export_cns infection Flashcards
1
Q
Tysabri and PML
A
-Prior exposure to JC virus (no exposure is almost no risk while if exposed you have to look at degree of positivity) - Prior immunosupression doubles the risk -Risk increases with number of tysabri infusions
2
Q
Subacute Combined Degeneration
A
- Lichtheim’s disease -Degenration of the posterior and lateral columns of the spinal cord as a result of B12 def, Cu def, or Vit E def. Usually associated with pernicious anemia
3
Q
Toxoplasmosis
A
- Toxoplasma Gondii, parasite - Infected meat, cat feces, or mother to fetus - Mostly mild flu-like in non-compromised humans - Eccentric target sign of todo on imaging -TX: empiric sulfadiazine/pyrimethamine–if no improvement, then bx the lesion. 90% respond to tx.
4
Q
Toxoplasmosisv. 1mary CNS lymphoma
A
- not really easy to differentiate in imaging -Antibody to toxo; mostly helpful if negative. -Lymphoma associated with EBV; do PCR -Lyphoma has no treatment ( 6 mo survival even with rdx)
5
Q
Cryptococcus Neoformans
A
-Meningitis in HIV - HA, mental status changes, meningeal signs -India ink ( 75% +, now cryptococcal antigen via latex agglutination 95% +) -Often opening pressure is elevated; papilledema -Tx: IV amphotercicin, then flucanozole continued for 3 months after CSF is sterilize
6
Q
HIV myopathy
A
-HIV or meds ( Zidovudine)
7
Q
HIV Neuropathy
A
- distal polyneuropathy -Can also be due to HIV meds
8
Q
HIV Myelopathy
A
- Can produce myelopathy similar to B12 def
9
Q
HIV meningitis
A
SImilar to any other— but from uncommon hosts
10
Q
HIV Dementia
A
-Common in late stages of disease
11
Q
HIV eye disease
A
-CMV; Also lumbar radiculitis
12
Q
HIV stroke
A
HIV vasculitis
13
Q
Opportunistic diseases HIV -CD4>500
A
-HIV meningitis -Acute Inflammatory demyelinating syndrome
14
Q
Opportunistic diseases HIV CD4=200-500
A
-HIV associated dementia -Mononeuritis multiplex HIV-associated myopathy/neuropathy
15
Q
Opportunistic diseases HIV CD4
A
CNS toxo PML 1mary CNS lymphoma Cryptococcal meningitis HIV vacuolar myelopathy CMV ventriculitis VZV vasculitis
16
Q
HSV encephalitis
A
-Most common sporadic -non-specific : fever, HA, confusion, personality changes, olfactory/gustatory hallucination. focal seizures/ motor distrubances - Frontal/temporal lobes (swelling-> uncal herniation) - LP grossly bloody CSF, elevated WBC, lymphocytes. PCR to confirm -EEG with PLEDs (temporal lobes) -IV acyclovir ASAP
17
Q
Human T-lymphotropic virus type I
A
-Tropical spastic paraparesis -Chronic myelopathy common in caribbean and Africa. US IV drug users
18
Q
VZV
A
-zoster/shinglesfrom reactivation of varicella in dorsal root ganglia-painful vesicular rash - usually thoracic dermatome, V1 distribution; zoster ophthalmic us - week of antiviral agents ( acyclovir. valacyclovir) Can occasionally infect cerebral arteries causing strokes. also can infect SC directly leading to severe myelopathy
19
Q
CMV
A
-devastating in utero -IC-encephalitis, often fatal in months -Associated with retinitis
20
Q
Rabies
A
-Bite from infected animal -Can cause encephalitis leading to psychiatric disturbances, death, or fatal paralysis due to SC infection - bx shows Negri bodies
21
Q
Polio
A
-Directly infects anterior horn cells of SC -Largely eradicated (vaccine)
22
Q
West Nile
A
Also infects anterior horn cells
23
Q
Bacterial Meningitis
A
-Most common Strep Pneumo -CSF with increased pressure, ^WBC with PMN predominance, elevated protein, and decreased glucose. - Empirically treat –3rd gen ceph/vanc; + ampicillin in neonates, >50 yo - LP but Ct with focal signs.
