Inflammatory And Infectious Neurologic Disorders Flashcards
T/f: the normal mechanisms of the CNS protect it from infecting organisms
True
Abnormal responses to infecting organisms is dependent on what factors?
The pathogens of the infection
Localized vs generalized infection
Type of organism that caused the infection
Personal factors (immune status and genetics)
What are the different pathogens for abnormal response to infectious organisms (different ways they enter)?
Entry through the BBB
Entry through a head wound
Entry through operative procedures
What would cause a localized infection of the CNS?
An abscess or area of infection/pus
What would cause a generalized infection of the CNS?
Leptomeninges, brain matter, or both being infected
What populations are most at risk of infection due to their immunologic status?
Very young
Very old
Anti-body deficient
Immunocompromised
What populations may be genetically predisposed to brain infections?
The Navajo Indians and American Eskimos
What are the most common types of CNS infections?
Meningitis (infectious, non-infectious, and aseptic)
Encephalitis
What are the most common causes of CNS infections?
Infection via bacteria, viruses, protozoan, parasites, or prions
autoimmune disorders
Cancer/neoplastic syndromes
Drug rxns
Is HIV/AIDS a viral or bacterial infection?
Viral
What are the common s/s of other less common CNS infections?
Behavioral, cognitive, mood, and some motor changes
Is neurosyphilis a bacterial or viral infection?
Bacterial
Is Whipple disease a bacterial or viral infection?
Bacterial infection first of the GI system, then other systems
What is the characteristic triad of symptoms in Whipple disease?
Dementia, opthalmoplegia, and myoclonus
Is tropic spastic paraparesis (TSP)/ HTLV 1 associated myopathy a bacterial or viral infection?
Viral of the SC of those living near the equator
Is progressive Multifocal leukoencephalopathy (PML) a bacterial or viral infection?
Viral
What kind of infection is Creutzfeldt Jakob Disease?
A slow viral infection resulting from prion protein dysfunction (genetic)
What kind of infection is neurocysticerosis?
Parasitic
What is neurocysticerosis commonly referred to as?
Brain worm
What kind of infection is toxoplasmosis?
Parasitic
What kind of infection is Reye syndrome?
Toxic encephalopathy with another common systemic virus
When microorganisms reach the brain tissue, what does it lead to?
Localized infection
How can microorganisms enter the brain tissue to cause a localized infection?
Via a penetrating wound
Via extension of another localized infection, such as sinusitis or otitis
T/f: penetrating wounds can cause abscesses to occur immediately or years later
True
What clinical triad do we see occur in <50% of localized brain abscesses? (It’s actually 4 so idk why it’s called a triad?)
Fever
Evidence of increased ICP
Focal neurological deficit
Change in consciousnesss
Why can there be an increase in ICP with a localized brain abscess?
Bc the infection causes inflammation and pressure
Why may there be a change in consciousness with a localized brain abscess?
Bc the buildup of pressure moves around structures and can lead to pressure on the brainstem
What is the main medical concern with localized brain abscesses?
Stabilization
What are the ways to medically manage a localized brain abscess?
With pharmaceuticals, surgery, corticosteroids, or anticonvulsants
What is involved in the pharmacological management of a localized brain abscess?
IV antibiotics (organism dependent)
How do we determine the organism affecting the brain abscess?
With a culture often done through lumbar puncture
What are very powerful antibiotics used to treat localized brain abscesses?
-mycin drugs
What is a side effect of using -mycin drugs to treat localized brain abscesses?
It is toxic to the inner ear and can cause BL loss of hearing
What are surgical interventions for localized brain abscesses?
CT guided stereotactic aspiration
Surgical drainage
Why are anticonvulsants often used to treat localized brain abscesses?
Bc seizures become a very critical side effect of encephalopathies
What is a big red flag to look out for with meningitis and encephalopathy?
Hydrocephalus
What are the s/s of hydrocephalus?
Wet (incontinence)
Wobbly (fall risk)
Wacky (mentation)
What are the two common types of meningitis?
Infectious and non-infectious/aseptic meningitis
What is meningitis?
Inflammation of the meninges that surround the brain and SC
Infectious meningitis can typically be caused by either ____ or ____
Bacteria, virus
T/f: infectious meningitis can be nosocomial
True
If a pt just had surgery, what should we be checking to help rule in/out meningitis?
