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MHD > Infections of the CNS > Flashcards

Infections of the CNS Flashcards

1
Q

Symptoms of Acute Meningitis

A

Fever, HA, malaise, lethargy, nausea, vomiting, nuchael rigidity, impaird consciousness, Brudzinski or Kernig signs

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2
Q

Which is more severe–bacterial or viral meningitis?

A

Acute bacterial meningitis more severe and may be fatal

Viral meningitis is benign, nonfatal, untreatable, but resolves spontaneously

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3
Q

How does a bacterial infection reach the CNS?

A

Trauma

Hematogenous spread from distant site

Directly from adjacent infection (otitis, sinusitis)

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4
Q

What test should be performed ASAP if you suspect bacterial meningitis?

A

Lumbar puncture

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5
Q

How will CSF appear if the patient has bacterial meningitis? Protein, glucose, cells?

A

Cloudy CSF, High protein, Low glucose, lots of PMNs

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6
Q

How will CSF appear if the patient has viral meningitis? Protein, glucose, cells?

A

Normal appearance, normal-high protein, normal glucose, lots of lymphocytes

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7
Q

How should bacterial meningitis treatment be initiated?

A

Start with broad spectrum ABX until you know the causative agent, then switch to more specific ABX

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8
Q

What are some potential complications of bacterial meningitis?

A

Hydrocephalus from pus obstructing CSF

Secondary inflammation and edema of cortex (meningoencephalitis)

Infarction from thrombosis of inflamed superficial vessels

Deafness

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9
Q

Who is most likely to suffer form chronic meningitis?

A

Elderly

Malnourished

Immunocompromised

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10
Q

Symptoms of chronic meningitis

A

Mild headache or confusion

No obvious meningeal signs

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11
Q

What is encephalitis? What may cause it?

A

Primary infection and inflammation of brain, often viral

Caused by…HSV1, WNV, Polio, Varicella Zoster, HIV

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12
Q

Herpes simplex encephalitis

What organism causes it and where in the brain will it likely infect?

A

Caused by HSV-1

Predilection for frontal and temporal lobes

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13
Q

Herpes simplex encephalitis

How is it treated?

A

Acyclovir (antiviral drug)

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14
Q

West Nile Virus

What is the spread? Symptoms?

A

Spread to humans by mosquitoes

Encephalitis (fever, headache, rash)

Weakness of the peripheral nerves or anterior horn cells

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15
Q

Poliovirus

Where does it infect and what does it cause?

A

Infects motor neurons in the brainstem and spinal cord

Could cause mild regional weakness to general paralysis

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16
Q

Shingles

What is the clinical manifestation?

A

Reactivation of Varicella-Zoster virus latent in the dorsal root ganglia

Vesicular rash with severe neuralgic pain along 1-2 dermatomes

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17
Q

HIV

How is it acquired? What is it’s MOA?

A

Transmitted by infected body fluid (intercourse, needle sticks, blood products)

HIV destroys CD4 T cells, which can lead to AIDS

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18
Q

AIDS dementia

What is it? What is seen on imaging?

A

Slow cognitive and behavioral decline with poor prognosis

Nonspecific atrophy and white matter alterations on MRI

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19
Q

PML

Caused by what virus? What is its clinical manifestation in the CNS?

A

JC Virus

Patchy demyelination in the CNS and focal deficits

20
Q

Toxoplasmosis

How is it acquired? What is seen on brain CT?

A

Acquired by ingestion of cat feces containing ova

See ring enhancing lesions on CT

21
Q

What 3 symptoms are associated with congenital toxoplasmosis?

A

Chorioretinitis

Hydrocephalus

Intracranial calcifications

22
Q

What bacterial infections of the CNS are most common in neonates?

A

E coli

GBS

Listeria

Pseudomonas

23
Q

What bacterial infections of the CNS are most common in babies 1-12 months?

A

S. pneumo

H flu

24
Q

What bacterial infections of the CNS are most common in age 1-16?

