Inflammatory/Infectious Disorders Flashcards
B12 Deficiency
- Cobalamin
- main dietary sources of B12 are meat and dairy
- if absorption is ceased, body stores depleted in 3-4 yrs
- common in vegans
- spinal cord disease of asc. sensory and desc. motor tracts
- ataxia, numbness, tingling
- anemia
- subacute combined degeneration (affects asc. and dec. tracts in spinal cord)
MS Demographic
- mostly young women
- mostly caucasians
- most common inflammatory CNS disease
- risk of relapse dec. over time
- inc. risk in first degree relatives
MS Genetics
-HLADR2, IL7, IL2
MS Causes
-causes: cigarettes, vitamin D deficiency, obesity
MS Diagnosis
- glucose normal on CSF analysis
- progressive brain atrophy present
- grey matter lesions in CNS
MS Therapy
- behavioral changes
- tx comorbidities
- tx acute attacks: methylprednisone, plasma exchange, interferon
- disease modifying therapies
- use more effective meds earlier/first
Chronic OH Intoxication
- earliest effects appear on white matter
- stopping drinking is effective
- brain damage related to OH damage via liver cirrhosis
- meninfial fibrosis
- atrophy of cerebellar vermis
Wilson Disease
- inherited disorder of copper metabolism that causes liver cirrhosis, leading to inc. amonia
- manifests with either jaundice (12 yo) and/or movement disorder
Central Pontine Myelinolysis (CPM)
- symmetric demyelination associated with electrolyte abnormalities
- related to liver damage (in the past)
- occurs when hyponatremic pts have serum Na rapidly corrected
Vitamin B1 Deficiency (Wernicke’s Encephalopathy) (Korsakoff Syndrome)
- thiamine deficiency or sudden glucose intake
- syndrome of oculomotor abnormalities
- common in alcoholics and people who vomit often
- Wernickes: ocular motility problems, nystagmus, ataxia, confusion
- shows selective vulnerability
- korsakoff: confabulation, psych features, dorsomedial nucleus
- imaging: mamillary body atrophy
- medical emergency
Vitamin E Deficiency
- vitamin E protects cells from free radical damage
- seen in CF, celiac, and other GI disease
- sensory periphery neuropathy, ataxia, retinopathy, myopathy, cardiomyopathy
- loss of dorsal root nerve cell bodies and degeneration of their axons
- axonal spheroids in lower medulla
Bacterial Meningitis Pathogenesis
- infection of subarachnoid space
- inflammation of SAS -> inc. BBB permeability ->infarct from vasculitis -> interferes CSF circulation -> bacteria induce pro-inflammatory cytokines
Bacterial Meningitis Clinical Features
- stiff neck (nuchal rigidity)
- fever
- depressed LOC
Kernig’s Sign
- supine pt, flex thigh to abdomen
- passive extension of leg, pt resists due to pain
Brudzinski’s Sign
- passive flexion of neck causes flexion of hips and knees
Bacterial Meningitis Treatment
-goal is antibiotics within 60 min of arrival
Work Up for Bacterial Meningitis
- blood culture (then immediately begin empiric antibiotics)
- lumbar puncture- key diagnostic feature (inc. opening pressure, inc. pleocytosis, inc protein, dec. glucose)
- empiric antibiotics+ corticosteroids (dexamehtasone) (give beofre or same time as antibiotics unless immunocompromised or from developing country)
- neuroimaging (do first in pts with possible CNS trauma)
- imaging should not delay tx
Bacteria Responsible for Neonatal Meningitis & Tx
- group B strep
- E. coli
- strep pneumo
- neisseria meningitidis
- listeria
- tx: ampicillin + cefotaxime OR ampicillin + aminoglycoside
Bacteria Responsible for Meningitis 2-23 months & Tx
- group B strep
- E. coli
- H flu
- strep pneumo
- neisseria
- tx: ceftriaxone + vancomycin
Bacteria Responsible for Meningitis 2-25 yrs
- neisseria
- strep pneumo
Bacteria Responsible for Meningitis >35 yrs & Tx
- strep pneumo
- neisseria
- listeria
- Tx: in adults >50, give ceftrizxone + vancomycine + ampicillin
Signs of Viral Meningitis and Encephalitis
- acute, febrile with headache
- stiff neck
- significantly altered mental status
- focal neuro defects
Causes of Viral Meningitis
- enteroviruses
- arboviruses: WNV, CEV, SLEV
- herpesvirus (HSV2)
- HIV, mumps, measles
Causes of Encephalitis
- WNV
- HSV1
CSF Profile of Viral CNS Infection
- inc. lymphocytic pleocytosis
- normal glucose
- inc. protein or normal
- PCR positive (very sensitive)
Enterovirus Tx
- no FDA approved tx
- pleconaril
HSV Meningitis Tx
- valacyclovir
- prophylaxis not currently recommended
WNV Meningoencephalitis Sx
- fever, headache, nuchal rigidity
- NV
- low back pain
- tremor
- parkinsonism-rigidity, bradykinesia
- weakness: flaccid paralysis
Most Sensitive Diagnostic Tool for Herpes
-CSF PCR
Most Sensitive Diagnostic Tool for WNV
-CSF IgM
Most Common Cause of Sporadic Encephalitis
-herpes simplex virus
Most common cause of epidemic encephalitis
WNV
Hepatic Encephalopathy
- in adults
- similar to Wilson’s
- caused by cirrhosis -> inc. ammonia -> astrocytes cannot break down inc. ammonia -> cytotoxic edema
- globus palladis most affected
Delerium Tremens
-pink elephants
