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Adams 10th ed > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Subdural empyema in which locations would require craniotomy?

A

Interhemispheric, subtemporal or posterior fossa

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2
Q

Dural sinuses most commonly involved by thrombophlebitis

A

Transverse
Cavernous
Petrous
Less frequently, sagittal sinuses

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3
Q

Organisms most often incriminated in intracranial septic thrombophlebitis

A

Streptococci and Staphylococci

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4
Q

True or False:
Anticoagulation, as in aseptic venous occlusion, has been shown to be beneficial in the treatment of intracranial septic thrombophlebitis.

A

False.

It is still of uncertain value but is still usually administered with high-dose antibiotics

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5
Q

Infection from one cavernous sinus spreads to the opposite side through which structure?

A

Circular sinus

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6
Q

Visual loss associated with septic cavernous sinus thrombophlebitis may occur without visible changes of the fundus and tend to persist. This has been associated with what finding?

A

Infarction of retroorbital part of the optic nerve

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7
Q

Brain abscess is always (90%) secondary to bacteremia and a bacterial focus elsewhere in the body except for cases of:

A

Compound fractures of skull
Bullet wounds
Intracranial infection

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8
Q

Metastatic Abscesses from hematogenous spread are usually situated in which vascular territory?

A

Distal territory of the MCA

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9
Q

Which organisms that cause endocarditis have the propensity to cause abscesses?

A

S. Aureus

Gram-negative bacteria

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10
Q

Percentage of congenital heard disease complicated by brain abscess?

A

5%

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11
Q

What congenital anomaly is most commonly implicated in brain abscess?

A

Tetralogy of Fallot
But abscesses may occur with any R to L shunt where venous blood enter systemic circulation without first passing through the lungs.

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12
Q

Which organisms, commonly implicated in bacterial meningitis, rarely cause abscess?

A

Pneumococci
Meningococci
H. Influenzae

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13
Q

The capsule of a brain abscess is frequently thinner on its
A. Medial or paraventricular side
B. Lateral or cortical side

A

A.

This accounts for propensity to spread in WM, produce daughter Abscesses and rupture into the ventricles.

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14
Q

Most frequent initial symptom of ok intracranial abscess

A

Headache

Other early sx in order of freq

  1. Drowsiness & confusion
  2. Focal or generalized sz
  3. Focal motor, sensory or speech disorders
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15
Q

Findings of cerebritis on MRI

A

Cerebritis or immature abscess appear as

Dot-sized areas of dec density that enhance with GAD

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16
Q

When should total excision of an abscess be attempted?

A

Only if:

Solitary, superficial, well-encapsulated or associated with a foreign body

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17
Q

Untreated, TB meningitis has a fatal outcome within _____?

A

4-8weeks

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18
Q

INH, RMP, PZA, EMB, moxifloxacin have the capacity to penetrate the BBB, however which 2 drugs have better penetration over the others?

A

INH and PZA

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19
Q

Dose of pyridoxine given to prevent neuropathy from isoniazid in TB treatment?

A

50mg pyridoxine daily

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20
Q

Anti TB drugs can be given only orally or via stomach tube except the following with parenteral forms:

A

INH and RMP

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21
Q

Cranial nerve most frequently involved in neurosarcoidosis.

A

CN VII or Facial nerve

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22
Q

True or False:

Serum reagin tests (VDRL) may be negative in neurosyphilis or those with neurosyphilis.

A

True.

There is seronegative syphilis.

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23
Q

What is Heubner arteritis and with what infection is it associated?

A

In secondary Neurosyphilis, inflammation and fibrosis of small arteries, usu distal territories of medium and small caliber lenticulostriate branches from MCA and ACA, that lead to narrowing and occlusion.

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24
Q

What is granular ependymitis?

A

A pathologic change in Meningovascular Syphilis wherein the ependymal surfaces of the ventricles are studded with granular elevations protruding bet ependymal cells.

