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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Tuberculous meningitis - etiology

A

hematogenous spread from pulmonary source

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2
Q

what area of meninges does TB have a predilection for

A

basal meninges (at base of brain)

  • presents with CN palsies
  • hydrocephalus
  • brain infarct from inflammation around cerebral vessels
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3
Q

typical course of TB meningitis

A

subacute/chronic, insiduous presentation with prolonged prodrome of malaise and nonspecific constitutional symptoms

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4
Q

CSF findings in TB meningitis

A
  • LYMPHOCYTE predominance
  • glucose very low
  • acid fast bacilli on gram stain (consider PCR stain)
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5
Q

presentation of tuberculoma

A

headache
focal neuro signs
seizures
- can calcify, variable enhancing on imaging and can be assoc with hydrocephalus

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6
Q

Pott disease

A

tuberculous infection of the spine

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7
Q

CF of Pott disease

A

fever and back pain

- if it extends into epidural space, can lead to subacute spinal cord or cauda equina compression

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8
Q

how can you differentiate Pott disease from metastatic cancer

A

Potts disease usually spread through disk spaces to adjacent vertebral bodies

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9
Q

how can Lyme dz affect CNS? (3)

A

meningitis
cranial nerve palsies
polyradiculopathy

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10
Q

how do you diagnose Lyme dz

A

serology tests of blood and CSF

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11
Q

CSF profile in Lyme dz

A

lymphocytic pleocytosis with elevated protein and normal glucose

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12
Q

early neurologic manifestations of Lyme dz

A

aseptic meningitis, facial nerve palsy or both, within weeks after infection

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13
Q

later neurologic manifestations of Lyme dz

A

leukoencephalopathy, painful polyradiculopathy or both, months after infection

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14
Q

tx of Lyme dz (CNS involvement)

A

isolated facial n. palsy w/ negative CSF –> oral antibiotics; if more disseminated, IV antibiotics

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15
Q

MCC of viral meningitis

A

enteroviruses, i.e. Coxsackie virus, arboviruses (West Nile)

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16
Q

CSF profile in viral meningitis

A

lymphocytic predominance
elevated protein w/o lower glucose
gram stain and culture unrevealing

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17
Q

Tx. viral meningitis

A

supportive care, unless HSV1 is suspected

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18
Q

presentation of encephalitis

A 
headache
fever
altered LOC
seizures
focal neuro deficits
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19
Q

where does HSV1 love in the brain?

A

base of the brain, esp. medial temporal lobes and orbitofrontal regions of cortex

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20
Q

common clinical presentation of HSV1 encephalitis

A

limbic dysfunction - complex partial seizures, olfactory hallucinations and memory disturbances (profound anterograde amnesia)

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21
Q

CSF in HSV1 encephalitis

A

elevated RBC count and leukocytosis

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22
Q

EEG findings in HSV1 encephalitis

A

periodic epileptiform discharges over one or both temporal regions

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23
Q

Tx. HSV encephalitis

A

IV acyclovir

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24
Q

definitive dx of HSV1 encephalitis

A

PCR of CSF - takes few days to get back so start acyclovir if you have high clinical suspicion

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25
Q

MCC of fungal meningitis

A

cryptococcus

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26
Q

how does one get cryptococcal meningitis?

A

more likely if you have HIV/AIDs but maybe if you are healthy and if you inhale soil and pigeon droppings, it can disseminate hematogenously

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27
Q

CSF profile in fungal meningitis

A

lymphocytic predominance of WBCs
elevated protein
low glucose

28
Q

Dx. of cryptococcal meningitis

A

India ink stain of CSF

now –> rapid latex agglutination assay for cryptococcal antigen

29
Q

where do toxoplasmosis lesions love to go?

