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Neurology > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is the classic triad of CNS infections?

A
  • Fever
  • Stiff neck
  • Altered mental status
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2
Q

When and Why should you do a CT of the head prior to LP? (4)

A 
Why- r/o herniation through foramen magnum!
When:
- Pt has papilledema 
- Pt has seizures
- Pt has focal neurological findings
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3
Q

Nearly all bacterial meningitis pts have 2 of the following….(4)

A
  • headache
  • fever
  • stiff neck
  • altered mental status
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4
Q

CNS Infection Evaluation (5)

A
  • Infection- CBC, blood culture
  • Meningitis- LP, CSF analysis
  • CXR- pneumonia (looks like meningitis)
  • Encapsulated organisms- latex agglutination
  • Bacteria & virus- PCR or CSF
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5
Q

What is the danger triangle of the face?

A
  • Between the eyebrows, down over nose, to the sides of the mouth
  • From the skin, to the facial vein, to superior ophthalmic vein, to cavernous sinus
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6
Q

Cavernous Sinus Thrombosis (6)

A 
- Infection of staph or strep
S/S:
- CN palsies
- Meningeal irritation
- Exophthalmos
- CT for diagnosis
- Ophtho/ENT EMERGENTLY
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7
Q

Meningitis Overview (3)

A
  • Infection involving the pia and arachnoid mater
  • D/t: bacteria, virus, malignancy, chemical, protozoa, helminths, fungus
  • Medical Emergency!
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8
Q

S/S of Infectious Meningitis (6)

A
  • headache
  • fever
  • sensory disturbances
  • neck and back stiffness
  • Kernig and Brudzinski’s sign
  • CSF abnormalities
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9
Q

Types of Meningitis (10)

A
  • Purulent
  • Chronic
  • Aseptic
  • Encephalitis
  • Partially treated bacterial meningitis
  • Neighborhood infection
  • Non-infectious meningeal irritation
  • Brain abscess
  • Amebic meningoencephalitis
  • Health care associated meningitis
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10
Q

Purulent Meningitis (5)

A
  • Acute, presents 1-2hrs of onset
  • 18-50yrs= strep. pneumo., N. meningitidus
  • Over 50= gram -, Listeria monocytogenes
  • Diagnose with CSF culture or gram stain
  • Tx with vanco + 2nd cephalosporin or ampicillin
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11
Q

CNS Infection Tx (3)

A
  • Abx prior to LP to avoid delay in tx
  • LP done in 4 hrs of abx start
  • Dexamethasone given to adults, most effective with strep
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12
Q

Chronic Meningitis (3)

A
  • Hx of symptoms for weeks or months
  • Common pathogens are atypical (mycobacterium TB, spirochetes, etc….)
  • Diagnosis is usually made by culture or serologic testing
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13
Q

Aseptic Meningitis

A
  • Usually d/t virus
  • Benign, self-limiting
  • Common viruses include: HSV, enteroviruses, EBV, etc…
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14
Q

What are three drugs that can cause drug-induced aseptic meningitis?

A
  • NSAIDS
  • Sulfonamides
  • Solid organ transplant agents- muromonab, CD3 (OKT3)
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15
Q

Partially Treated Bacterial Meningitis (4)

A
  • Appears similar to aseptic meningitis on CSF evaluation
  • Happens when pt comes off abx too soon
  • May not have the same bacterial count as before
  • May look different in CSF from the first time
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16
Q

Neighborhood Rxn Meningitis (7)

A
  • Purulent infectious process close to CNS
  • Spills inflammatory products into CSF
    Caused by:
  • Brain abscess
  • Osteomyelitis of the vertebrae
  • Epidural abscess
  • Subdural Empyema
  • Bacterial sinusitis or mastoiditis
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17
Q

Noni Infectious Meningeal Irritation (8)

A 
Caused by:
- Carcinomatous meningitis
- Sarcoidosis
- SLE
- Chemical Meningitis
- Drugs
- Signs of meningeal irritation i.e. headache
CSF shows
- increased protein level
- low or normal glucose level
- increased cells (pleocytosis)
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18
Q

What are the 2 types of Amebic Meningoenchephalitis

A
  • Diagnosis confirmed by culture
  • 2 distinct syndromes:
    1. Primary
    2. Granulomatous amebic encephalitis
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19
Q

Primary Amebic Meningoencephalitis (3)

A
  • N. fowleri
  • Children, young adults
  • acute, fulminant dz, rapid progression to death
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20
Q

Granulomatous Amebic Encephalitis (5)

A
  • Acanthamoeba, Balamuthia
  • indolent dz
  • immunocompromised
  • cutaneous lesions
  • headache, N/V, seizures, hemiparesis
21
Q

Health Care associated Meningitis (6)

A 
Caused by:
- invasive neuro surgery
- complicated head trauma
- hospital acquired blood stream infection
Typical organism:
- pseudomonas
- Staph
- Coag neg staph
22
Q

Encephalitis (3)

A
  • inflammation of brain
  • caused by a virus i.e. HSV, etc…
  • Pt more ill than with viral meningitis
23
Q

Symptoms of Encephalitis (2)

A
  • Sensory disturbances

- Seizures

24
Q

Diagnosis of Encephalitis (2)

A
  • CSF may be normal or show lymphocytes

- CSF may show RBC in cases of HSV

25
Q

Brain Abscess Overview (3)

