Inflammatory And Infectious Neurologic Disorders Flashcards
1
Q
T/f: the normal mechanisms of the CNS protect it from infecting organisms
A
True
2
Q
Abnormal responses to infecting organisms is dependent on what factors?
A
The pathogens of the infection
Localized vs generalized infection
Type of organism that caused the infection
Personal factors (immune status and genetics)
3
Q
What are the different pathogens for abnormal response to infectious organisms (different ways they enter)?
A
Entry through the BBB
Entry through a head wound
Entry through operative procedures
4
Q
What would cause a localized infection of the CNS?
A
An abscess or area of infection/pus
5
Q
What would cause a generalized infection of the CNS?
A
Leptomeninges, brain matter, or both being infected
6
Q
What populations are most at risk of infection due to their immunologic status?
A
Very young
Very old
Anti-body deficient
Immunocompromised
7
Q
What populations may be genetically predisposed to brain infections?
A
The Navajo Indians and American Eskimos
8
Q
What are the most common types of CNS infections?
A
Meningitis (infectious, non-infectious, and aseptic)
Encephalitis
9
Q
What are the most common causes of CNS infections?
A
Infection via bacteria, viruses, protozoan, parasites, or prions
autoimmune disorders
Cancer/neoplastic syndromes
Drug rxns
10
Q
Is HIV/AIDS a viral or bacterial infection?
A
Viral
11
Q
What are the common s/s of other less common CNS infections?
A
Behavioral, cognitive, mood, and some motor changes
12
Q
Is neurosyphilis a bacterial or viral infection?
A
Bacterial
13
Q
Is Whipple disease a bacterial or viral infection?
A
Bacterial infection first of the GI system, then other systems
14
Q
What is the characteristic triad of symptoms in Whipple disease?
A
Dementia, opthalmoplegia, and myoclonus
15
Q
Is tropic spastic paraparesis (TSP)/ HTLV 1 associated myopathy a bacterial or viral infection?
A
Viral of the SC of those living near the equator
16
Q
Is progressive Multifocal leukoencephalopathy (PML) a bacterial or viral infection?
A
Viral
17
Q
What kind of infection is Creutzfeldt Jakob Disease?
A
A slow viral infection resulting from prion protein dysfunction (genetic)
18
Q
What kind of infection is neurocysticerosis?
A
Parasitic
19
Q
What is neurocysticerosis commonly referred to as?
A
Brain worm
20
Q
What kind of infection is toxoplasmosis?
A
Parasitic
21
Q
What kind of infection is Reye syndrome?
A
Toxic encephalopathy with another common systemic virus
22
Q
When microorganisms reach the brain tissue, what does it lead to?
A
Localized infection
23
Q
How can microorganisms enter the brain tissue to cause a localized infection?
A
Via a penetrating wound
Via extension of another localized infection, such as sinusitis or otitis
24
Q
T/f: penetrating wounds can cause abscesses to occur immediately or years later
A
True
25
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
26
Why can there be an increase in ICP with a localized brain abscess?
Bc the infection causes inflammation and pressure
27
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
28
What is the main medical concern with localized brain abscesses?
Stabilization
29
What are the ways to medically manage a localized brain abscess?
With pharmaceuticals, surgery, corticosteroids, or anticonvulsants
30
What is involved in the pharmacological management of a localized brain abscess?
IV antibiotics (organism dependent)
31
How do we determine the organism affecting the brain abscess?
With a culture often done through lumbar puncture
32
What are very powerful antibiotics used to treat localized brain abscesses?
-mycin drugs
33
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
34
What are surgical interventions for localized brain abscesses?
CT guided stereotactic aspiration
Surgical drainage
35
Why are anticonvulsants often used to treat localized brain abscesses?
Bc seizures become a very critical side effect of encephalopathies
36
What is a big red flag to look out for with meningitis and encephalopathy?
Hydrocephalus
37
What are the s/s of hydrocephalus?
Wet (incontinence)
Wobbly (fall risk)
Wacky (mentation)
38
What are the two common types of meningitis?
Infectious and non-infectious/aseptic meningitis
39
What is meningitis?
Inflammation of the meninges that surround the brain and SC
40
Infectious meningitis can typically be caused by either ____ or ____
Bacteria, virus
41
T/f: infectious meningitis can be nosocomial
True
42
If a pt just had surgery, what should we be checking to help rule in/out meningitis?
