CNS infections

Question 1

meningitis is inflammation of which meningeal layers?

Answer 1

arachnoid and pia

Question 2

classic triad for meningitis?

Answer 2

• fever
• headache
• nuchal rigidity

Question 3

what is kernig sign?

Answer 3

resistance to passive extension at the knee

Question 4

what is brudzinksi sign?

Answer 4

spontaneous flexion of the knees and hips when neck is passively flexed

Question 5

what is the most common pathogen causing meningitis in people over 18?

Answer 5

s. pneumo

Question 6

when does imaging precede LP for meningitis diagnosis?

Answer 6

• new onset sz
• immunocompromised state
• focal findings
• decreased level of consciousness

Question 7

what is the normal value for CSF pressure?

Answer 7

60-180

Question 8

which WBC predominates in LP for meningitis?

Answer 8

neutrophils

Question 9

what is the treatment for bacterial meningitis? why?

Answer 9

• steroids

- critical event in pathogenesis of CNS complications is inflammatory reaction

Question 10

what is seen in CSF for viral meningitis?

Answer 10

• pleocytosis (lymphocytic vs PMNs)
• hypoglycorrachia
• mild protein elevation

Question 11

what is the most common viral pathogen causing viral meningitis?

Answer 11

enterovirus

Question 12

what is the clinical presentation of HSV encephalitis?

Answer 12

• global: fever, headache, change in LOC

- focal: bizarre behavior, aphasia, seizure, hemiparesis

Question 13

how is diagnosis made for HSV encephalitis?

Answer 13

attempt to localize to temporal lobe with MRI or EEG

Question 14

what are the CSF findings in HSV encephalitis?

Answer 14

• WBC: 5-500 lymphs
• frequently hemorrhagic
• mild increased protein
• decreased glucose

Question 15

• acute duration (under 4 weeks)

- mild-moderate monopleocytosis, nl glucose, mild inc in protein

Answer 15

viral

Question 16

• acute duration (under 4 weeks)

- significant PMN pleocytosis, low glucose, high protein

Answer 16

bacterial

Question 17

• chronic course (over 4 weeks)

- moderate monopleocytosis, low glucose, high protein

Answer 17

fungal, mycobacterial, noninfectious

Question 18

what are the noninfectious causes of chronic meningitis?

Answer 18

• neoplastic
• sarcoid
• vasculitis
• chemical meningitis

Question 19

how does meningitis from TB spread?

Answer 19

discharge from bacilli from tubercles within brain or meninges into subarachnoid space
- thick, gelatinous exudate produces basal meningitis placing CNs at risk

Question 20

what are the clinical symptoms of TB meningitis?

Answer 20

• headache, fever, meningismus, menal status changes
• cranial neuropathies
• hemiparesis

Question 21

what is used to treat progressive multifocal leukoencephalopathy?

Answer 21

natalizumab

Question 22

what is the pathophysiology of PML?

Answer 22

reactivation of endemic JC papovavirus

Question 23

what are the clinical symptoms of PML?

Answer 23

• insidious progression of dementia with focal findings
• behavioral, cognitive, and speech impairment
• hemiparesis, visual field defects

Question 24

how is diagnosis of PML made (tests / findings)?

Answer 24

• MRI: nonenhancing multifocal white matter lesions

- CSF: protein elevation, PCR for JC virus

Question 25

what are the focal deficits seen in CJD?

Answer 25

• hemianopia
• focal weakness, ataxia
• myoclonus

Question 26

what protein is detected in the CSF of patients with CJD?

Answer 26

14-3-3 protein