24
Q
Neonatal Bacterial Meningitis
A
GBS
25
Indication for CT before LP
- Neurological defecits, papilledema, IC, hx of CNS disease, AMS
26
Causes of bacterial Meningitis
\>80% adults: N. meningitides ,S. Penumoniae -\>50 yo more chance of l. monocytogenes
27
Kernig's Sign
Supine; pain with thigh and knee flexion
28
Brudzinski's Sign
-Supine, lift head -+ when there is involuntary lifting of the legs
29
Meningitis Drugs by age
-Neonate: amp/3rd gen ceph -Child-50: 3rd gen ceph+vanc+rifampin - \>50 y.o, IC: Amp, 3rd gen ceph+vanc+rifampin -CSF shunts/neurosurgery:3rd gen ceph+vanc -Skull fracture: 3rd gen ceph+metronidazole \*\* + steroids to prevent hearing loss
30
CNS TB
-meningitis ( usually basal)-malaise, to stupor, to coma, seizures, and often hemiparesis -IC tuberculomas -Pott's disease -TX- INH, rifampin, pyrazinamide for 12 months
31
Pott's Disease
-Usually lower thoracic or upper lumbar of the spine. -From hematogenous spread from other sites ( usually pulm) - spreads from 2 adjacent vertebrae into adjoining IVertebral space
32
Supplement to Izoniazid/rifampin to prevent peripheral neuropathy
-pyridoxine/ Vit B -Excess pyridoxine can also lead to peripheral neuropathy
33
CNS Abscess
-Brain usually direct invasion--\> usually temporal lobe--\> focal deficits -Hard to distinguish on imaging - Multiple means heme spread; Single means more direct spread -MOre inflammatory/ edema means early on
34
Syphilis
-primary (chancre) -\> 2ndary (rash on palms/soles)-\> Tertiary (meningitis, Tabes Dorsalis, General Paresis) -small, irregular pupils that do not react to light, but do to accommodation -
35
Tertiary TB-Meningitis
Can cause MCA stroke ( vaculitis)
36
Tabes Dorsalis
Inflmmatory destruction of lumbosacral dorsal root ganglia with loss of sensation and pain in legs and abdomen, damage to posterior columns
37
General paresis
Encephalitic infection characterized by dementia, psych symptoms (Syphilis)
38
Syphilis w/u
1) Non-troponemal (RPR/ VDRL)-non-specific (CONFIRMATION) 2) Troponemal (TP-PA/TPHA/FTA-ABS/EIA)-specific; remain for life. do not correlate with treatment/titers (SCREEN) LP needed--high CSF WBC and oligoclonal bands
39
Penicillin neurosyphilis
- IV/IM penicillin for 14 days. F/u blood tests 3, 6, 12, 24, 36 months to ensure success. decrease in lymphocyte count and protein, decrease in VDRL titer
40
Lyme Disease
-Stage 1- acute-erythema migraines -Stage 2- flu-like, meningitis,cardiac pathology -Stage 3- CNS
41
Stage 3 Lyme
Sensory Neuropathy, subtle cognitive changes in some tx: oral doxycycline or if neuro--\> IV ceftriaxone
42
Taenia Solium
-Pork Tapeworm -Cysticercosis (India/SA--\> primary epilepsy) - Infection through fecal.oral or undercooked pork - cysts in muscles, brain, eyes TX:abendezole and steroids to reduce inflammation
43
Naegleria fowleri
" brain eating amoeba' found in warm bodies of fresh water such as ponds, lakes, rivers, and hot springs
44
racemos neurocysticercosis
- cysts in the ventricular system, esp 4th--obstruction of CSF flow and hydrocephalus -May need shunting
45
CJD
-double hockey stick sign -Spongiform degeneration of grey matter caused by neuronal loss -Rapid dementia, sporadic 80% of the time ( also genetic/iatorgenic forms) CSF-14-3-3 protein ( non-specific) -Conformational change in prion protein
46
Kuru
spongiform encephalopahty formerly seen in new guinea, consumption of human brain tissue
47
-Prior exposure to JC virus (no exposure is almost no risk while if exposed you have to look at degree of positivity) - Prior immunosupression doubles the risk -Risk increases with number of tysabri infusions
Tysabri and PML
48
- Lichtheim's disease -Degenration of the posterior and lateral columns of the spinal cord as a result of B12 def, Cu def, or Vit E def. Usually associated with pernicious anemia
Subacute Combined Degeneration
49
- Toxoplasma Gondii, parasite - Infected meat, cat feces, or mother to fetus - Mostly mild flu-like in non-compromised humans - Eccentric target sign of todo on imaging -TX: empiric sulfadiazine/pyrimethamine--if no improvement, then bx the lesion. 90% respond to tx.
