Encephalitis Flashcards
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
3 - 4000/year
What is meningoencephalitis?
- combination of meningitis and encephalitis
Which of the following does NOT typically cause encephalitis?
1 - virus
2 - bacteria
3 - parasites
4 - fungi
4 - fungi
- virus is the most common cause
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
3 - immune response that attacks the brain
- leads to subsequent inflammation of the brain
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
1 - 0.7-13.8 per 100 000
- generally more common in immunocompromised patients
Who is more at risk of developing Encephalitis?
1 - older ages
2 - younger ages
3 - immunocompromised
4 - all of the above
4 - all of the above
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
1 - herpes simplex virus
- generally due to an infection elsewhere in the body
- HSV-1 is more common
- HSV-2 does occur as well
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
3 - temporal
- patients are generally asymptomatic
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
3 - neck stiffness
- common in meningitis but not Encephalitis
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
5 - all of the above
In Encephalitis, what % of patients have seizures?
1 - 10%
2 - 20%
3 - 33%
4 - 55%
3 - 33%
Which of the following is NOT a common differential for encephalitis?
1 - meningitis
2 - stroke
3 - sub arachnoid haemorrhage
4 - brain tumours
3 - sub arachnoid haemorrhage
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
2 - lumbar puncture and CT scan
- MRI imaging within 24-48 hours
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
3 - increased intracranial pressure (ICP)
- if ICP is present the lumbar puncture could cause a drop in CSF
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/normal glucose
4 - increased glucose
4 - increased glucose
- pathogen and brain are using glucose, so it will be low
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
3 - periodic sharp but slow wave forms
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
4 - lymphocytes
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
3 - aciclovir
- antiviral medication
- dosage is 10mg/kg/8h via IV
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%
2 - 20-30%
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
3 - 14-21 days
- re-test lumbar puncture until CSF is negative for virus
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
2 - weight loss
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
1 - NMDAR, LGI1 and CASPR2
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
2 - seizures, psychiatric, cognitively impaired
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
1 - tumour (thyoma, lung cancer)
What steroid is generally use to treat auto-immune encephalitis?
1 - corticosteroid
2 - dexamethasone
3 - hydrocortisone
4 - methyl-prednisolone
4 - methyl-prednisolone
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
3 - decreases antibodies
- less chance of them damaging the brain tissue
What is the long term treatment for auto-immune encephalitis?
1 - steroids methyl-prednisolone
2 - rituximab
3 - antibbiotics
4 - aciclovir
2 - rituximab
- monoclonal antibody targeting CD20 on B cells, which cannot be activated
In addition, what supportive treatments may patients with encephalitis receive?
1 - fluids
2 - analgesia
3 - oxygen
4 - antipyretic
5 - all of the above
5 - all of the above
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)
2 - MMR (given at 1y/o)
- measles, mumps and rubella, which are all viruses