Temp
43
Non-infectious/aseptic meningitis is typically caused by what?
Viral infection
Autoimmune disorders, CA/neoplastic syndromes
Drug rxns
44
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
45
What groups of drugs can cause drug induced aseptic meningitis?
NSAIDs, antibiotics
Immunosuppressive/modulatory drugs
Antiepileptics
Alcohol
46
With leptomeningitis/meningitis, the infection is either __________, ____________, or ________
Community-acquired, nosocomial, non-infectious/aseptic
47
Community-acquired meningitis is the result of _____ entering the blood
Infection(bacteremia)
48
Which type of leptomeningitis is a direct extension from localized infection (ENT/lung/wound)?
Community-acquired
49
Which type of leptomeningitis results from infection following an invasive procedure?
Nosocomial
50
If a patient has had a craniotomy or infected wound, what should we be looking for?
Temp
Sudden change in behavioral/cognition
51
What is the vulnerable area of the BBB where bacteria can enter?
The choroid plexus of the subarachnoid space
52
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
53
What type of leptomeningitis is an inflammation typically caused by an autoimmune disorder, CA/neoplastic syndromes, or drug rxns
Non-infectious/aseptic
54
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
55
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
56
How will pts with leptomeningitis often describe their HA?
“The worst HA of my life”
57
What are the two characteristics signs of meningitis?
HA and nuchal rigidity
58
Petechial rash in meningitis is a sign of what?
Bleeding under the skin
59
T/f: the neurological deficits in meningitis resemble a stroke
True
60
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
61
What is Kernig sign in meningitis?
In supine, bring the knee into flexion then SLR
Causes pain in the lumbar/posterior thigh
62
What is Brudsinski sign in meningitis?
In supine, flex the neck
This will elicit hip/knee flexion
63
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
64
What is the diagnostic test for meningitis?
A lumbar puncture
65
T/f: there is an increased risk for mortality/morbidity with delayed medical treatment of meningitis
True
66
The mortality rate of meningitis is based upon what factors?
The type of organism
Time to initiation of antimicrobial treatment
Age
67
Risk for stroke with meningitis is greatest when?
During the 1st 5 days
68
Systemic complications, cardiorespiratory failure, or sepsis occur in ___% of the time with meningitis
40
69
Neuro sequelae are permanent in __% of those with bacterial meningitis
30
70
T/f: there is a risk for seizures with meningitis
True
71
How is bacterial meningitis treated?
antibiotics
antiinflammatories
Prevention/managing secondary symptoms (seizures and hydrocephalus)
72
How is viral meningitis treated?
Symptom management
73
Does bacterial or viral meningitis have a generally better prognosis?
Viral meningitis
74
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)
75
What residual sensorimotor deficits may result from meningitis?
Sensory processing
Hemiparesis, spasticity
CN 8 (vestibular) involvement can cause balance deficits, falls, and visual symptoms
76
What is encephalitis?
Inflammation and swelling of parachyma (fxnal tissue) of the brain and surrounding meninges caused by a virus
77
T/f: different CNS cells have different susceptibility to different viruses that cause encephalitis
True
78
Why does everyone with encephalitis present differently?
Bc different viruses effect different neurons
79
T/f: in encephalitis, inflammation can be treated and resolve OR it can progress to hemorrhagic necrosis, increased ICP, or brain herniation
True
80
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
81
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
82
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
83
What are the 3 most common forms of encephalitis?
Herpes simplex encephalitis
West Nile virus
Parainfectious encephalomyelitis
84
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
85
What produces symptoms in herpes simplex encephalitis?
Cerebral edema and increased ICP and risk of transtentorial herniation downward into the brain stem
86
___% of those with herpes simplex encephalitis have significant varied neuro sequelae
55
87
What is the most common mosquito borne virus?
West Nile virus
88
T/f: West Nile virus may present like a stroke with memory and cognitive impairments
True
89
Which type of encephalitis may vary from asymptomatic to severe neuro invasion?
West Nile virus
90
Which type of encephalitis is associated with COVID-19, measles, mumps, or varicella?
Parainfectious encephalomyelitis
91
What are the outcomes with Parainfectious encephalomyelitis?
