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Neuropsych Board Prep > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Which type of meningitis is associated with worse outcomes?

A

Bacterial

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2
Q

What are the three most common types of bacterial meningitis?

A

Haemophilus - most common, children <2 at greatest risk
meningococcal - children 2-18, increased risk associated with crowding (dorms)
pneumococcal - greater cognitive impairment

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3
Q

What are ways of bacteria spread to the meninges?

A

From an adjacent infected area (ears, sinuses)
From the environment (penetrating injury, congenital defect)
Through the bloodstream (hematogenous) - MOST COMMON

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4
Q

What is the primary cause of brain damage in bacterial meningitis?

A

Inflammation, which leads to tissue and vascular injury, septic thrombosis, and smaller infarcts

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5
Q

Which cranial nerve is most often impacted in meningitis?

A

VIII -auditory - can result in sensorineural hearing loss

CN defects are more common in children than adults

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6
Q

What is mortality rate of BM?

A

10%, down from near 90% since the development of antibiotics in the 50s

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7
Q

What are the most common neurobehavioral sequelae of BM?

A

Hearing loss (11%)
ID (4%)
Spasticity/paresis (4%)
Seizure disorders (4%)

Cognitive/behavioral issues are most common in children (78%)

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8
Q

What are the two most vulnerable age groups for BM?

A

Children < 5 y.o. and older adults (60+)

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9
Q

What is the biggest medical risk factor for BM?

A

Immunosuppression

Causes include treatment
HIV
Cystic fibrosis
Diabetes

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10
Q

What are risk factors for worse outcomes in children with BM?

A

Acute neurological complications (prolonged seizures, coma, bilateral hearing loss)
Low CSF glucose levels
<1 y.o. - worse language outcomes
Male gender - worse behavioral outcomes

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11
Q

What are symptoms of acute BM?

A

Sudden fever
Severe headaches
Nuchal rigidity (stiff neck)

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12
Q

What are symptoms of gradual BM?

A

Typically non-specific “flu-like” symptoms

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13
Q

What are common presenting symptoms of BM in children?

A

Hyperthermia, lethargy, anorexia/vomiting, respiratory distress, irritability, jaundice, bulging fontanelle (space between bones of skull where sutures are not fully formed in an infant), diarrhea, nuchal rigidity

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14
Q

What is the diagnostic method to confirm BM?

A

Lumbar puncture - look for bacteria, also red & white blood cells, high protein levels, and low glucose

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15
Q

Are CT and brain MRI useful in diagnosis of BM?

A

No - meningeal enhancement may be seen but absence dis not a rule out

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16
Q

What are academic consequences in children with BM?

A

More than twice as likely to require special education

More likely to repeat a grade

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17
Q

What are NP findings in adults with meningitis?

A

Attention problems, slowed processing speed, executive deficits
Sensorimotor problems - hearing loss, hemiparesis, cortical blindness, ataxia* (* - typically resolve)
Memory findings are mixed

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18
Q

What are NP findings in children with meningitis?

A

Lower IQ in those with acute complications
Attention problems (elevated ADHD symptoms)
Language problems in those with BM before 1 y.o.
Executive deficits below expectation but not impaired
Behavioral changes

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19
Q

What is aseptic meningitis?

A

Meningitis caused by viruses, fungi, and parasites

! Stuckey mentioned tuberculosis but it is caused by bacteria

20
Q

What is the most common cause of aseptic meningitis?

A

Enteroviruses

21
Q

Which type of meningitis if more common?

A

Viral

22
Q

What are symptoms of VM?

A

Severe headache, fever, nausea, vomiting, still neck, rash, fatigue

Flu-like symptoms precede neurologic symptoms by about 48 hours

23
Q

What diagnostic methods are used in VM?

A

LP and blood work to detect viral pathogens

24
Q

Is there a specific treatment for VM?

A

No, treatment is supportive (rest, fluids, anti-inflammatory)

25
Q

What are NP findings in viral M?

A

Mild to moderate attention and processing speed issues

No long-term problems

26
Q

What is the most common cause of encephalitis?

A

Viruses:

primary - direct infection of the brain
secondary - from a previous viral infection (e.g., chickenpox) or immunization (measles vaccination)

27
Q

What are common viruses causing encephalitis?

A 
Herpes simplex (HSV)
Varicall zoster
Epstein-Barr
adenoviruses
enteroviruses
arboviruses (Anthropod Borne)
cytomegalovirus
28
Q

What is the pathway of HSV to the CNS?

A

Along the trigeminal nerve

29
Q

What viruses are associated with the highest mortality in encephalitis?

A

Rabies and HSV (if not treated)

30
Q

What age groups are associated with the highest prevalence rates of encephalitis?

A

Children and young adults

31
Q

What virus/encephalitis is associated with more cognitive and psychiatric impairments?

A 
HSV encephalitis (2-4x risk for cog impairment)
Worse outcome in bilateral lesions
32
Q

What are stages and symptoms of encephalitis?

A

Acute (hours to days) - severe HA, fever, altered mental status, general and focal neurologic signs
Subacute (weeks) - seizures and speech disturbance
Chronic - can progress over years with occasional acute symptoms (HIV, Lyme disease)

33
Q

What is the behavioral presentation of HSV encephalitis?

A

Psychotic and affective symptoms

34
Q

What encephalitis may require a hemispherectomy?

A

Rasmussen’s

35
Q

What is a common cognitive sequalae of HSV encephalitis?

A

Anterograde amnesia

36
Q

What are consequences of intracranial abcess in the brain?

A

Increased intracranial pressure

Mass effects

37
Q

Which type of abcess is more common in the spinal cord?

A

Epidural abscess

38
Q

What is a sign of brain abcess on the CT or MRI with contrast?

A

Ring enhancing lesions

39
Q

What are symptoms of prion disease?

A 
Rapidly progressive dementia
Personality changes
Hallucinations
Speech impairment 
Physical symptoms - ataxia, weakness
40
Q

What viral disease results in progressive and multifocal damage of the white matter?

A

Progressive multifocal neuroencephalopathy

typically affects immune compromised indivdiuals

41
Q

What is the most common cause of brain abcess in patient with HIV/AIDS?

A

Cerebral toxoplasmosis

42
Q

Which viral disease resembles multiple sclerosis?

A

Acute disseminated encephalomyelitis (ADEM)

43
Q

What are MRI findings associated with acute disseminated encephalomyelitis?

A

White matter intensities in both hemispheres, cerebellum, and the spinal cord

44
Q

What is associated with better outcomes: ADEM or pediatric MS?

A

ADEM

45
Q

What are paraneoplastic disorders?

A

Neurologic disorders associated with cancer and caused by autoimmune reaction in response to the tumor

46
Q

What is leptomeningitis?

A

Inflammation of only the pia mater and subarachnoid space

47
Q

What is transverse myelitis?

A

Caused by an inflammatory process in the spinal cord, results in demyelination of axons

Neuropsych Board Prep (32 decks)

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