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CNS infections Flashcards

1
Q

What, technically, is meningitis?

A

Inflammation of the pia or arachnoid mater

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2
Q

What are the three major, noninfectious causes of meningitis?

A

Blood
Carcinoma
Sarcoid

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3
Q

What is encephalitis?

A

Inflammation of the brain parenchyma

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4
Q

What is meningoencephalitis?

A

Inflammation of meninges and the brain

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5
Q

What is myelitis?

A

Inflammation of the spinal cord

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6
Q

What is the classic triad for meningitis?

A

fever
HA
Stiff neck

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7
Q

Rash + meningitis = ?

A

Neisseria meningitidis

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8
Q

What is Kernig’s sign?

A

Resistance to passive extension at the knee

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9
Q

What is Brudzinski’s sign?

A

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

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10
Q

What are the age ranges for Neisseria meningitidis caused meningitis?

A

Young adults

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11
Q

What are the age ranges for Strep pneumo caused meningitis?

A

Adults over 18

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12
Q

What are the four conditions where imaging should precede LP?

A
  • New onset sz
  • Immunocompromised state
  • Focal findings
  • Decreased LOC
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13
Q

Where is the needle inserted with an LP?

A

L3/L4 interspace

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14
Q

What is the normal value for opening pressure with an LP?

A

60-180

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15
Q

What is the normal value of glucose in CSF?

A

45-80

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16
Q

What is the normal protein in CSF?

A

15-45

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17
Q

What is the normal WBC count in CSF?

A

Less than 5

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18
Q

What is the definition of hypoglycorrhachia?

A

CSF [glucose] is less than 60% of blood

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19
Q

What happens to the following with bacterial meningitis:

  • Opening pressure
  • WBCs
  • CSF:BG ratio
  • Protein
A
  • Opening pressure = more than 180
  • WBCs More than 10 (PMNs)
  • CSF:BG ratio Less than 0.31
  • Protein More than 50
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20
Q

What is the treatment for strep pneumonia caused meningitis?

A

Third or fourth generation cephalosporin

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21
Q

Why are steroids used in the treatment of meningitis?

A

To relieve the side effects of the inflammation on the brain

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22
Q

What is the steroid of choice for meningitis?

A

Decadron

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23
Q

What is the most common cause of meningitis: bacterial, fungal, viral, or parasitic?

A

Viral

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24
Q

Unless (___) occurs, viral meningitis is usually self limited.

A

Meningoencephalitis

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25
What are the CSF findings of aseptic meningitis?
Pleocytosis Hypoglycrorrachia Protein elevation
26
What are the usual viral causes of aseptic meningitis?
- Enterovirus - arboviruses - HIV - HSV
27
What is the treatment for aseptic meningitis?
Supportive
28
How does meningitis lead to seizures in the long term?
Scarring in the brain leads to an epileptic focus
29
What are the two bugs that more commonly cause meningitis in immunosuppressed patients?
- Listeria | - Strep monocytogenes
30
Are PCRs done with aseptic meningitis? Why or why not?
No--does not change treatment plan
31
Treatment for viral meningitis is supportive except for infections with which virus?
HSV
32
What usually causes HSV encephalitis?
Reactivation from a trigeminal ganglion
33
What is the presentation of HSV encephalitis?
- Fever - HA - Changes in LOC - Bizzare CNS s/sx
34
Why can there be RBCs in the CSF of pts with HSV encephalitis?
Hemorrhagic changes in the brain 2/2 infx
35
What are the CT/MRI findings of HSV encephalitis?
Focal area of high attenuation
36
What is the treatment for HSV encephalitis?
IV acyclovir
37
What are the CSF findings of HSV encephalitis?
5-500 WBCs | -Decreased glucose
38
How are the s/sx of HIV caused meningitis, as opposed to other viral causes of meningitis?
No real difference, but may progress to dementia
39
What are the two focuses of lyme disease?
- Minnesota/wisconsin | - Northeast
40
What is the classic neurological findings of lyme disease?
Bell's palsy
41
What is chronic lyme disease?
Nonspecific s/sx of unknown cause
42
What is the definition of acute meningitis?
Less than a 4 week duration
43
What are the protein findings of aseptic, septic, and chronic meningitis?
``` Aseptic = mild increase Septic = High protein Chronic = High protein ```
44
What are the WBCs that characterize chronic meningitis?
Moderate monocytic pleocytosis
45
What are the usual causes of chronic meningitis?
Fungal TB Sarcoidosis
46
How does the clinical presentation of chronic meningitis compare to acute?
Usually more subtle
47
How do you diagnose chronic meningitis?
MRI with contrast | CSF
48
Why is gadolinium used with MRIs in diagnosing meningitis?
Breakdown of the BBB leads to uptake of the Gd by the meninges
49
What causes TB meningitis?
Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space
50
True or false: TB encephalitis is usually caused by hematogenous spread of bacilli
False--Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space
51
What causes CN involvement with TB meningitis?
Thick, gelatinous exudate
52
What causes hydrocephalus with CNS TB?
Blockage of CSF flow from exudate
53
How does TB meningitis usually present, relative to usual meningitis?
Slower onset, with cranial neuropathies, and hemiparesis
54
What are the CSF findings of TB, in terms of: - WBCs - Protein - Glucose
- Increase lymphocytes - Normalish protein - Decreased Glucose
55
What is the treatment for TB meningitis? Duration?
Rifampin Isoniazid Pyrazinamide Ethambutol 6-18 months
56
What is the major challenge in treating TB meningitis?
BBB
57
What is the prognosis of TB meningitis?
25%, with worse outcomes at age extremes
58
Who usually gets Progressive multifocal leukoencephalopathy?
Immunosuppressed patients
59
What is the infectious agent that causes PML?
JC papovavirus
60
What is the presentation of PML?
Insidious progression of dementia with focal findings
61
What are the MRI findings of PML?
Non-enhancing multifocal white matter lesions
62
What are the CSF findings of PML?
Protein elevation
63
What is the presentation of Prion diseases?
Progressive dementia
64
Who gets Kuru?
South sea islanders who participate in eating the dead
65
What, besides progressive dementia, does Creutzfeldt-Jakob disease present with?
- Hemianopsia - Ataxia/focal weakness - Myoclonus

Neurology (23 decks)

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