Excellent with limited sequelae
92
What is the cluster of hallmark signs with encephalitis?
Fever
HA
Nuchal rigidity
Vomiting
General malaise
93
What signs of encephalitis are more suggestive of significant cerebral involvement?
Coma
CN palsy
Hemiplegia
Involuntary movt
Ataxia
94
What is involved in the medical management of encephalitis?
Symptom mangement
Medications
Aggressive management of increased ICP
Sometimes aggressive care to sustain life
95
What is primary medical management in encephalitis?
Symptoms management
96
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
97
T/f: alcohol has significant negative effects on nerves and muscle cells
True
98
Alcohol causes altered levels of what nutrients needed for normal fxn?
B1, B6, B9, B12, thiamine, and folic acid
99
Are more women or men affected by alcohol related neurological disease?
Women
100
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
101
What are the 2 components of Wernicke Korsakoff syndrome?
Wernicke’s encephalopathy
Korsakoff psychosis
102
What is Wernicke’s encephalopathy?
Mental confusion, impaired coordination, paralysis of the nerves that move the eyes
103
What is Korsakoff psychosis?
Problems with learning and memory (even amnesia)
Forgetfulness
Decreased coordination
Ataxic gait
Postural instability
104
What is the role of PT in encephalitis?
We tend to manage the residual impairments and limitations
105
Infection of encephalitis affects the function of what in the brain?
The primary areas of the CNS
The areas of the CNS (edema, shifts)
106
T/f: brain structure is affected in encephalitis
True
107
T/f: the presentation of a pt with encephalitis is focal s/s that are dependent upon CNS structures involved
True
108
What are the most involved structures in encephalitis?
The frontal, parietal, and temporal lobes
109
What results from frontal, parietal, and temporal lobe involvement in encephalitis?
Memory, cognitive, and speech deficits
110
_____% of those with encephalitis have persistent seizures
30-50
111
_____% of those with encephalitis have hemiparesis
15-30
112
____% of those with encephalitis have speech/language disorders?
10-20
113
What are possible s/s of encephalitis?
Memory, cognitive, and speech deficits
Persistent seizures
Hemiparesis
Speech/language disorders
114
T/f: infectious/inflammatory disorders have a well defined presentation
False, they have an ill defined presentation
115
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
116
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
117
T/f: we should cast a wide net during the eval for encephalitis to determine the examination items needed
True
118
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
119
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
120
What mental functions should we be screening with encephalitis?
Arousal (GSC)
Cognition
Dual tasking
Sleep screen
Behavioral involvement
121
What sensory fxns should we be screening for with encephalitis?
CN (sensory)
Pain assessment
Sensory screen
Skin hypersensitivity
Myalgia
Discriminatory touch
122
Should we screen voice and speech fxns with encephalitis?
Yes
123
What CV, hemo, immuno, and respiratory fxns should we screen for in encephalitis?
VSs
RPE
Autonomic and physiologic responses to therapeutic activities
O2
124
What GU fxn should we screen for with encephalitis?
Incontinence (wet )
125
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)
126
When we have a pt with infectious/inflammatory diseases of the CNS, we should observe ____ mobility outside of the exam
General
127
When we have a pt with infectious/inflammatory diseases of the CNS, we should observe ___ movt in a movt analysis
Specific
128
When we have a pt with infectious/inflammatory diseases of the CNS, we should correlate with _____ complaints and symptoms
Pt specific
129
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
130
What is a highly recommended movt screen in infectious/inflammatory diseases of the CNS?
The Rivermead Mobility Index
131
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
132
What is the Rivermead Plus?
A two part exam of mobility with a self report section of fxnal limitations and a focus fxnal exam
133
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
134
T/f: someone with an infectious/inflammatory disease of the CNS can have multiple different movt diagnoses
True
135
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
136
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
137
With CN 8 involvement, what is the central focus of interventions?
Balance
138
The prognosis with inflammatory/infectious CNS diseases depends on what?
The infectious organism and the extent of involvement
139
T/f: many pts will never return to their prior LOF
False, many pts will
140
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
141
T/f: patient with infectious/inflammatory CNS disorders may have focal and generalized CNS dysfunction
True
142
The intervention plan with inflammatory/infectious CNS disorders is highly dependent on what?
Exam findings
