosis hydrocephaly
• Dx
  
  • Cryptococcus in CSF
• Untreated = Fatal

Question 19

Toxoplasmosis

Answer 19

• From Cats and Liter Boxes
• Opportunistic infxn
• Acute
  
  • extensive brain necrosis
• Affects
  
  • Basal ganglia
  • Brain stem
• Chronic
  
  • cystic leasions filled w/ necrotic material

Question 20

Complications of meningitis

Answer 20

• Deaf and blind (Hellen Keller)
• SIADH
• Hydrocephalus
• Seizures
• Etc

Question 21

• Where does the spinal cord end?
• Where do you do a LP?

Answer 21

• Ends at L2
• Between L3-L4 or L4-L5

Question 22

LP indications

Answer 22

• Dx of CNS infnx
• Subarachnoid hemorrhage (SAH)
• Infusion of anesthetic, chemo, or contrast in spinal canal
• Tx of Idiopathic Intracranial Hypertension (aka. Psuedotumor cerebri)
• Dx of demyelinating or inflammatory CNS process
  
  • MS
  • Guillain-Barre
  • Rule out ALS: nml CSF

Question 23

Contraindications to LP

Answer 23

• Absolute
  
  • Skin infnx over site
  • Papilledema
  • Focal neurological signs
• Relative:
  *

Question 24

Complications of LP

Answer 24

• Headache
• Back pain
• Seeding of infxn
• Uncal or transtentorial herniation