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NBB1 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Encephalopathy

A

Altered brain function/change in consciousness

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2
Q

Encephalitis

A

Sudden onset brain inflammation

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3
Q

Brain Abcess (causes)

A
  • contiguous spread (sinus–>brain)
  • hematogenous seeding (bacteremia–>brain)
  • post-traumatic (injury, surgery leaving brain accessible)
  • cryptogenic (idk why)
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4
Q

Brain Abcess (locations)

A

frontal-temporal>frontal-parietal>cerebellar>occipital

-multiple regions = hematogenous spread

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5
Q

Brain abcess (pathogens)

A
  • streptococci, anaerobes, fungi

- NOT s. pneumo, H. influenza (they do meningitis)

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6
Q

Brain abcess clinical signs

A
  • headache
  • slow progressive- weeks
  • focal neurologic findings, seizures (since abcess presses on brain)
  • nausea/vomiting
  • fever+/- (unlike meningitis, +)
  • no nuchal rigidity (unlike mengitis)
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7
Q

Cranial Epidural Abcess

A
  • Usually related to frontal sinus disease/osteomyelitis

- Elliptical shape (Epidural–>”E”lliptical)

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8
Q

Cranial Subdural Abcess

A
  • Emergency (like subdural hematoma, also crescent moon)
  • Bacteremia related
  • headache/seizure common
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9
Q

Paraspinal abcess

A
  • Epi/subdural
  • bacteremia origin, can be contiguous spread
  • S. aureus most common (most common metastatic infection in general)
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10
Q

Spinal Subdural Abcess

A
  • radicular pain (999/1000 sciatica, but with further symtoms diagnose SSA)
  • urinary retention
  • constipation
  • leg weakness
  • hyperreflexia
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11
Q

Spinal Epidural Abcess

A
  • Thoracic>Lumbar>Cervical
  • Cord compression symptoms (radicular pain, urinary retention, constipation, hyperreflexia, leg weakness)
  • Vertebral osteomyelitis common
  • CSF shows Polys, elevated protein, normal/low glucose (indicating bacterial infection), can be culture -
  • Posterior>anterior but presents the same
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12
Q

Chronic Meningitis

A

Can be infectious/noninfectious

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13
Q

Chronic Meningitis (infectious)

A
  • TB
  • cryptococcus (in immunocompromised)
  • coccidioidomycosis
  • histoplasmosis (mississippi r. valley)
  • Lyme Disease
  • Syphilis
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14
Q

TB-caused chronic meningitis

A
  • PPD -
  • Need high index of suspicion (recent/past/current TB infection/TB endemic area)
  • CSF: high protein, low glucose, lymphocytes (unlike bacterial meningitis- PMNs)
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15
Q

Cryptococcus chronic meningitis

A
  • immunocompromised patients
  • stain with india ink
  • Presents similar to fungal meningitis but with india ink stain
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16
Q

Lyme Meningitis (chronic meningitis)

A
  • Can occur at any stage of Lyme infection (unlike syphilis- just 2º/3º)
  • CSF: Nonspecific lymphocyte (protein elevated, normal glucose, lymphocytes)
  • Often see uni/bilateral Bell’s Palsy, headache, disrupted thoughts
17
Q

Syphilitic Meningitis (chronic meningitis)

A
  • Common in 3º>2º syphilis, most frequent manifestation of 3º syphilis
  • So suspect with Sexual history
18
Q

Meningovascular syphilis

A
  • Endarteritis Obliterans causes small vessel stroke
  • See stroke symptoms but no HTN or other indicators
  • Seizures
19
Q

Parenchymatous Neurosyphilis

A
  • Destruction of neurons in cortex shows PARESIS and Tabes Dorsalis
  • psychiatric/neurologic issues
  • PARESIS: Personality, Affect, Reflexes, Eye, Sensorium, Intellect, Speech
20
Q

Tabes Dorsalis

A

Less common

  • shooting pains
  • ataxia
  • sphincter disturbance
  • peripheral (decreased vibration) and cranial neuropathies
  • uveitis, deafness, optic neuritis/atrophy
21
Q

Neurocysticercosis

A
  • Caused by infection of Taenia Solium (pork parasite) with neural involvement
  • Brain cysts cause epileptic seizures
  • CSF: lymphocyte pleiocytosis (abnormal lymphocyte increase, 1000+), low glucose
22
Q

Non-Infectious Chronic Meningitis (causes)

A
  • Neoplasms
  • Sarcoidosis (looks like TB meningitis but more CN neuropathy)
  • Vasculitis
  • Drug-induced (bactrim, NSAIDs)
23
Q

Meningitis vs. Encephalitis

A

-Differentiate by altered mental status (E), neck stiffness (M). See fever, CSF alterations, headache in both.

24
Q

Viral Encephalitis CSF

A

Cell count <500

  • Lymphocytes, though EES and other encephalopathies can have PMNs
  • RBCs>500 in HSV, California Encephalitis, Colorado Tick Fever
  • Glucose normal (since viral)- if low, consider alternative
  • Diagnose with PCR, serology, MRI, brain biopsy (last resort)
25
Q

Herpes Simplex Encephalitis

A
  • Clinical suspicion (signs/Hx of HSV)
  • lumbar puncture/PCR for HSV1
  • MRI (show medial temporal lobe involvement), brain biopsy
  • Treat with acyclovir
26
Q

Viral Encephalitis Etiologies

A 
HSV
CEF, CTEF
St Louis Encephalitis (SLE)
EEE
WEE
West Nile E
Varicella Zoster
Rare:
EBV
HIV
HHV-6
CMV
PML (progressive multifocal leukodystrophy- JC virus)
27
Q

Eastern Equine Encephalitis (EEE)

A

Highest mortality encephalitis

  • avian reservoir
  • daytime mosquito feeder (unlike most night)
28
Q

West Nile Encephalitis

A

-Greatest in elderly
-Fever + altered mental status
CSF: elevated protein, lymphocytes, normal glucose
-Can have muscle weakness/flaccid paralysis

29
Q

Non-viral Encephalitis causes

A

Bacteria: Listeria, salmonella, nocardia (will culture + on lumbar puncture, glucose low)

  • spirochetes
  • rickettsia
  • parasites
  • mycoplasma
  • drugs
  • vasculitis
  • carcinomatosis (cancer metastasis)
30
Q

Naegleria Fowleri

A
  • Freshwater amoeba
  • causes acute hemmorrhagic encephalitis
  • CSF: looks like bacterial (low glucose, PMNs, high protein), but becomes bloody in days (from hemorrhage)
  • 99% mortality
31
Q

Post Infectious Encephalitis

A
  • kids>adults
  • Acute Disseminated Encephalomyelitis (demyelination but no direct infection)
  • multifocal neurologic symptoms
  • CSF shows inflammation
  • follows viral illness (MMR, mycoplasma, varicella, EBV, influenza..)
  • treat with glucocorticoids. But need to diagnose prior encephalitis to properly treat

NBB1 (11 decks)

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