Intoxication/Infection of the Nervous System

Question 1

What is the effect of tetanus toxin?

Answer 1

The exotoxin binds to interneurons of brain, brain stem, spinal cord, preventing release of inhibitory glycine and GABA leading to motor disinhibition.

Question 2

What are the symptoms of tetanus poisoning?

Answer 2

– painful spasms in muscles near wound, or generalized,
including jaws, face, respiratory muscles
– generalized convulsive seizures

Question 3

Where can you get C. tetani infection?

Answer 3

• Soil contaminated wounds

- Unsterile IV needles

Question 4

What is the effect of botulism toxin?

Answer 4

Binds to presynaptic nerve terminals preventing ACh release

Question 5

What are the symptoms of botulism poisoning?

Answer 5

Ptosis, diplopia, later dysphagia, facial, limb, and respiratory weakness may occur

Question 6

What are the symptoms of lead poisoning in adults?

Answer 6

Peripheral neuropathy - wrist drop

Question 7

What are the symptoms of lead poisoning in children?

Answer 7

Encephalopathy or abdominal pain

Question 8

What are some lingering effects of CO poisoning that survivors may have?

Answer 8

Survivors may have amnesia and parkinsonism

Question 9

What does a stroke in a young person raise suspicion of?

Answer 9

Drug Use - cocaine is most common

Question 10

What is the early stage of alcohol withdrawal syndrome?

Answer 10

Hypersympathetic stage - tremulous, sweaty, tachycardic with limited seizures

Question 11

What is the late stage of alcohol withdrawal syndrome?

Answer 11

Delirium tremens - 3-4 days after drinking stopped, with fluctuating motor and autonomic activity, confusion, hallucinations

Question 12

What is the support for someone with alcohol withdrawal syndrome?

Answer 12

• Benzodiazepines for seizures and sedation

- Thiamine supplementation

Question 13

Wernicke-Korsakoff Syndrome

Answer 13

Caused from chronic alcoholism

• Acute -> Wernicke encephalopathy (nystagmus, ophthalmoplegia, gait ataxia, confusion) correctible with thiamine supplementation
• Chronic -> Korsakoff psychosis (amnesia, confabulation)

Question 14

Alcoholic Cerebellar Degeneration

Answer 14

Degeneration of the anterior-superior vermis that leads to gait ataxia and dysmetria of lower limbs

Question 15

What is the more dangerous type of meningitis?

Answer 15

Acute bacterial meningitis is more severe, fulminant; may be fatal if not treated early and aggressively

Question 16

What added with antibiotics can reduce neurological complications of meningitis?

Answer 16

Intravenous Dexamethasone

Question 17

What is done when meningitis is suspected?

Answer 17

Lumbar Puncture

Question 18

What is the profile of CSF in a bacterial meningitis?

Answer 18

Increased polymorphonuclear WBCs, decreased CSF glucose.

Question 19

Who does chronic meningitis tend to affect?

Answer 19

• Elderly

- Immunocompromised

Question 20

Encephalitis

Answer 20

Brain is the primary site of infection and inflammation - often viral

Question 21

How does encephalitis present?

Answer 21

• Seizures
• Focal Neurological Deficits
• Impairment of Consciousness

Question 22

Where does HSV encephalitis tend to affect?

Answer 22

Predilection for frontal and temporal lobes

Question 23

What is used to treat HSV encephalitis?

Answer 23

Acyclovir

Question 24

What are the signs of West Nile Virus?

Answer 24

Weakness from affecting peripheral nerves or anterior horn cells (similar to polio)

Question 25

What does poliovirus tend to affect?

Answer 25

Anterior horn cells and brainstem motor nuclei

Question 26

Progressive Multifocal Leukoencephalopathy

Answer 26

An opportunistic infection in immunodeficient patients that is caused by papovavirus infection of oligodendrocytes, leading to patchy demyelination in the CNS and focal deficits - UNTREATABLE

Question 27

What are opportunistic infections that are common in AIDS?

Answer 27

• cerebral toxoplasmosis (protozoa)
• cryptococcal meningitis (fungus)
• cytomegalovirus (CMV) retinitis or encephalitis

Question 28

What is AIDS vacuolar myelopathy similar to?

Answer 28

Similar to subacute combined degeneration from vitamin B-12 deficiency.

Question 29

Abscess

Answer 29

Localized, encapsulated, usually bacterial, infection; meningitis if rupture into CSF

Question 30

Creutzfeldt-Jakob Disease

Answer 30

Prion disease that is rapidly progressive, untreatable, fatal in weeks to months and presents with dementia with prominent myoclonus, often corticospinal, extrapyramidal, cerebellar or lower motor neuron signs