Toxoplasmosis
50
- not really easy to differentiate in imaging -Antibody to toxo; mostly helpful if negative. -Lymphoma associated with EBV; do PCR -Lyphoma has no treatment ( 6 mo survival even with rdx)
Toxoplasmosisv. 1mary CNS lymphoma
51
-Meningitis in HIV - HA, mental status changes, meningeal signs -India ink ( 75% +, now cryptococcal antigen via latex agglutination 95% +) -Often opening pressure is elevated; papilledema -Tx: IV amphotercicin, then flucanozole continued for 3 months after CSF is sterilize
Cryptococcus Neoformans
52
-HIV or meds ( Zidovudine)
HIV myopathy
53
- distal polyneuropathy -Can also be due to HIV meds
HIV Neuropathy
54
- Can produce myelopathy similar to B12 def
HIV Myelopathy
55
SImilar to any other--- but from uncommon hosts
HIV meningitis
56
-Common in late stages of disease
HIV Dementia
57
-CMV; Also lumbar radiculitis
HIV eye disease
58
HIV vasculitis
HIV stroke
59
-HIV meningitis -Acute Inflammatory demyelinating syndrome
Opportunistic diseases HIV -CD4\>500
60
-HIV associated dementia -Mononeuritis multiplex HIV-associated myopathy/neuropathy
Opportunistic diseases HIV CD4=200-500
61
CNS toxo PML 1mary CNS lymphoma Cryptococcal meningitis HIV vacuolar myelopathy CMV ventriculitis VZV vasculitis
Opportunistic diseases HIV CD4
62
-Most common sporadic -non-specific : fever, HA, confusion, personality changes, olfactory/gustatory hallucination. focal seizures/ motor distrubances - Frontal/temporal lobes (swelling-\> uncal herniation) - LP grossly bloody CSF, elevated WBC, lymphocytes. PCR to confirm -EEG with PLEDs (temporal lobes) -IV acyclovir ASAP
HSV encephalitis
63
-Tropical spastic paraparesis -Chronic myelopathy common in caribbean and Africa. US IV drug users
Human T-lymphotropic virus type I
64
-zoster/shinglesfrom reactivation of varicella in dorsal root ganglia-painful vesicular rash - usually thoracic dermatome, V1 distribution; zoster ophthalmic us - week of antiviral agents ( acyclovir. valacyclovir) Can occasionally infect cerebral arteries causing strokes. also can infect SC directly leading to severe myelopathy
VZV
65
-devastating in utero -IC-encephalitis, often fatal in months -Associated with retinitis
CMV
66
-Bite from infected animal -Can cause encephalitis leading to psychiatric disturbances, death, or fatal paralysis due to SC infection - bx shows Negri bodies
Rabies
67
-Directly infects anterior horn cells of SC -Largely eradicated (vaccine)
Polio
68
Also infects anterior horn cells
West Nile
69
-Most common Strep Pneumo -CSF with increased pressure, ^WBC with PMN predominance, elevated protein, and decreased glucose. - Empirically treat --3rd gen ceph/vanc; + ampicillin in neonates, \>50 yo - LP but Ct with focal signs.