Other patho changes include:
Meningeal thickening, brain atrophy, ventricular enlargement

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25
Q

The early/ initial skin manifestation of Lyme disease

A

Erythema chronicum migrans - a solitary enlarging, ring-like erythematous lesion that may be surrounded by annular satellite lesions

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26
Q

What is Bannwarth or Garin-Bujadoux Syndrome?

A

European variant of Borrelia burgdorferi infection with acute radicular pain ff by chronic lymphocytic meningitis with peripheral and cranial neuropathies

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27
Q

Neurologic manifestations of Lyme

A

Aseptic meningitis or fluctuating meningoencephalitis lasting for mos
Cranial neuropathies - about half
Multiple radicular or peripheral nerve lesions - 1/3-1/2 of patients
European:
Meningoradiculitis of the cauda equina
Also:
GBS

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28
Q

Proposed criteria for neuroborreliosis

A

4 out 5

  1. NO past hx of neuroborreliosis
  2. Active CSF ELISA serology
  3. Anti-Borrelia Ab index >2
  4. Favorable outcome after specific antibiotic treatment
  5. NO alternative diagnosis
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29
Q

What is probably the most effective antibiotic therapy for neuroborreliosis once meninges and central or peripheral nervous system implicated?

A

Ceftriaxone 2g daily IV x 14 days

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30
Q

Other than bacterial infections, the following may rarely cause in the a persistent polymorphonuclear pleocytosis of the CSF

A 
Tuberculosis
Nocardiosis
Actinomycosis
Aspergillus
Other causes: Coccidiomycosis, Histoplasmosis, Blastomycosis
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31
Q

Among patients without AIDS, cryptococcal meningitis patients do not have fever on first examination in this percentage of patients

A

20-40%

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32
Q

Level of Blood Urea Nitrogen at which the administration of Amphotericin B for cryptococcal meningitis should be discontinued.

A

40mg/dL

AmphoB may be resumed when it descends to normal levels.

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33
Q

Rickettsias are maintained in nature by a cycle involving an animal reservoir, an insect vector and humans except

A 
Epidemic typhus (only lice and human beings)
Q fever contracted by inhalation
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34
Q

Most common cause of focal cerebral lesions in patients with AIDS

A

Toxoplasma

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35
Q

What are Dürck nodes

A

In cerebral malaria, small foci of necrosis surrounded by glia that dot the brain

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36
Q

Organism that causes cerebral malaria

A

Plasmodium falciparum

37
Q

Amebic meningoencephalitis is practically always fatal and treatment with usual antiprotozoal agents is ineffective. What medication/s may be given instead?

A

Amphotericin B (same sched as for cryptococcal meningitis) + Rifampin

38
Q

A dependable sign of severe malaria

A

Retinopathy - macular whitening, orange or white discoloration of retinal vessels, and intra-retinal blot-type hemorrhages

39
Q

What is the Winterbottom sign, to which infection is it associated?

A

Posterior cervival adenopathy in trypanosomiasis

40
Q

What is Kerandel hyperesthesia?

A

In African Sleeping Sickness type of trypanosomiasis, pronounced pain at sites of minor injury

41
Q

Match virus with certain neuron/ NS component it has affinity to:

  1. Polio virus
  2. VZV
  3. Rabies virus
  4. JC virus

A. Brainstem neurons
B. Motor neurons
C. Peripheral Sensory neurons
D. Supporting glial cells

A

1B
2C
3A
4D

42
Q

Most common viral cause of acute aseptic meningitis

A

Enterovirus: echovirus and Coxsackie virus
Followed by the ff
- HSV2
- Varicella, HIV, mumps in children, lymphocytic choriomeningitis, HSV1 & adenovirus
- EBV, CMV, leptospira, HSV1, (Mycoplasma pneumoniae), tick-borne encephalitis virus, Borrelia, arboviruses

43
Q

Other viruses that can cause orchitis other than Mumps

A

Group B Coxsackie virus
Infectious mononucleosis
Lymphocytic choriomeningitis

44
Q

Natural host of the Lymphocytic Choriomeningitis (LCM) virus

A

Common house mouse (Mus musculus)

45
Q

Neurologic manifestations of Parvovirus in the adult esp when contracted from a child

A

Brachial neuritis
Encephalitis and Meningitis (B-19 strain)
Some can have strokes

46
Q

In chronic persistent and recurrent meningitis, when is biopsy of the meninges suggested?

