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Neuro > Infections > Flashcards

Infections Flashcards

1
Q

What is prion disease

A

Group of neurodegenerative diseases caused by prions which accumulate and damage nerve cells

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2
Q

What is the most common prion disease

A

CJD

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3
Q

What causes CJD

A

Sporadic - protein -> prion
New variant - consuming meat from cow with bovine spongiform encephalopathy
Familial - genetic
Acquired - infection

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4
Q

How does sporadic present

A 
Rapidly progressive dementia
Myoclonic jerks
>60
Behaviour abnormality
Cerebellar ataxia
Parkinsonism - Tremor / rigid / bradykinesia
Weakness
Hyperreflexia / UMN sign 
Seizure
Blidness
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5
Q

What is prognosis

A

Death in 6 months

13 if new variant

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6
Q

How does new variant present

A

Younger onset
Early behaviour change
Anxiety / withdrawal / dysphonia
Better prognosis

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7
Q

How do you Dx

A

MRI = hyperextense
EEG
CSF = usually normal
Immunoassay for brain protein

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8
Q

How do you Rx

A

No treatment currently

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9
Q

What are differentials

A 
Viral encephalitis
PML
HIV dementia
Lyme's / neurosyphillis
Whipple's
Alzheimer's
Lewybody
Tumour
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10
Q

What is Reye’s

A

Fatty infiltration of liver, pancreas, kidney and brain

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11
Q

What causes Reye’s

A

Post viral infection
Aspirin use
Common in children

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12
Q

What are the symptoms

A 
Severe progressive encephalopathy
Confusion
Seizures
N+V
Cerebral oedema
Coma
Abnormal LFT
Hypoglycaemia
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13
Q

How do you treat

A

Supportive

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14
Q

What are other rare infections in brain / affect nerves

A 
Poliomyelitis
Lyme's
Neurosyphillis
Rabies
Tetanus
Botulism
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15
Q

What does poliovirus 1,2,3 (enterovirus) cause and where does it affect

A

Poliomyelitis

Affects anterior horn cell to affect LMN

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16
Q

How do you prevent

A

Vaccine

17
Q

What happens in rabies

A

Humans bitten by infected animal
Virus enters PNS
Migrates to CNS

18
Q

What does it cause

A

Ascending paralysis
Paraesthesia
Encephalitis

19
Q

How do you Dx

A

Nerve conduction
Culture of wound
Serology

20
Q

How do you Rx

A

Immunisation killed vaccine if high risk area before travel

If bitten
Clean and disinfect wound 
Immunisation active vaccine to boost 
Human rabies Ig
Consider Ax
21
Q

What causes tetanus

A 
Clostridium tetani
Anaerobic gram +ve
Toxin acts at TMJ and blocks inhibition of motor neurones
Prevents release of GABA
Present in soil and can enter body
22
Q

How does it present

A 
Fever
Lethargy
Hedache 
Trismus - locked jaw
Spasms
Rigidity 
Arched back and hyperextended neck
Dysphagia due to spasm
23
Q

How do you prevent

A

Immunisation x5

Penicillin and Ig if high risk wounds

24
Q

How do you treat

A

Ventilatory support
Muscle relaxant
IM Ig for high risk wounds
Metronidazole

25
Q

What causes botulism

A

Clostrodium botulinum
Anaerobic gram +Ve
Binds to pre-synaptic membranes of peripheral NMJ
Block Ach release

26
Q

What are symptoms

A 
Flaccid paralysis
Resp failure
Autonomic dysfunction
- Urinary retention
- Dry mouth
- Dilated fixed pupils 
Diplopia
Ataxia 
Bulbar palsy 
- Dysphagia
- Dysphonia
27
Q

How do you Dx botulism / tetanus

A

Nerve conduction
Wound culture
Mouse neutralisation bioassay

28
Q

How do you treat

A

Anti-toxin ABE
Prolonged penicillin
Wound debridement

29
Q

What are considered high risk tetanus wound requiring prophylaxis with IM Ig + muscle relxant

A 
Burns requiring surgery >6 hour wait
Soil containation
FB
Compound fracture
Systemic sepsis
30
Q

Meningitis and encephalitis

A

See infection

31
Q

What is most common cause of encephalitis

A

Viral

- HSV / VZV

32
Q

What is another cause

A

Autoimmune

33
Q

What are general encephalitis features

A 
Fever
Altered mental status
Seizure
Flu like prodrome 
Meningitis can become
34
Q

How do you Dx and Rx

A

CT head
MRI
LP if no focal

Rx

  • Aciclovir
  • Anticonvulsant
35
Q

What does HSV cause

A

Temporal lobe change and multi-focal haemorrhage

36
Q

How does autoimmune present

A 
Confusion
Siezure
Movement disorder
Psychosis
Cognitive change
Low GCS
Often fluctuating

Increasingly recognised as acute / subacute mental status change in the young

37
Q

How do you Dx

A

Ab

  • NMDA receptor Ab
  • Voltage gated K channel (low Na)
  • Anti-Hu

MRI head
EEG
PET CT

38
Q

What is important to do in autoimmune

A

Cancer screen as can be parenoplatic - PET CT
Ovarian = NMDA
SCLC = anti-Hu

39
Q

How do you Rx

A

Steroid

IV Ig if required

Neuro (19 decks)

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