Temp
Non-infectious/aseptic meningitis is typically caused by what?
Viral infection
Autoimmune disorders, CA/neoplastic syndromes
Drug rxns
What is the difference between infectious vs non-infectious/aseptic meningitis? (Going to double check with Dr T or Dr V)
Infectious meningitis tends to be more from infection while non infectious tends to come from disease or injury
What groups of drugs can cause drug induced aseptic meningitis?
NSAIDs, antibiotics
Immunosuppressive/modulatory drugs
Antiepileptics
Alcohol
With leptomeningitis/meningitis, the infection is either __________, ____________, or ________
Community-acquired, nosocomial, non-infectious/aseptic
Community-acquired meningitis is the result of _____ entering the blood
Infection(bacteremia)
Which type of leptomeningitis is a direct extension from localized infection (ENT/lung/wound)?
Community-acquired
Which type of leptomeningitis results from infection following an invasive procedure?
Nosocomial
If a patient has had a craniotomy or infected wound, what should we be looking for?
Temp
Sudden change in behavioral/cognition
What is the vulnerable area of the BBB where bacteria can enter?
The choroid plexus of the subarachnoid space
When bacteria enters the BBB, what happens?
It triggers the immune system and causes swelling of the meninges to stop the spread of the infection
What type of leptomeningitis is an inflammation typically caused by an autoimmune disorder, CA/neoplastic syndromes, or drug rxns
Non-infectious/aseptic
What is the chain of events in leptomeningitis?
The pia and arachnoid maters get acutely inflamed
Purulent exudate forms in the subarachnoid space
Exudate obstructs the flow of CSF
Increase in accumulation of CSF
Increased ICP
Venous obstruction
Further ICP increase
Decrease in cerebral blood flow (stroke risk)
Reflex mechanisms are activated and systemic BP increases
What are the presenting s/s of leptomeningitis?
HA (rapid onset, entire head)
Nuchal rigidity (stiff neck)
Fever
Altered mental state/confusion/irritability
Nausea and vomiting
Petechial skin rash
Myalgia
Dizziness
Seizures/coma
Neurological deficits
How will pts with leptomeningitis often describe their HA?
“The worst HA of my life”
What are the two characteristics signs of meningitis?
HA and nuchal rigidity
Petechial rash in meningitis is a sign of what?
Bleeding under the skin
T/f: the neurological deficits in meningitis resemble a stroke
True
What are the clinical signs of meningitis?
Stretch of the meninges, nerve root, SC causes pain and reflex spasms or rigidity
Nuchal rigidity
Kernig sign
Brudsinski sign
Jolt sign
What is Kernig sign in meningitis?
In supine, bring the knee into flexion then SLR
Causes pain in the lumbar/posterior thigh
What is Brudsinski sign in meningitis?
In supine, flex the neck
This will elicit hip/knee flexion
What is the Jolt sign in meningitis?
Having the pt turn their head quickly from side to side 2-3x per second
Causes an increase in their HA
What is the diagnostic test for meningitis?
A lumbar puncture
T/f: there is an increased risk for mortality/morbidity with delayed medical treatment of meningitis
True
The mortality rate of meningitis is based upon what factors?
The type of organism
Time to initiation of antimicrobial treatment
Age
Risk for stroke with meningitis is greatest when?
During the 1st 5 days
Systemic complications, cardiorespiratory failure, or sepsis occur in ___% of the time with meningitis
40
Neuro sequelae are permanent in __% of those with bacterial meningitis
30
T/f: there is a risk for seizures with meningitis
True
How is bacterial meningitis treated?
antibiotics
antiinflammatories
Prevention/managing secondary symptoms (seizures and hydrocephalus)
How is viral meningitis treated?
Symptom management
Does bacterial or viral meningitis have a generally better prognosis?
Viral meningitis
What are the chronic neurological sequelae/residual effects of meningitis?
Cognitive impairment and slowness
Residual sensorimotor deficits (hemiparesis, spasticity, vestibular, sensory processing)
Ongoing HA, fatigue, pain (intermittent with health/illness)
Communicating hydrocephalus (non-obstructive)
What residual sensorimotor deficits may result from meningitis?
Sensory processing
Hemiparesis, spasticity
CN 8 (vestibular) involvement can cause balance deficits, falls, and visual symptoms
What is encephalitis?
