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Neurology > CNS infections > Flashcards

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
Q

What are the CSF findings of aseptic meningitis?

A

Pleocytosis
Hypoglycrorrachia
Protein elevation

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26
Q

What are the usual viral causes of aseptic meningitis?

A
  • Enterovirus
  • arboviruses
  • HIV
  • HSV
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27
Q

What is the treatment for aseptic meningitis?

A

Supportive

28
Q

How does meningitis lead to seizures in the long term?

A

Scarring in the brain leads to an epileptic focus

29
Q

What are the two bugs that more commonly cause meningitis in immunosuppressed patients?

A
  • Listeria

- Strep monocytogenes

30
Q

Are PCRs done with aseptic meningitis? Why or why not?

A

No–does not change treatment plan

31
Q

Treatment for viral meningitis is supportive except for infections with which virus?

A

HSV

32
Q

What usually causes HSV encephalitis?

A

Reactivation from a trigeminal ganglion

33
Q

What is the presentation of HSV encephalitis?

A
  • Fever
  • HA
  • Changes in LOC
  • Bizzare CNS s/sx
34
Q

Why can there be RBCs in the CSF of pts with HSV encephalitis?

A

Hemorrhagic changes in the brain 2/2 infx

35
Q

What are the CT/MRI findings of HSV encephalitis?

A

Focal area of high attenuation

36
Q

What is the treatment for HSV encephalitis?

A

IV acyclovir

37
Q

What are the CSF findings of HSV encephalitis?

A

5-500 WBCs

-Decreased glucose

38
Q

How are the s/sx of HIV caused meningitis, as opposed to other viral causes of meningitis?

A

No real difference, but may progress to dementia

39
Q

What are the two focuses of lyme disease?

A
  • Minnesota/wisconsin

- Northeast

40
Q

What is the classic neurological findings of lyme disease?

A

Bell’s palsy

41
Q

What is chronic lyme disease?

A

Nonspecific s/sx of unknown cause

42
Q

What is the definition of acute meningitis?

A

Less than a 4 week duration

43
Q

What are the protein findings of aseptic, septic, and chronic meningitis?

A 
Aseptic = mild increase
Septic = High protein
Chronic = High protein
44
Q

What are the WBCs that characterize chronic meningitis?

A

Moderate monocytic pleocytosis

45
Q

What are the usual causes of chronic meningitis?

A

Fungal
TB
Sarcoidosis

46
Q

How does the clinical presentation of chronic meningitis compare to acute?

A

Usually more subtle

47
Q

How do you diagnose chronic meningitis?

A

MRI with contrast

CSF

48
Q

Why is gadolinium used with MRIs in diagnosing meningitis?

A

Breakdown of the BBB leads to uptake of the Gd by the meninges

49
Q

What causes TB meningitis?

A

Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space

50
Q

True or false: TB encephalitis is usually caused by hematogenous spread of bacilli

A

False–Discharge of bacilli from tubercles within the brain or meninges into the subarachnoid space

51
Q

What causes CN involvement with TB meningitis?

A

Thick, gelatinous exudate

52
Q

What causes hydrocephalus with CNS TB?

A

Blockage of CSF flow from exudate

53
Q

How does TB meningitis usually present, relative to usual meningitis?

A

Slower onset, with cranial neuropathies, and hemiparesis

54
Q

What are the CSF findings of TB, in terms of:

  • WBCs
  • Protein
  • Glucose
A
  • Increase lymphocytes
  • Normalish protein
  • Decreased Glucose
55
Q

What is the treatment for TB meningitis? Duration?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

6-18 months

56
Q

What is the major challenge in treating TB meningitis?

A

BBB

57
Q

What is the prognosis of TB meningitis?

A

25%, with worse outcomes at age extremes

58
Q

Who usually gets Progressive multifocal leukoencephalopathy?

A

Immunosuppressed patients

59
Q

What is the infectious agent that causes PML?

A

JC papovavirus

60
Q

What is the presentation of PML?

A

Insidious progression of dementia with focal findings

61
Q

What are the MRI findings of PML?

A

Non-enhancing multifocal white matter lesions

62
Q

What are the CSF findings of PML?

A

Protein elevation

63
Q

What is the presentation of Prion diseases?

A

Progressive dementia

64
Q

Who gets Kuru?

A

South sea islanders who participate in eating the dead

65
Q

What, besides progressive dementia, does Creutzfeldt-Jakob disease present with?

A
  • Hemianopsia
  • Ataxia/focal weakness
  • Myoclonus

Neurology (23 decks)

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