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Neuro 2 Exam 2 > DSA 30 CNS Infections (Vuitch) > Flashcards

DSA 30 CNS Infections (Vuitch) Flashcards

1
Q

what pathogen causes acute pyogenic (bacterial) meningitis in neonates?

A

e.coli and group B strep

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2
Q

what pathogen causes acute pyogenic (bacterial) meningitis in infants/children?

A

s. pneumoniae

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3
Q

what pathogen causes acute pyogenic (bacterial) meningitis in adolescents/young adults?

A

neisseria meningitidis (aka meningococcal disease)

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4
Q

what pathogen causes acute pyogenic (bacterial) meningitis in the elderly?

A

s. pneumoniae and listeria monocytogenes

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5
Q

what is the clinical presentation of acute pyogenic (bacterial) meningitis?

A

fever, headache, photophobia, clouded sensorium, neck stiffness

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6
Q

what are the characteristics of CSF in acute bacterial meningitis?

A

purulent, neutrophils and organisms, increased protein, decreased glucose

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7
Q

what is the expected protein and glucose level in the CSF of patient with viral meningitis?

A

moderate increase in protein, normal glucose

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8
Q

what is the most common etiology of viral meningitis?

A

enteroviruses

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9
Q

what are the principal organisms involved in brain abscess?

A

streptococcus and staphylococcus

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10
Q

what is clinical presentation of brain abscess?

A

focal neurologic deficits and signs of increased ICP

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11
Q

what would be seen with an older brain abscess?

A

fibrous capsule surrounded by reactive gliosis and marked vasogenic edema (results from disruption of BBB)

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12
Q

what are characteristics of CSF in brain abscess?

A

high WBC count, increased protein, normal glucose

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13
Q

with prompt diagnosis and treatment, what is the residuum of subdural empyema?

A

thickened dura

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14
Q

what causes subdural empyema?

A

bacterial/fungal infection of skull bones or air sinuses spreads to subdural space

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15
Q

what can result from untreated subdural empyema?

A

focal neurologic signs, lethargy, and coma

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16
Q

what is the clinical presentation for tuberculous meningitis?

A

headache, malaise, mental confusion, and vomiting

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17
Q

what are characteristics of CSF in tuberculous meningitis?

A

pleocytosis of mononuclear cells or mix of neutrophils and mononuclear cells, increased protein, moderately decreased or normal glucose

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18
Q

what are complications of chronic tuberculous meningitis?

A

arachnoid fibrosis → hydrocephalus. obliterative endarteritis → arterial occlusion and infarction.

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19
Q

what is meningovascular neurosyphilis?

A

chronic meningitis involving the base of the brain, more variably cerebral convexities and spinal leptomeninges

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20
Q

what is paretic neurosyphilis?

A

caused by invasion of brain by t. pallidum

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21
Q

what is the clinical manifestation of paretic neurosyphilis?

A

insidious but progressive cognitive impairment associated with mood alterations that terminate in severe dementia. parenchymal damage of cerebral cortex in frontal lobe.

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22
Q

identify: these lesions are characterized by loss of neurons, proliferation of microglia, gliosis, and iron deposits

A

paretic neurosyphilis

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23
Q

what causes tabes dorsalis?

A

damage to the sensory axons in the dorsal roots → impaired joint position sense and ataxia, loss of pain sensation (Charcot joints), lightning pains, no DTRs.

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24
Q

identify: symptoms include aseptic meningitis, facial nerve palsies, other polyneuropathies, and encephalopathy.

A

neuroborreliosis (Lyme disease)

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25
Q

what is Waterhouse-Friderichsen syndrome?

A

results from mengitis-associated septicemia with hemorrhagic infarction of adrenal glands and cutaneous petechiae

26
Q

what is the clinical presentation of arthropod-borne viral encephalitis?

A

generalized neurologic deficits: seizures, confusion, delirium, stupor, coma.

focal signs: ocular palsy, reflex asymmetry.

27
Q

identify: CSF is colorless with slightly elevated pressure, increased protein, normal glucose, neutrophilic pleocytosis → lymphocytosis.

A

arthropod-borne viral encephalitis

28
Q

what are the symptoms of meningoencephalitis caused by HSV-1?

A

alterations in mood, memory, and behavior

29
Q

in which demographic do you predominantly see meningoencephalitis caused by HSV-1?

A

children and young adults

30
Q

what areas of the brain are affected by meningoencephalitis caused by HSV-1?