A

Neisseria meningitidis

S pneumo

H flu

25
Q

What bacterial infections of the CNS are most common in age 16-50?

A

S pneumo

N meningitidis

26
Q

What bacterial infections of the CNS are most common in the elderly?

A

Listeria

Pseudomonas

27
Q

Tuberculous Meningitis

What is seen on histology?

A

Necrotizing granulomatous inflammation with epithelioid histiocytes, T cells, and multinucleated giant cells

28
Q

Describe the CSF in Tuberculoid Meningitis

A

Mostly lymphocytes,
Moderately high protein,
Mildly low glucose

29
Q

Cryptococcus Meningitis is most likely to occur in…

A

Immunocompromised

30
Q

Cryptococcus Meningitis

How would you confirm this infection?

A

On biopsy, see clear yeasts with a mucoid capsule in the perivascular (Virchow Robbins) space

Done with mucicarmine or India Ink stain

31
Q

How might Angioinvasive Aspergillus appear on histology?

A

On GMS stain, see dark fungi with hyphae branching at 45 degree angles

32
Q

How does Cysticercosis appear on brain imaging?

A

See empty cystic spaces filled with scolex

33
Q

Naegleria fowleri

How is the infection acquired? What does it cause?

A

Swimming in freshwater lakes, the amoeba enters and penetrates the cribiform plate to cause Acute Fulminant Meningoencephalitis (often fatal)

34
Q

What are the microscopic findings of viral encephalitis?

A

Perivascular inflammation

Leptomeningeal inflammation

Microglial nodules

Neuronophagia

35
Q

What is neuronophagia?

A

Dead neurons surrounded by microglial cells and histiocytes

Seen in viral encephalitis

36
Q

Rabies Virus

Transmission? Incubation? Histology?

A

Transmitted from rabid animals (bats, raccoons)

Incubation can last 10 days-1 year depending on bite location

Histology: NEGRI BODIES (cytoplasmic inclusions)

37
Q

CMV

What are some complications of CMV Encephalitis?

A

Large intracytoplasmic and intranuclear inclusions

Hydrocephalus

Many foci of calcifications seen in white matter

38
Q

HIV encephalitis

Describe where it is seen and what cells may be involved

A

Widespread microglial nodule encephalitis with multinucleated giant cells with predilection to grey matter

39
Q

HIV Leukoencephalopathy

Describe where it is seen and what cells may be involved

A

Diffuse white matter myelin pallor with microglial nodules and multinucleated giant cells

40
Q

Vacuolar Myelopathy

Describe where it is seen and what cells may be involved

A

Spastic paraparesis with hyperreflexia and ataxia

Vacuolation of spinal cord white matter

Resembles subacute combined degeneration

41
Q

Brain Abscess

What is it? How does it appear on MRI?

A

Focal discrete CNS infection

Appears as a ring enhancing lesion on MRI

42
Q

Brain Abscess

What are the 4 stages of evolution of an abscess?

A

Early cerebritis
Confluent necrosis
Early encapsulation
Late encapsulation

43
Q

Brain Abscess

Treatment

A

Surgical excision (if there is one)

Antibiotics

44
Q

Prion Disease

What are the two main prion diseases?

A

Cruetzfeld Jakob Disease (CJD)

Bovine spongiform encephalopathy (BSE)

45
Q

Prion Disease

MOA

A

Misfolded proteins induce conformational changes in normal proteins

Neuronal death occurs WITHOUT inflammation

46
Q

Cruetzfeld Jakob Disease (CJD)

Symptoms

A 
Dementia
Prominent myoclonus (jerky contractions of muscle groups)

CST, extrapyramidal, LMN signs

47
Q

Cruetzfeld Jakob Disease (CJD)

Histology

A

Spongiform changes (cytoplasmic vacuoles in neurons and astrocytes)

Neuronal death without inflammation

MHD (57 decks)

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