A

If dx not clarified in 6-12mos OR if febrile Meningitis persists for several weeks

47
Q

What is Vogt-Koyanagi-Harada syndrome

A 
Iridocyclitis
Depigmentation of a thick swath of hair (poliosis circumscripta) and skin
Vitiligo around eyes
Loss of eyelashes
Dysacusis
Deafness
Chronic or acute recurrent meningitis
48
Q

Characterized by episodes of acute Meningitis with severe headache, low grade fever lasting about 2 weeks and recurring over several months or years.
Have been associated with HSV1 and HSV2 infection

A

Mollaret recurrent meningitis

49
Q

Viral meningitis causes ONLY these 4 symptoms, if any other symptoms are added, the condition is called a meningoencephalitis.

A

Fever, headache, stiff neck and photophobia

50
Q

What are the histopathologic hallmarks of viral encephalitis?

A

Perivascular cuffing by lymphocytes and other mononuclear leukocytes and plasma cells; patchy infiltration of the meninges with similar cells

51
Q

Areas of predilection of HSV Encephalitis

A

Inferomedial or Lateral portions of the frontal and temporal lobes and the insula

52
Q

False negative HSV PCR tests are most likely to occur during which period of the infection?

A

First 48 hours of febrile infection

53
Q

True or False
In cases of HSV Encephalitis, coma and pupillary changes is most probably due to mass effect from the hemorrhagic necrosis and edema of the temporal lobes, regardless of whether compression is evident on imaging.

A

False.
The infection is capable of spreading to the mesencephalon from the contiguous deep temporal lobe and may cause coma through a direct destructive effect. Do not attribute this to mass effect unless evident on imaging.

54
Q

Survival from HSV Encephalitis if treatment is begun within 4 days of illness onset in an awake patient

A

Greater than 90%

55
Q

Virus that causes a medial temporal lobe limbic encephalitis n adult patients following allogeneic hematopoietic stem cell bone marrow transplant

A

Mainly HHV-6
Also the cause of roseola or exanthema subitum

Others
Adenoviruses

56
Q

What are the pathologic features of Rabies?

A

Negri bodies - cytoplasmic eosinophilic inclusions most prominent in pyramidal cells of the hippocampus and Purkinje cells

Babes nodules - focal collections of microglia

Inflam most intense at brainstem
On top of those seen in viral encephalitis.

57
Q

Post-exposure prophylaxis for rabies

A

Human rabies immune globulin 20U/kg
1/2 infiltrated around the wound
1/2 IM
- provides passive immunization x 10-20days

58
Q

Specific zoster to which Cerebral Angiitis is most closely associated

A

Ophthalmic Zoster

59
Q

Disseminated Herpes Zoster

A

Lesions in more than 3 dermatomes

60
Q

First proven viral polyneuritis in humans

A

HIV peripheral polyneuropathy

61
Q

What are the opportunistic infections and neoplasms of the CNS in AIDS?

A 
In Approx this order of frequency:
Toxoplasmosis 
CMV infection 
Primary B-cell lymphoma 
Cryptococcosis
Progressive Multifocal Leukoencephalopathy
62
Q

Two particular types of mycobacterial infection that tend to complicate AIDS

A

Mycobacterium tuberculosis

Mycobacterium avium - intracellulare

63
Q

Organism that causes cat scratch fever

A

Bartonella henselae

64
Q

What is quaternary syphilis

A

Seen among patients with HIV, Aggressive and rapidly progressive necrotizing process that causes strokes and dementia as a result of involvement of brain parenchyma and vessels.

65
Q

Viruses other than the polio virus that causes an acute anterior poliomyelitis

A

Enteroviruses such as Coxsackie groups A and B
Japanese encephalitis
West Nile virus

66
Q

Of the viruses other than polio virus that causes an acute anterior poliomyelitis, which is associated with a severe and persistent asymmetrical flaccid poliomyelitis?

