Encephalitis

Question 1

Encephalitis is inflammation of the brain (parenchyma), which is typically cause by an infection. How common is encephalitis?

1 - 40/year
2 - 400/year
3 - 4000/year
4 - 40,000/year

Answer 1

3 - 4000/year

Question 2

What is meningoencephalitis?

Answer 2

• combination of meningitis and encephalitis

Question 3

Which of the following does NOT typically cause encephalitis?

1 - virus
2 - bacteria
3 - parasites
4 - fungi

Answer 3

4 - fungi

• virus is the most common cause

Question 4

Encephalitis can lead to Acute disseminated encephalomyelitis (ADEM). What is ADEM?

1 - anaphylactic shock to treatment for encephalitis
2 - inflammation of the meninges and brain parenchyma
3 - immune response that attacks the brain

Answer 4

3 - immune response that attacks the brain

• leads to subsequent inflammation of the brain

Question 5

In western settings what is the incidence of Encephalitis?

1 - 0.7-13.8 per 100 000
2 - 7-23.8 per 100 000
3 - 17-38 per 100 000
4 - 0.7-80 per 100 000

Answer 5

1 - 0.7-13.8 per 100 000

• generally more common in immunocompromised patients

Question 6

Who is more at risk of developing Encephalitis?

1 - older ages
2 - younger ages
3 - immunocompromised
4 - all of the above

Answer 6

4 - all of the above

Question 7

In western settings the incidence of Encephalitis is 0.7-13.8 per 100 000 people. What is the most common cause?

1 - herpes simplex virus
2 - varicella-zoster virus
3 - enterovirus
4 - cytomegalovirus

Answer 7

1 - herpes simplex virus

• generally due to an infection elsewhere in the body
• HSV-1 is more common
• HSV-2 does occur as well

Question 8

The herpes simplex virus is the most common cause of Encephalitis. Which part of the brain is generally affected?

1 - frontal
2 - parietal
3 - temporal
4 - occipital

Answer 8

3 - temporal

• patients are generally asymptomatic

Question 9

Which of the following is NOT a common clinical presentations of Encephalitis?

1 - fever
2 - mental disturbance
3 - neck stiffness
4 - severe headache
5 - nausea
6 - vomiting
7 - reduced GCS

Answer 9

3 - neck stiffness

• common in meningitis but not Encephalitis

Question 10

In addition to the following symptoms fever, mental disturbance, severe headache, nausea and vomiting, patients can present with signs associated with the cost of Encephalitis. If herpes simplex virus (most common) is the cause, which of the following symptoms may also be present specific to the viurus?

1 - herpes simplex rash
2 - conjunctivitis
3 - cold sores
4 - lymphadenopathy
5 - all of the above

Answer 10

5 - all of the above

Question 11

In Encephalitis, what % of patients have seizures?

1 - 10%
2 - 20%
3 - 33%
4 - 55%

Answer 11

3 - 33%

Question 12

Which of the following is NOT a common differential for encephalitis?

1 - meningitis
2 - stroke
3 - sub arachnoid haemorrhage
4 - brain tumours

Answer 12

3 - sub arachnoid haemorrhage

Question 13

In encephalitis what 2 investigations should be performed asap?

1 - lumbar puncture and FBC
2 - lumbar puncture and CT scan
3 - EEG and lumbar puncture
4 - EEG and CT scan

Answer 13

2 - lumbar puncture and CT scan

• MRI imaging within 24-48 hours

Question 14

Prior to performing a lumbar puncture to help diagnose encephalitis, what must be ruled out?

1 - infection
2 - hypertension
3 - increased intracranial pressure (ICP)
4 - ACS

Answer 14

3 - increased intracranial pressure (ICP)

• if ICP is present the lumbar puncture could cause a drop in CSF

Question 15

When performing a lumbar puncture, in addition to sending a sample for culturing, we nay see all of the following EXCEPT:

1 - raised protein
2 - raised lymphocytes
3 - reduced glucose
4 - increased glucose

Answer 15

4 - increased glucose

• pathogen and brain are using glucose, so it will be low

Question 16

An EEG can be performed on patients with suspected encephalitis. What do they tend to show?