A
  • Arise as sequela of dz of the ear, nose, or an infection elsewhere
  • Arise from surgical intervention or trauma
  • Common organisms: staph, strep, anaerobes
26
Q

Early S/S of Brain Abscess (5)

A
  • Headache
  • Drowsiness
  • Inattention
  • Confusion
  • Seizures
27
Q

S/S of Late Brain Abscess (2)

A
  • Increasing ICP

- Focal neurological deficit

28
Q

Brain Abscess Imaging (2)

A

CT- area of contrast enhancement surrounding a low density core
MRI with and w/out contrast- more sensitive, catch it earlier

29
Q

Procedures for Brain Abscess (4)

A
  • Stereotactic needle aspiration allows drainage and culture (if they are >2cm)
  • CSF not helpful
  • LP contraindicated d/t herniation
  • Serum leukocytosis may be present
30
Q

Brain Abscess Tx (4)

A
  • IV abx for 6-8wks
  • Followed by oral abx for 2-3 months
  • PCN G + 3rd cephalosporin + metronidazole
  • add Nafcillin if staph is suspected
31
Q

Brain Abscess F/U (2)

A
  • CT/MRI every 2 weeks or if symptoms worsen

- Reduce edema with dexamethasone or mannitol

32
Q

Lyme Dz Overview (4)

A 
- B. burgdorfer in CNS + PNS
Early CNS manifestations include:
- headache 
- fever
- neck stiffness
33
Q

What is neuroborreliosis? (6)

A
  • Late finding in Lyme Dz
  • Subtle changes in memory
  • Hx of erythema migrans or arthritis
  • encephalopathy prompting CSF evaluation
  • CSF may show elevated protein/pleocytosis
  • Serology positive
34
Q

Lyme’s Dz Peripheral Neuropathy (4)

A
  • Facial Nerve Palsy
  • Abnormal EMG
  • Abnormal nerve biopsy- perivascular lymphocytes
  • Positive serology
35
Q

Lyme’s Dz Tx (4)

A 
Facial Nerve Palsy:
- doxycycline
- amoxicillin/cefuroxime
CNS:
- Ceftriaxone
- PCN G/ Cefotaxime IV
36
Q

Neurosyphilis (4)

A
  • Can occur at any stage of infection
  • Progressive, disabling, life threatening
  • Meningovascular syphilis occurs early
  • Tabes dorsalis & general paresis occur late
37
Q

Asymptomatic Neurosyphilis (4)

A

CSF abnormalities:

  • increased protein
  • lymphocytic pleocytosis
    • CSF reagin test
  • No neurologic findings
38
Q

Meningovascular Syphilis (8)

A
  • Meningial involvement
  • Changes in vasculature of brain
  • S/S of acute/chronic meningitis
  • cranial nerve palsies
  • unequal reflexes
  • MLF involvement
  • CSF abnormalities
    • serology
39
Q

Tabes Dorsalis Definition

A

Degeneration of dorsal columns of spine and posterior sensory and nerve roots

40
Q

Tabes Dorsalies S/S (8)

A
  • impairs prop/FT/vib
  • Muscle hypotonia & hyporeflexia
  • Wide based gait
  • argyll-robertson pupil
  • parasthesia/analgesia/ shooting pain
  • neurogenic bladder
  • painless ulcers
  • joint damage (charcot foot)
41
Q

What is the Tabes Dorsalis “crises”? (5)

A
  • lasts for hours to days then stops
  • gastric crises (sharp abd. pain, N/V)
  • laryngeal crisis (cough, dyspnea)
  • urethral crises (bladder spasms)
  • rectal/anal crises (pain)
42
Q

General Paresis (8)

A
  • involves cerebral cortex
  • decrease in concentration
  • memory loss
  • dysarthria
  • tremors of the fingers and lips
  • irritability
  • mild headaches
  • personality change (irresponsible, confused, psychotic)
43
Q

TB Meningitis (7)

A
  • M. tuberculosis
  • *gradual onset
  • listlessness/irritability/anorexia
  • headache, vomiting, seizure
  • CN abnormalities
  • *TB elsewhere in the body
  • *CSF shows lymphocytic pleocytosis, low glucose, high protein
44
Q

TB Meningitis Tx (3)

A
  • *All anti TB meds penetrate BBB
  • rifampin + isoniazid + pyrazinamide + ethambutol
  • add corticosteroids if focal deficits/altered mental status
45
Q

HSV Encephalitis Presentation (7)

A
  • Fever
  • Headache
  • Psychiatric symptoms
  • Seizures
  • Vomiting
  • Focal Weakness
  • Memory loss
46
Q

HSV Encephalitis Diagnosis (5)

A
  • CSF pleocytosis
  • *RBC’s in CSF
  • PCR on CSF
  • MRI shows increased signal in temporal and frontal lobes
  • EEG may show temporal lobe seizure foci
47
Q

HSV Encephalitis Tx (4)

A
  • IV acyclovir
  • not really toxic but watch the kidneys
  • long term neurologic sequellae are common
  • late pediatric relapse is recognized
48
Q

Creutzfeld-Jakob Dz

A
  • transmissable spongiform encephalopathies (TSE)
  • Several forms
  • Starts with forgetfulness, discoordination
  • progressive over a short time to coma and death

Neurology (12 decks)

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