Module 5: Neuroinfectious Disease 3 Flashcards
Post-herpetic neuralgia?
Pain of VZV persists for over 1 month after rash subsides
Ramsey-hunt syndrome triad? Aka?
Triad: ipsilateral facial paralysis, ear pain, vesicular rash in ears
Herpes zoster oticus
Hyperestesia?
Management?
Increased pain to light touch due to damaged nerve endings
#Gabapentin #TCAs #SNRIs #Transdermal lidocaine patch
Primary HIV related neurologic diseases?
Caused by antiretrovirals?
#AIDS dementia complex #HIV vacuolar myelopathy #HIV neuropathy #HIV myopathy
#Myopathy (AZT) #Neuropathy
Fungal meningitis – onset? General CSF findings?
If CSF shows eosinophils? Neutrophils?
Subacute/chronic
#Elevated opening pressure #lymphocytic pleocytosis #Elevated protein #Decreased glucose
C. Immitis
Aspergillus or Mucor
Pathology from patient with CNS infection shows hyphae – suspect?
Aspergillus or Mucor (diabetics)
Most common cause of fungal meningitis? Enters body via? Diagnosed with? Treatment?
Cryptococcus; inhalation
- Latex antigen agglutination test
- India ink
Amphotericin B + flucytosine, followed by fluconazole
Aspergillus manifests as what CNS diseases? Treatment?
#Brain abscess #Parenchymal granuloma #Vasculitis of posterior circulation
Amphotericin followed itraconazole
Risk factors for Mucor? Typically infects? Can also cause?
Clue on physical exam?
Treatment?
Diabetes and acidosis
Rhino-orbital-cerebral invasion through bone via Vascular channels; cavernous sinus thrombosis
Black discharge from the nose
Radical surgical Debridement and amphotericin B
Most common cause of seizures in tropical countries? When to treat? Therapy?
Neurocysticercosis
#Treat if lesions are not calcified (calcified lesions are old scars) with Albendazole or praziquantel #Surgical resection if causing ICP issues
Cerebral malaria definition? Which strain of malaria? Pathogenesis? Symptoms?
Malaria with unexplained unconsciousness over 30 minutes
Plasmodium falciparum
Cytoadherence of infected RBCs cells in small cerebral arterials leading to stasis
#Seizures #Acute delirium # focal deficits from infarctions
Cerebral malaria – LP results? Diagnostic criteria? Mortality without treatment? Tx? Chemoprophylaxis?
Normal
1/3 positive blood smears
100%
Quinine IV and PO (chloroquine resistance is widespread)
Mefloquine
Primary toxoplasmosis infection – symptoms?
Usually asymptomatic but can present with: #Fevers/lymphadenopathy/crash #Meningioencephalitis with normal glucose #Focal necrotizing retinal vasculitis
Toxoplasmosis reactivation – seen in HIV patients with what CD4 count? Typical presentation? Treated with? Step if unresponsive to treatment?
Under 200;
Mass lesion with headache and focal deficits
Sulfadiazine + pyrimethamine
Brain biopsy
Most common cause of brain mass in patients with HIV?
Toxoplasmosis
