Meningitis/Encephalitis

Question 1

what is the most common cause of bacterial meningitis in adults, infants and young children?

Answer 1

S. pneumoniae

Question 2

N. Meningitidis is a highly contagious cause of meningitis in which populations?

Answer 2

teens and young adults

Question 3

What is a common cause of meningitis in the elderly?

Answer 3

L. monocytogenes

Question 4

What are is a unique characteristic of fungal meningitis?

What is the common culprit?

Answer 4

It “smolders” over months to years

Cryptococcal (esp. in DM or immunocompromised)

Question 5

What is the go-to treatment for meningitis?

Answer 5

IV vancomycin, ceftriaxone, steroids and maybe acyclovir if you aren’t sure if it’s viral or bacteria

Question 6

What are the common causes of infectious encephalitis?

Answer 6

HSV 1 or 2

HIV

West Nile

Varicella

T. pallidum (the Syph)

Question 7

What are some common pathogens that cause encephalitis in neonates?

Answer 7

HSV2

CMv

Rubella

L. Monocytogenes

T. Pallidum

T. Gondii

Question 8

What are some common pathogens that cause encephalitis in infants and children?

Answer 8

Eastern equine encephalitis

Japanese encephalitis

Murray Valley encephalitis

Influenza

La Crosse

Question 9

What are some common pathogens that cause encephalitis in the elderly?

Answer 9

eastern equine encephalitis

St. Louis encephalitis

West Nile

CJD

L. Monocytogenes

Question 10

What is the common presentation of HSV 1 encephalitis?

Answer 10

rapidly progressive illness with fever, HA, impaired consciousness, Szs, and focal neuro deficits

Question 11

In HSV1 encephalitis, where are the MRI and EEG changes seen?

What is the treatment?

Answer 11

Temporal lobe

Acyclovir

Question 12

What syndrome can develop in up to 25% of pt’s who experience HSV1 encephalitis?

Answer 12

recurrent neuropsych sx, sometimes associated with autoantibodies (NMDA) with a secondary encephalitis

Question 13

In a patient with rapidly progressive encephalopathy (<6wks) or psychiatric disturbance with possibly seizures and or fever, what should be considered?

Answer 13

autoimmune encephalitis

Question 14

What are two causes of autoimmune encephalitis?

What is the treatment?

Answer 14

NMDA encephalitis

LGI1 encephalitis

steroids, IVIG, plasma exchange, rituximab, cyclophosphamide, or other immunusuppresants

Question 15

Who is most affected by NMDA encephalitis and what are the symptoms (at least 4/6 present for less than 3 months)

Answer 15

abnormal psychiatric behavior or cognitive dysfunction

speech dysfunction

Szs

movement disorders

decreased Levels of consciousness

autonomic dysfunction or central hypoventilation

Question 16

What are the diagnostic results for NMDA encephalitis?

Answer 16

abnormal EEG with EXTREME DELTA BRUSH

CSF with pleocytosis or oligoclonal bands and or NMDA receptor abs

Question 17

NMDA encephalitis is commonly associated with what?

Answer 17

Teratomas

Question 18

Who is comonly affected by LGI1 encephalitis and what are the main sx?

Answer 18

men

faciobrachial dystonic seizures that often do not respond to AEDs alone

sleep disturbances

temporal lobe abnormalities

frequent relapse

Question 19

According to the AAN, do recurrent HA patients require imaging?

Answer 19

no, if there is no change, no Sz, no focal neuro deficits, etc.