1- low frequency wave forms
2 - low voltage wave forms
3 - periodic sharp but slow wave forms
4 - periodic sharp and fast wave forms

Answer 16

3 - periodic sharp but slow wave forms

Question 17

If we do take a lumber puncture what cells are we expecting to see raised in the CSF of a patient with encephalitis?

1 - neutrophils
2 - RBCs
3 - macrophages
4 - lymphocytes

Answer 17

4 - lymphocytes

Question 18

What is the primary treatment for encephalitis that is typically given within 30 minutes of patient arriving and a diagnosis is confirmed??

1 - vancomycin
2 - rifampacin
3 - aciclovir
4 - prednisolone

Answer 18

3 - aciclovir

• antiviral medication
• dosage is 10mg/kg/8h via IV

Question 19

The antiviral aciclovir is used to treat encephalitis. If left untreated the mortality of encephalitis is 70%, but what is the mortality with treatment?

1 - 10%
2 - 20-30%
3 - 50-60%
4 - 70%

Answer 19

2 - 20-30%

Question 20

The antiviral aciclovir is used to treat encephalitis. How long is this used for?

1 - 7 days
2 - 14 days
3 - 14-21 days
4 - 35 days

Answer 20

3 - 14-21 days

• re-test lumbar puncture until CSF is negative for virus

Question 21

The antiviral aciclovir is used to treat encephalitis. Which of the following is NOT a side effect of the medication?

1 - confusion
2 - weight loss
3 - seizures
4 - hallucination
5 - headaches
6 - anaemia
7 - leukopaenia

Answer 21

2 - weight loss

Question 22

Limbic encephalitis can be caused by auto-immune conditions where the body has created antibodies that subsequently target the brain tissue. What are the 3 most common antibodies that are involved in Limbic encephalitis?

1 - NMDAR, LGI1 and CASPR2
2 - NMDAR, GAD65 and AK5
3 - LGI1, CASPR2 and AK5
4 - NMDAR, LGI1 and GAD65

Answer 22

1 - NMDAR, LGI1 and CASPR2

Question 23

Limbic encephalitis can be caused by auto-immune conditions where the body has created antibodies that subsequently target the brain tissue. What are the 3 most common ways limbic encephalitis may present from a neurological perspective?

1 - seizures, cranial nerve palsy, cognitively impaired
2 - seizures, psychiatric, cognitively impaired
3 - psychiatric, cranial nerve palsy, cognitively impaired
4 - seizures, cranial nerve palsy, psychiatric

Answer 23

2 - seizures, psychiatric, cognitively impaired

Question 24

What condition is commonly associated with auto-immune encephalitis and is most commonly the cause?

1 - tumour (thyoma, lung cancer)
2 - inflammatory bowel disease
3 - meningitis
4 - hydrocephalus

Answer 24

1 - tumour (thyoma, lung cancer)

Question 25

What steroid is generally use to treat auto-immune encephalitis?

1 - corticosteroid
2 - dexamethasone
3 - hydrocortisone
4 - methyl-prednisolone

Answer 25

4 - methyl-prednisolone

Question 26

In addition to steroid, why can plasma exchange be useful in auto-immune encephalitis?

1 - increase WCC
2 - increases antibodies
3 - decreases antibodies
4 - decreases WCC

Answer 26

3 - decreases antibodies

• less chance of them damaging the brain tissue

Question 27

What is the long term treatment for auto-immune encephalitis?

1 - steroids methyl-prednisolone
2 - rituximab
3 - antibbiotics
4 - aciclovir

Answer 27

2 - rituximab

• monoclonal antibody targeting CD20 on B cells, which cannot be activated

Question 28

In addition, what supportive treatments may patients with encephalitis receive?

1 - fluids
2 - analgesia
3 - oxygen
4 - antipyretic
5 - all of the above

Answer 28

5 - all of the above

Question 29

To prevent encephalitis from occurring, we can use vaccinations. Which vaccine would be especially useful in reducing the risk of encephalitis?

1 - Pneumococcal (given at 12 wks)
2 - MMR (given at 1y/o)
3 - MenB (given at 8wks)
4 - DTap/IPV/Hib/Hep B (given at 8, 12 and 16 wks)

Answer 29

2 - MMR (given at 1y/o)

• measles, mumps and rubella, which are all viruses