Infections

Question 1

What are the most common bugs in bacterial menigitis

Answer 1

Neonates: E.Coli, GBS, Listeria
Children: Strep pneumo, Neisseria, Haemophilus
Young Adults:Strep pneumo, Neisseria
Older adults: Strep pneumo, Neisseria, Listeria

Question 2

What findings make us do steroids before LP?

Answer 2

1. GCS

Question 3

What is worrisome about a petichial rash?

Answer 3

1. Sign of Neisseria, which is contagious-ISOLATE

Question 4

What findings indicate spinal epidural abcess?

Answer 4

1. Triad of back pain, fever, neurological deficit

Question 5

What are the signs of West Nile CNS infection?

Answer 5

1. Tremor
2. Myoclonus
3. Parkinonism
4. Confusion
5. Acute flaccid paralysis

Question 6

What are the signs of Herpes Zoster CNS infection?

Answer 6

1. Dermatomal distribution
2. Burning/itching rash
3. Neuropathic pain

May get post-herpetic neuralgia

Question 7

CNS abcess

Answer 7

May be associated with previous trauma ie. cribiform plate fracture.
Often polymicrobial, may involve strep viridans, strep milleri, strep pneumo, nocardia

Question 8

Lyme Disease

Answer 8

Caused by Borrelia Burgdorferi
Hx of outdoors, summer, tick bite
Sx: Bull’s Eye Rash, Cardiac issues, aseptic meningitis, encephalopathy, decreased DTRs

Question 9

Neurosyphilis

Answer 9

Fx: rapidly progressive dementia, non-reactive pupils (argyll-roberston) tabes dorsalis

Question 10

Tuberculosis

Answer 10

Ix: MRI shows ring enhancing lesions

Question 11

Neurocysticercosis

Answer 11

Ex: Helminth infection
Hx: Pig exposure
Fx: adult onset seizures, CNS and muscle involvment
Ix: MRI shows cyst with dot inside, xray of thighs is horrifying.
Tx: Albendazole

Question 12

Toxoplasmosis Gondi

Answer 12

Ex: Protozoan infection
Hx: Cat exposure (feces)
Fx: confusion, lethargy
Ix: MRI: ring enhancing lesions + edema, PCR
Tx: pyramethimire, follinic acid

Question 13

Cryptococcus Gatti

Answer 13

Ex: Fungal infection
Hx: Vancouver Island, AIDS
Fx: Headaches, decreased short term memory, seizures
Ix: MRI-ring enhancing lesions, India Ink preparation diagnostic
Tx: Amphotericin B, fluconazole

Question 14

HIV

Answer 14

Fx: Kaposi’s sarcoma, spastic paresis, increased DTRS, distal sensory neuropathy, polyradiculopathy, dementia, aseptic meningitis

Question 15

JC virus

Answer 15

Hx: immunosuppression
Fx: Ataxia, dysarthria, changes to visual fields, confusion
Ix: MRI, PCR CSF

Question 16

HSV infection CNS

Answer 16

Fx: temporal lobe seizures, behavioural changes, confusion, aphasia, focal neuro deficits
Ix: LP xanthochromia, lymphocytes
Tx: IV acyclovir

Question 17

Rabies

Answer 17

Hx: Animal bite
Fx: fever, headache, weakness progressing to hallucinations, drooling
Ix: PCR/serology
Tx: Rabies IVIG

Question 18

Findings bacterial meningitis

Answer 18

Nucal rigidity
Kernigs Sign
Brudinkskis sign