A

West Nile Virus

67
Q

Atrophy in poliomyelitis can be detected as early as A and is maximal at B?

A

A. within 3 weeks

B. 12-15 weeks

68
Q

Earliest histopathologic changes in the anterior horn in acute poliomyelitis

A

Central chromatolysis of the nerve cells, along with an inflammatory reaction

69
Q

Diagnosis of SSPE

A

Presumptive clinical case
Periodic complexes on EEG
Elevated gamma globulin and oligoclonal bands in CSF
Elevated measles titers in serum and CSF

70
Q

Histopathologic hallmark of SSPE

A

Eosinophilic inclusions in the cytoplasm of neurons and glia

71
Q

This part of the brain is usu spared in SSPE

A

Cerebellum

72
Q

Characteristic EEG abnormality in SSPE

A

Periodic (every 5-8sec) bursts of 2-3/s high voltage waves, followed by a relatively flat pattern

73
Q

Antibodies to the JC virus is present in approximately what percent of the normal adult population?

A

70%

74
Q

In the non-AIDS patient PML from JC virus is untreatable. In AIDS patients however, what is the treatment that slows down progression of PML and leads to remission in almost half of patients for a year?

A

Aggressive treatment with anti-retroviral drug combinations, including protease inhibitors.

75
Q

A poor prognostic sign for recovery in PML

A

CD4 count below 100cells/uL

76
Q

Main pathologic findings in Encephalitis Lethargica or von economo Disease

A

Depigmentation of the substantia nigra and locus ceruleus because of nerve cell destruction
Neurofibrillary changes in the surviving nerve cells of the Substantia nigra and Oculomotor nuclei

Location primarily in the midbrain, subthalamus and hypothalamus

77
Q

What is a prion

A

A proteinaceous infectious particle devoid of nucleic acid, resists actions of enzymes that destroy RNA nd DNA, fails to produce an immune response, and electron microscopically does not have the structure of a virus

78
Q

In humans the prion protein (PrP) is normally encoded by a gene on which chromosome?

A

Short arm of Chromosome 20

79
Q

Spongiform encephalopathy is associated with the conversion of a normal cellular protein PrPc to an abnormal isoform. This conversion involves ____

A

Change in confirmation of the protein in which the helical proportion diminishes and the proportion of B pleated sheet increases

80
Q

Mechanism of infectivity of prions

A

Susceptibility of native PrP to alter its shape as a result of physical exposure to the abnormal protein

81
Q

Most common variant of CJD? least common?

A

Most common is MM type 1

Least common is VV

82
Q

Brownell-Oppenheimer variant

A

Variant of CJD that presents with cerebellar ataxia

83
Q

Heidenhain variant

A

Variant of CJD that presents with visual disturbances preceding the mental changes

84
Q

Confirmatory test for CJD and its Sn Sp

A

14-3-3
Sn 92%
Sp 80%

85
Q

Pathology of CJD

A

Degeneration and disappearance of nerve cells associated with extensive astroglial proliferation;
Microscopic vacuoles within the cytoplasmic processes of glia cells and dendrites of nerve cells

86
Q

Differential diagnoses for CJD that may mimic it in the early weeks of illness

A 
Lithium intoxication
Hashimoto encephalopathy
Whipple disease
Intravascular lymphoma
Carcinomatous Meningitis
Also
CBD
LBD
SSPE
limbic-brainstem-cerebellar encephalitis
87
Q

The transmissible agent in CJD is resistant to boiling, formalin, alvohol and UV radiation but can be activated via any of the ff

A
  1. Autoclaving (132C at 15lbs/in2 x 1hr)

2. Immersion in 5% Sodium hypochlorite (bleach) x 1hr

88
Q

Like CJD, Fatal insomnia is characterized by a methionine at codon 129 on chromosome 20 but with the addition of what other mutation?

A

Mutation in the prion gene at codon 178

- protease resistant form of the gene

89
Q

Kuru plaques

A

Periodic acid-Schiff- positive stellate plaques of amyloid-like material

Adams 10th ed (11 decks)

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