Inflammation and swelling of parachyma (fxnal tissue) of the brain and surrounding meninges caused by a virus
T/f: different CNS cells have different susceptibility to different viruses that cause encephalitis
True
Why does everyone with encephalitis present differently?
Bc different viruses effect different neurons
T/f: in encephalitis, inflammation can be treated and resolve OR it can progress to hemorrhagic necrosis, increased ICP, or brain herniation
True
What characteristics of encephalitis would contribute to likely poorer outcomes?
Persistent or prolonged increase in ICP
Prolonged, unmanaged infection leading to widespread destruction of white matter by the inflammatory response
Why does prolonged, unmanaged infection in encephalitis lead to poorer outcomes?l
Bc it results in widespread destruction of white matter by the inflammatory response
The clinical presentation of encephalitis depends on what factors?
What virus it is
What CNS tissue is involved in
The severity of the damage
The success of management
What are the 3 most common forms of encephalitis?
Herpes simplex encephalitis
West Nile virus
Parainfectious encephalomyelitis
Which type of encephalitis has a preference for the gray matter of the temporal lobe, insular cortex, cingulate gurus, and inferior frontal lobe?
Herpes simplex encephalitis
What produces symptoms in herpes simplex encephalitis?
Cerebral edema and increased ICP and risk of transtentorial herniation downward into the brain stem
___% of those with herpes simplex encephalitis have significant varied neuro sequelae
55
What is the most common mosquito borne virus?
West Nile virus
T/f: West Nile virus may present like a stroke with memory and cognitive impairments
True
Which type of encephalitis may vary from asymptomatic to severe neuro invasion?
West Nile virus
Which type of encephalitis is associated with COVID-19, measles, mumps, or varicella?
Parainfectious encephalomyelitis
What are the outcomes with Parainfectious encephalomyelitis?
Excellent with limited sequelae
What is the cluster of hallmark signs with encephalitis?
Fever
HA
Nuchal rigidity
Vomiting
General malaise
What signs of encephalitis are more suggestive of significant cerebral involvement?
Coma
CN palsy
Hemiplegia
Involuntary movt
Ataxia
What is involved in the medical management of encephalitis?
Symptom mangement
Medications
Aggressive management of increased ICP
Sometimes aggressive care to sustain life
What is primary medical management in encephalitis?
Symptoms management
What chronic neuro sequelae may result from encephalitis? (hint it’s a shit ton)
Inappropriate behavior and poor social skills
Epilepsy
Inability to understand and communicate
Problems with new learning
Cognitive (thinking) problems
Hormone problems
Fatigue
Problems with pain and other sensations
Problems with daily living skills
Emotional problems
Memory problems
Physical difficulties
Personality changes
T/f: alcohol has significant negative effects on nerves and muscle cells
True
Alcohol causes altered levels of what nutrients needed for normal fxn?
B1, B6, B9, B12, thiamine, and folic acid
Are more women or men affected by alcohol related neurological disease?
Women
What are the various alcohol related neurological diseases?
Wernicke Korsakoff syndrome
Alcoholic neuropathy
Alcoholic cerebellar degeneration
Alcoholic myopathy
Fetal alcohol syndrome
Alcohol withdrawal syndrome and delirium tremens
What are the 2 components of Wernicke Korsakoff syndrome?
Wernicke’s encephalopathy
Korsakoff psychosis
What is Wernicke’s encephalopathy?
Mental confusion, impaired coordination, paralysis of the nerves that move the eyes
What is Korsakoff psychosis?
Problems with learning and memory (even amnesia)
Forgetfulness
Decreased coordination
Ataxic gait
Postural instability
What is the role of PT in encephalitis?
We tend to manage the residual impairments and limitations
Infection of encephalitis affects the function of what in the brain?
The primary areas of the CNS
The areas of the CNS (edema, shifts)
T/f: brain structure is affected in encephalitis
True
T/f: the presentation of a pt with encephalitis is focal s/s that are dependent upon CNS structures involved
True
What are the most involved structures in encephalitis?
The frontal, parietal, and temporal lobes
What results from frontal, parietal, and temporal lobe involvement in encephalitis?
Memory, cognitive, and speech deficits
_____% of those with encephalitis have persistent seizures
30-50
_____% of those with encephalitis have hemiparesis
15-30
____% of those with encephalitis have speech/language disorders?
10-20
What are possible s/s of encephalitis?