A

basal ganglia or at gray-white matter junction

30
Q

differential of toxoplasmosis like lesions

A

CNS lymphoma

31
Q

management of suspected toxoplasmosis

A

empiric anti-toxo therapy –> if lesions dont improve with this, consider brain biopsy for definitive diagnosis

32
Q

MC parasitic infection of the CNS

A

neurocysticercosis

33
Q

neurocysticercosis on imaging

A

multiple cystic lesions which can be ring-enhancing or calcified with surrounding edema

34
Q

tx of neurocysticercosis

A

albendazole
IV steroids
anticonvulsants

35
Q

clinical presentation of HIV dementia

A

subcortical dementia with cognitive impairment and psychomotor slowing

36
Q

MRI findings in HIV dementia

A

patchy T2 hyperintensity in white matter as well as cerebral atrophy

37
Q

vacuolar myelopathy - what does it resemble?

A

vit B12 deficiency (subacute combined degeneration)

38
Q

CF in vacuolar myelopathy

A
  • posterior column signs with loss of vibration and proprioception with sensory ataxia
  • corticospinal tract dysfunction bilaterally (spasticity, hyperreflexia)
39
Q

PML

A

demyelinating dz of CNS caused by infection oligodendrocytes with JC virus –> result of prolonged immunosuppression (HIV or medications)

40
Q

MRI in PML

A

patchy non-enhancing foci of T2 hyperintensity within subcortical white matter

41
Q

Fever and mental status changes equal…

A

CNS infection unless proven otherwise

42
Q

What can bacteria cause in CNS?

A

Meningitis, empyema, abscess

43
Q

What can viruses cause in CNS?

A

Meningitis, encephalitis

44
Q

What can fungi cause in CNS?

A

Meningitis

45
Q

MCC of bacterial meningitis in neonates and elderly

A

Group B strep
E.coli
Listeria

46
Q

MCC of bacterial meningitis in toddlers

A

H.influenza (recently decreasing due to vaccination)

47
Q

MCC of bacterial meningitis in teenagers

A

N.meningitidis

48
Q

MCC of bacterial meningitis in adults

A

Strep pneumoniae

49
Q

Clinical signs of bacterial meningitis

A 
Headache 
Fever
Neck stiffness
Mental status changes - delirium 
- usually there's a prodrome flu-like feeling
50
Q

Complications of acute bacterial meningitis

A

Cortical vein thrombosis and stroke
Seizures
Increased ICP and herniation

51
Q

CSF profile in acute bacterial meningitis

A 
High WBC (>1000, mostly PMNs)
Decreased glucose (<40)
Increased protein 
High opening pressure
Positive gram stain or culture
52
Q

When should you order a CT scan before performing LP in meningitis?

A

Papilledema on fundoscopic exam
Focal neurologic signs
Non communicating hydrocephalus

53
Q

Tx of bacterial meningitis

A

IV antibiotics: vancomycin and ceftriaxone
Ampicillin if concerned about Listeria
Corticosteroids in children or strep pneumoniae in adults (given a few minutes before antibiotics)

54
Q

MCC of viral meningitis

A

Enteroviruses - polio, coxsackie, echo
Arbovirus
Herpes simplex

55
Q

Sx of viral meningitis

A

Fever
Bad headache
Mildly stiff neck
- no mental status changes

56
Q

CSF profile in viral meningitis

A

WBC < 1000: mainly lymphocytes
Normal glucose
Slightly elevated protein
Pressure not as high

57
Q

Tx of viral meningitis

A

Acetaminophen and other symptomatic treatment

58
Q

Types of chronic (basilar) meningitis

A

Fungal - cryptococcus

Mycobacterium tuberculosis

59
Q

Symptoms of chronic meningitis

A

Headache
Low grade fever
Confusion
- last for few weeks and are non specific

60
Q

CSF profile in chronic basilar meningitis

A

WBC < 1000: mainly monocytes
Glucose very low
Protein elevated

61
Q

Tx of cryptococcal meningitis

A

Amphotericin

62
Q

Tx of TB meningitis

A

Triple therapy

63
Q

Complications of basilar meningitis

A

Visual and hearing complications (pooling of pus in base of brain)

64
Q

CSF profile of HSV encephalitis

A 
Lymphocytic pleocytosis
Mildly elevated protein
Normal glucose 
Negative gram stain and culture
RBC present (hemorrhagic encephalitis)
65
Q

What cells of CNS does HIV primarily infect

A

Macrophages and microglia

Neurology (15 decks)

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