Lecture 71: CNS Infections

Question 1

Acute bacteria meningitis is a…presents originally as?

Answer 1

Medical emergency; a few days of headache, malaise, photosensitivity

Question 2

Meningitis neck stiffness on…

Answer 2

Flexion (not lateral rotation)

Question 3

CSF in meningitis

Answer 3

Elevated opening pressure, low glucose (0.6 of peripheral glucose), elevated protein, elevated WBC w/ PMNs

Question 4

Adults get bacterial meningitis from (3)

Answer 4

Adults (

Question 5

Older adults get bacterial meningitis from (3)

Answer 5

S. pneumoniae, L. monocytogenes, gram (-) rods

Question 6

Worse bacterial meningitis: name, bacteria, transmission, exposure prophylaxis, sign

Answer 6

Meningococcal meningitis caused by Neisseria; close contact; rifampin; petechial rash

Question 7

What is a feared complication of meningococcal meningitis?

Answer 7

Waterhouse-Friderichsen Syndrome due to bleeding into adrenal gland –> adrenal failure, hypotension

Question 8

Neonates get bacterial meningitis from (4)

Answer 8

Group B strep, E. coli, L. monocytogenes, gram (-) rods

Question 9

Children get bacterial meningitis from (3)

Answer 9

S. pneumoniae, N. meningitidis, H. influenzae type B

Question 10

Children and adults often get viral meningitsi from…

Answer 10

Enteroviruses

Question 11

How does neonatal meningitis presentation differ?

Answer 11

Signs of meningeal irritation might be absence. Look for bulging fontanelles and fever

Question 12

Describe tuberculous meningitis

Answer 12

Very purulent over base of brain (CN symptoms, CNS flow entrapment)

Question 13

Describe tuberculoma

Answer 13

Growth of tubercles, which enlarge within the CNS parenchyma or remain encapsulated within the meninges,

Question 14

CSF with tuberculous meningitis

Answer 14

High opening pressure, low glucose, very high protein, mixed cell types

Question 15

Neurosyphilis can cause…discuss CSF

Answer 15

CN lesions, meningitis, gummas, “general paresis of the insane”; positive VDRL in spinal fluid = syphilis but neg DOES NOT rule out, negative CSF FTA rules out neurosyphilis

Question 16

In encephalitis, you’re more likely to have what? Less likely to have what?

Answer 16

Altered consciousness; headache

Question 17

Encephalitis is more likely bacterial/viral

Answer 17

Viral

Question 18

CSF fugal findings

Answer 18

Increased opening pressure, decreased glucose, increased proteins, increased lymphocytes (difficult to tell apart from viral meningitis)

Question 19

CSF fungal infections are usually associated with…

Answer 19

Immunocompromise

Question 20

Some fungal infections that can infect brain

Answer 20

Apergillosis, mucormycosis (ketoacidosis w/ red swollen eyes), cryptococcus neoformans, candidiasis

Question 21

Common causes of encephalitis (3)

Answer 21

Enteroviruses (autumn), HSV, arbovirus (summer)

Question 22

Acute viral encephalitis (4) and chronic (2)

Answer 22

Arbovirus, herpes encephalitis, poliomyelitis, rabies; HIV and subacute sclerosing panencephalitis (measles)

Question 23

Characteristic findings of HSV encephalitis? Morbidity/mortality? Diagnosis (3)?

Answer 23

Hemorrhagic lesions of temporal lobes; high morbidity/mortality; PCR for HSV virus, RBCs in CSF, temporal lobe spikes on EEG

Question 24

Where do you lose motor neurons in polio?

Answer 24

Anterior horns

Question 25

What is the histological sign of Rabies?

Answer 25

Negri bodies (eiosinophilic intracytoplasmic inclusions)

Question 26

How to diagnose subacute scerlosing panencephalitis?

Answer 26

Measles IgG antibody in CSF