CNS Infections

Question 1

How would the LP look for bacterial, viral, and fungal meningitis?

Answer 1

Bacterial: neutrophils, low glucose

Viral: lymphocytes, normal glucose

Fungal: lymphocytes, low glucose

Question 2

How would you differentiate dementia from confusional states with meningitis?

Answer 2

Dementia –> long term, chronic
Confusional state –> TEMPORAL pattern with acute infection (may have exceptions for chronic infections like neurosyphilis)

Question 3

Argyl Robertson Pupils? Would make you suspicious of what type of infection?

Answer 3

AKA “prostitute’s pupil” because they are specific sign for neurosynphilis.

They can accommodate (constrict to near object) but cannot constrict with light (light-near dissociation).

Question 4

Triad of meningitic symptoms?

Answer 4

Headache
Stiff Neck
Fever

Question 5

What are the common bacterial meningitic agents in different groups?

Answer 5

Newborns/neoantes: Group B strep and E. coli (birth canal), listeria

Children/teenagers: Neisseria

Elderly: S. pneumoniae

Unvaccinated children: H. influenzae

Question 6

In the case of viral meningitis, imaging is not helpful except for:

Answer 6

HSV –> temporal lobe encephalitis!

Hemorrhage and necrosis of inferior mediotemporal lobes.

Question 7

What is a common initial presenting symptom for primary infection with HSV-1?

Answer 7

Gingivostomatitis, which eventually turns to cold sores (herpes labialis)

Question 8

Treatments for following viral encephalitis infections:

• VZV
• Rabies
• HSV and HZV
• CMV

Answer 8

• VZV: vaccination
• Rabies: post exposure prophylaxis
• HSV/HZV: acyclovir
• CMV: gangcyclovir