Bacterial Meningitis
70
GBS
Neonatal Bacterial Meningitis
71
- Neurological defecits, papilledema, IC, hx of CNS disease, AMS
Indication for CT before LP
72
\>80% adults: N. meningitides ,S. Penumoniae -\>50 yo more chance of l. monocytogenes
Causes of bacterial Meningitis
73
Supine; pain with thigh and knee flexion
Kernig's Sign
74
-Supine, lift head -+ when there is involuntary lifting of the legs
Brudzinski's Sign
75
-Neonate: amp/3rd gen ceph -Child-50: 3rd gen ceph+vanc+rifampin - \>50 y.o, IC: Amp, 3rd gen ceph+vanc+rifampin -CSF shunts/neurosurgery:3rd gen ceph+vanc -Skull fracture: 3rd gen ceph+metronidazole \*\* + steroids to prevent hearing loss
Meningitis Drugs by age
76
-meningitis ( usually basal)-malaise, to stupor, to coma, seizures, and often hemiparesis -IC tuberculomas -Pott's disease -TX- INH, rifampin, pyrazinamide for 12 months
CNS TB
77
-Usually lower thoracic or upper lumbar of the spine. -From hematogenous spread from other sites ( usually pulm) - spreads from 2 adjacent vertebrae into adjoining IVertebral space
Pott's Disease
78
-pyridoxine/ Vit B -Excess pyridoxine can also lead to peripheral neuropathy
Supplement to Izoniazid/rifampin to prevent peripheral neuropathy
79
-Brain usually direct invasion--\> usually temporal lobe--\> focal deficits -Hard to distinguish on imaging - Multiple means heme spread; Single means more direct spread -MOre inflammatory/ edema means early on
CNS Abscess
80
-primary (chancre) -\> 2ndary (rash on palms/soles)-\> Tertiary (meningitis, Tabes Dorsalis, General Paresis) -small, irregular pupils that do not react to light, but do to accommodation -
Syphilis
81
Can cause MCA stroke ( vaculitis)
Tertiary TB-Meningitis
82
Inflmmatory destruction of lumbosacral dorsal root ganglia with loss of sensation and pain in legs and abdomen, damage to posterior columns
Tabes Dorsalis
83
Encephalitic infection characterized by dementia, psych symptoms (Syphilis)
General paresis
84
1) Non-troponemal (RPR/ VDRL)-non-specific (CONFIRMATION) 2) Troponemal (TP-PA/TPHA/FTA-ABS/EIA)-specific; remain for life. do not correlate with treatment/titers (SCREEN) LP needed--high CSF WBC and oligoclonal bands
Syphilis w/u
85
- IV/IM penicillin for 14 days. F/u blood tests 3, 6, 12, 24, 36 months to ensure success. decrease in lymphocyte count and protein, decrease in VDRL titer
Penicillin neurosyphilis
86
-Stage 1- acute-erythema migraines -Stage 2- flu-like, meningitis,cardiac pathology -Stage 3- CNS
Lyme Disease
87
Sensory Neuropathy, subtle cognitive changes in some tx: oral doxycycline or if neuro--\> IV ceftriaxone
Stage 3 Lyme
88
-Pork Tapeworm -Cysticercosis (India/SA--\> primary epilepsy) - Infection through fecal.oral or undercooked pork - cysts in muscles, brain, eyes TX:abendezole and steroids to reduce inflammation
Taenia Solium
89
" brain eating amoeba' found in warm bodies of fresh water such as ponds, lakes, rivers, and hot springs
Naegleria fowleri
90
- cysts in the ventricular system, esp 4th--obstruction of CSF flow and hydrocephalus -May need shunting
racemos neurocysticercosis
91
-double hockey stick sign -Spongiform degeneration of grey matter caused by neuronal loss -Rapid dementia, sporadic 80% of the time ( also genetic/iatorgenic forms) CSF-14-3-3 protein ( non-specific) -Conformational change in prion protein
CJD
92
spongiform encephalopahty formerly seen in new guinea, consumption of human brain tissue
Kuru