A

inferior and medial regions of the temporal lobes; orbital gyri of the frontal lobes

31
Q

what can HSV-2 cause in patients with active HIV infection?

A

acute hemorrhagic and necrotizing encephalitis

32
Q

what two populations are affected by CMV infections in the nervous system?

A

fetuses and immunosuppressed

33
Q

how does CMV manifest in utero?

A

periventricular necrosis → severe brain destruction → microcephaly and periventricular calcification

34
Q

what are Negri bodies and what infection are they involved in?

A

cytoplasmic eosinophilic inclusions found in rabies infection

35
Q

where can Negri bodies be found?

A

pyramidal neurons in hippocampus and Purkinje cells in cerebellum

36
Q

what are the clinical features of rabies infection?

A

malaise, headache, fever, and local paresthesias around the wound initially. progression to extraordinary CNS excitability, foaming at the mouth, hydrophobia, flaccid paralysis.

alternating mania and stupor → coma → death from respiratory failure.

37
Q

what is HIV encephalitis?

A

chronic inflammatory reaction associated with widely distributed microglial nodules often containing multinucleated giant cells. foci of tissue necrosis and reactive gliosis

38
Q

what causes progressive multifocal leukoencephalopathy?

A

JC polyomavirus

39
Q

what cells are preferentially affected in PML and what is the result?

A

oligodendrocytes, demyelination

40
Q

identify: focal and progressive neurologic signs and symptoms. extensive lesions in hemispheric or cerebellar white matter

A

progressive multifocal leukoencephalopathy

41
Q

identify: this CNS infection occurs in children or young adults after an initial infection with measles.

A

subacute sclerosing panencephalitis

42
Q

identify: CNS infection chracterized by widespread gliosis and myelin degeneration, viral inclusions in nucleus of oligodendrocytes and neurons, inflammation of white and gray matter, and neurofibrillary tangles.

A

subacute sclerosing panencephalitis

43
Q

what is the clinical presentation of subacute sclerosing panencephalitis?

A

cognitive decline, spasticity of limbs, and seizures

44
Q

what organisms can cause fungal meningoencephalitis, specifically vasculitis?

A

mucor species and aspergillus; directly invade the blood vessels

45
Q

which fungal species can cause fungal meningoencephalitis, specifically parenchymal invasion?

A

candida and cryptococcus, often cause granulomas or abscesses

46
Q

cryptococcal meningitis is seen in what clinical setting?

A

it is common in AIDS patients

47
Q

identify: soap bubbles (small cysts within parenchyma) seen in basal ganglia.

A

chronic meningitis resulting from cryptococcal infection

48
Q

identify: abnormal forms of cellular protein that cause rapidly progressive neurodegenerative disorders that may be sporadic, familial, or transmitted.

A

prions

49
Q

what is the pathogenesis and molecular biology of prion diseases?

A

conformational change of normal neuronal protein PrP. resistant to protease digestion, induces more protein molecules to change conformation

50
Q

what is the clinical course of CJD?

A

rapid progression of dementia with gait abnormalities and myoclonus. spongiform change, neuronal loss, no inflammation.

51
Q

what pathologically characteristic of vCJD?

A

extensive cortical plaques surrounded by halo of spongiform change

52
Q

name 3 ways in which vCJD differs from CJD.

A
  1. ) affects young adults
  2. ) behavioral disorders in early stages
  3. ) neurologic syndrome progresses more slowly
53
Q

idenfity: onset is linked to consumption of bovine spongiform encephalopathy agent in contaminated foods.

A

vCJD

54
Q

identify: cerebral gummas (plasma cell-rich mass lesions)

A

meningovascular neurosyphilis

55
Q

what is common pattern of meningeal involvement in pneumococcal meningitis?

A

outer surfaces of cerebral hemispheres (cerebral convexities)

56
Q

CSF findings in TB meningitis?

A

normal glucose, high protein, lymphocytes

57
Q

what are common complications of TB meningitis?

A

obliterative endarteritis, hydrocephalus, destruction of cranial nerves

58
Q

identify: this organism is most common CNS organism seen in AIDS patients. imaging shows ring-enhancing lesions. CSF has high protein, normal glucose, no organisms.

A

toxoplasma gondii

59
Q

how can you use CSF findings to differentiate between toxoplasma gondii and cryptococcus infection?

A

toxoplasma gondii organisms will not be present in CSF while cryptococcus organisms will be present in CSF

60
Q

identify: cell type with CD4 coreceptor and CCR5 or CXCR4 chemokine receptors

A

microglia

Neuro 2 Exam 2 (16 decks)

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