Infections

Question 1

1) CSF profile of patient with HSV encephalitis? Treatment?

Answer 1

High RBCs (non traumatic), lymphocytic whites, normal glucose. Treat with acyclovir. Also shows a predeliction for the temporal lobes

Question 2

2) Cryptococcus CNS infection. Strong CSF profile association with?

Answer 2

Elevated opening pressure. Crypto has strong effects on ICP and happens in immunocomprovmised hosts (HIV)

Question 3

3) Sequelae of bacterial meningitis long term?

Answer 3

Can cause bilateral sensorineural hearing loss, even after successful treatment. Can also cause vision loss as well as in Hellen Keller.

Question 4

4) CSF profile with high protein, low glucose, and elevated whites. What’s top two of differential?

Answer 4

Bacterial and TB meningitis. TB is lymphocytic predominant while bacterial is PMN predominant

Question 5

5) Patient presents with diffuse extremity weakness and tingling after a vaccination. Diagnosis and CSF profile?

Answer 5

Guillain Barre syndrome! Albumocytologic dissociation with high protein and low cells is characteristic CNS finding

Question 6

2) HIV patient with multiple ring enhancing lesions in the brain. What two things should be considered and in what order?

Answer 6

Toxoplasmosis first and foremost. If doesn’t respond to appropriate therapy, you worry about primary lymphoma caused by EBV in these patients

Question 7

5) Acute onset high fever, upper motor neuron signs in a patient three days after an epidural placement for colectomy surgery. Diagnosis? Treatment?

Answer 7

Epidural abscess from skin-derived organisms from poor sterile technique on epidural. Treat with coverage for S. aureus: Ceftriaxone, Vancomycin

Question 8

6) Presentation of neurocysticercosis? (Imaging, clinical manifestations, geographic location)

Answer 8

Imaging: calcified cystic lesions throughout the brain
Manifestations: epilepsy (i.e. seizures)
Epidemiology: many developing countries including Dominican republic, rural asia, and subsaharan Africa

Question 9

6) Pathogen and treatment of neurocysticercosis

Answer 9

Pathogen: Taenia solium (Pork tapeworm). Most common cause of acquired epilepsy in the developing world
Treatment: Albendazole (or Praziquantel)

Question 10

7) What is Rifampin useful for?

Answer 10

Prophylaxis against Neiserria meningitides infection in a patient recently exposed to another person with the disease (think college students…)

Question 11

8) New onset dribbling/drooling out of corner of the mouth with a scratchy eye occurring during the winter months? during the summer months? Treatment for both?

Answer 11

• Winter: Bell’s Palsy, Rx: prednisone +/- valcyclovir

- Summer: Lyme disease, Rx: ceftriaxone (or doxycycline)