Memory, cognitive, and speech deficits
Persistent seizures
Hemiparesis
Speech/language disorders
T/f: infectious/inflammatory disorders have a well defined presentation
False, they have an ill defined presentation
T/f: infectious/inflammatory disorders of the CNS can present as any other disorder we’ve studied so far (BG, BS, cerebellar, cerebral disorders)
True
What is an important PT role for patients with encephalitis?
Taking a good hx
Determining medical stability
Listening and observing the patient
Hypothesize potential impairments and limitations based on pathophysiology
T/f: we should cast a wide net during the eval for encephalitis to determine the examination items needed
True
Why do we have to cast such a wide net for screening during our evaluation with encephalitis?
Bc the presentation is so variable from case to case
What questions should we be asking during the evaluation of a patient with encephalitis?
The date of onset
The nature of symptoms
If they received immediate medical management
If they received diagnostic testing/results
How they were managed
Have they had any complications and what they were
What mental functions should we be screening with encephalitis?
Arousal (GSC)
Cognition
Dual tasking
Sleep screen
Behavioral involvement
What sensory fxns should we be screening for with encephalitis?
CN (sensory)
Pain assessment
Sensory screen
Skin hypersensitivity
Myalgia
Discriminatory touch
Should we screen voice and speech fxns with encephalitis?
Yes
What CV, hemo, immuno, and respiratory fxns should we screen for in encephalitis?
VSs
RPE
Autonomic and physiologic responses to therapeutic activities
O2
What GU fxn should we screen for with encephalitis?
Incontinence (wet )
What neuromusculoskeletal and movt related fxns should we screen for with inflammatory/infectious diseases of the CNS?
Neural tension special test
Abnormal postural reflexes
CN (motor)
Possible motor assessment (UMN), balance assessment, and fxnal assessment (wobbly)
When we have a pt with infectious/inflammatory diseases of the CNS, we should observe ____ mobility outside of the exam
General
When we have a pt with infectious/inflammatory diseases of the CNS, we should observe ___ movt in a movt analysis
Specific
When we have a pt with infectious/inflammatory diseases of the CNS, we should correlate with _____ complaints and symptoms
Pt specific
What are the nets for assessing large movt in infectious/inflammatory diseases of the CNS?
AMPAC 6 clicks in acute settings
Mobility assessment for the quality, assistance, and safety
Rivermead Mobility Index
FIM or STREAM
What is a highly recommended movt screen in infectious/inflammatory diseases of the CNS?
The Rivermead Mobility Index
What is the Rivermead Mobility Index?
A 15 item mobility assessment with progressing difficulty scored 0 (no) or 1 (yes) depending on if they can do it with higher scores indicating higher mobility
What is the Rivermead Plus?
A two part exam of mobility with a self report section of fxnal limitations and a focus fxnal exam
What are more narrow tests and measures we can use for assessing someone with an infectious/inflammatory disease?
CN exam
Executive fxn tests
Sensory/sensorimotor integration tests
Super six tests
MiniBEST v BBT
Gait assessment
T/f: someone with an infectious/inflammatory disease of the CNS can have multiple different movt diagnoses
True
What are possible movt diagnoses for persons with infectious/inflammatory diseases of the CNS?
Movt pattern coordination deficit (motor sequencing problem)
Force production deficit
Fractionated movt deficit (influence of synergies)
Postural vertical deficit
Sensory selection and weighting deficit
Sensory detection deficit
Hypokinesia
Dysmetria
Cognitive deficit
What are some interventions we can implement with inflammatory/infectious disorders of the CNS?
Positioning
Strength and resistance training
Flexibility activities
NeuroMSK re-ed
Mobility and gait training
Balance training
Physical agents and modalities to manage pain and tenderness
Fatigue management and pacing
Pt education and caregiver support
With CN 8 involvement, what is the central focus of interventions?
Balance
The prognosis with inflammatory/infectious CNS diseases depends on what?
The infectious organism and the extent of involvement
T/f: many pts will never return to their prior LOF
False, many pts will
T/f: our exam and eval will help provide info on the extent and degree of fxnal impairment in inflammatory/infectious diseases of the CNS
True
T/f: patient with infectious/inflammatory CNS disorders may have focal and generalized CNS dysfunction
True
The intervention plan with inflammatory/infectious CNS disorders is highly dependent on what?
Exam findings
