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General ID 2019 > Neuro ID > Flashcards

Neuro ID Flashcards

1
Q

Name the major etiologies of viral meningitis?

A

herpes viruses, enteroviruses, lymphocytic choriomeningitis virus, mumps, HIV, adenovirus, arbovirus, parainfluenza virus 2 and 3. (HELM HAP)

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2
Q

Key basics of enterovirus?

A

fecal oral spread, summer/fall seasonality, risk factor of chronic enteroviral meningoencephalitis agammaglobulinemia (CEMA), Rituximab. PCR better than CSF culture.

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3
Q

scattered maculopapular rash enterovirus with meningitis?

A

echovirus 9, RNA virus, MCC aspetic meningitis in children, naturally found in GI tract.

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4
Q

herpangina with enterovirus meningitis?

A

coxsackievirus A

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5
Q

pericaridtis/pleuritis with enterovirus meningitis?

A

Coxsackievirus B

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6
Q

rhomboencephalitis with enterovirus?

A

enterovirus 71

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7
Q

keys of mumps virus?

A

male>females 5-9 years old, can have +/- parotitis by ~ 5 days. CSF culture 30-50%, PCR better.

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8
Q

Describe mollaret’s ?

A

Recurrent benign lymphocytic meningitis cuased by HSV-2 with at least 10 episodes lasting 2-5 days followed by spontaneous recovery

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9
Q

What is LCMV?

A

lymphocytic choriomeningits virus, transmitted to humans by contact with rodents or their excreta.

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10
Q

Clinical features of herpes simplex encephalitis?

A

most severe of all human viral infections, no seasonality, majority caused by HSV-1. See fever, personality changes, dysphasia, and autonomic dysfunction

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11
Q

what would you expect to see on EEG/brain biopsy in herpes simplex encephalitis?

A

EEG - periodic lateralizing epileptiform discharges (PLEDs), brain biopsy - intranuclear inclusions/inflammation with widespread hemorrhagic necrosis.

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12
Q

what would you expect to see on MRI in herpes simplex encephalitis?

A

MRI - bilateral asymmetrical involvement of the limbic system, medial temporal lobes, insular cortices and inferolateral frontal lobes. The basal ganglia are typically spared, helping to distinguish it from a middle cerebral artery infarct.

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13
Q

The treatment dosage for HSV encephalitis?

A

30mg/kg/day in q8 hours for 14-21 days. No added benefit of 3 months of oral valacyclovir.

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14
Q

basics of HHV6?

A

worry about it in immunocompromised patients. CSF PCR has high sensitivity but PPV low. Treat with ganciclovir or foscarnet.

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15
Q

Describe B virus?

A

macaques bite or scratch with the vesicular eruption at the site, the neurologic disease in 3-7 days. Give prophylactic valacyclovir, treat with acyclovir, valacyclovir or ganciclovir.

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16
Q

describe the transmission of west nile virus?

A

mosquito vector, bird reservoir hosts, incidental infections with humans, horses.

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17
Q

MRI findings for CMV encephalitis?

A

subependymal gadaloinium enhacement and non-specific white matter changes

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18
Q

how would you diagnose CMV?

A

CSF PCR?

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19
Q

treatment of CMV encephalitis?

A

ganciclovir + foscarnet

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20
Q

what are the WNV clinical syndromes?

A

80% - no symptoms. 20% fever; the severe disease is meningitis, meningoencephalitis, poliomyelitis - like flaccid paralysis

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21
Q

how would you diagnose WNV encephalitis?

A

8-14 days Serum IgM antibody, CSF IgM>90%, CSF PCR<60%, T2/FLAIR MRI showing hyperintensity within deep brain structures, including the thalami, basal ganglia and midbrain structures 5; the latter includes the red nucleus, cerebral peduncle and substantia nigra

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22
Q

what are the 3 diseases measles virus can cause?

A

acute disseminated encephalitis with MRI showing asymmetric demyelination 2-4 weeks after exposure, inclusion body disease, subacute sclerosing pan-encephalitis (6-10 years later)

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23
Q

when do you see symptoms of measles?

A

1-6 months after exposure.

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24
Q

what are the two forms of rabies?

A

encephalitic (furious - 80%) agitation, hydrophobia and paralytic (dumb - 20%) (ascending paralysis, early muscle weakness, later cerebral involvement

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25
Q

what are the two big noninfectious etiologies of encephalitis?

A

Acute disseminated encephalomyelitis (ADEM) and anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis

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26
Q

describe ADEM? Tx?

A

encephalitis with either post-infectious (URI, viral, hep C, HIV) or post-immunization 2-4 weeks. Tx with steroids

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27
Q

what are the MRI findings in ADEM?

A

bilateral asymmetric T2 hypersensitivity in subcortical and deep white matter.

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28
Q

Describe Anti-NMDAR encephalitis?

A

Neuronal antibody associated encephalitis with psych, cognitive, seizures, LOC associated with ovarian teratoma

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29
Q

Describe the CSF studies associated with Anti-NMDAR encephalitis?

A

Mild pleocytosis (median WBC 23), normal glucose and protein. antibodies to NR 1 subunit of the NMDAR in CSF and serum

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30
Q

what is associated with the development of NMDAR antibodies?

A

viral causes of encephalitis (HSV)

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31
Q

MRI findings of anti-NMDAR encephalitis?

A

abnormal FLAIR or T2 hyperintensity can be seen in the medial temporal lobe, cerebral/cerebellar cortex, basal ganglia, and brainstem 1,2. Typically there is no abnormal enhancement or hemorrhage 8.

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32
Q

Treatment of anti-NMDAR encephalitis?

A

First-line usually corticosteroids + IVIG. second is plasma exchange. Females should be evaluated for ovarian teratoma.

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33
Q

meningococal meningitis epidemiologic feature?

A

children and young adults. THose with terminal complement deficiencies (c5-C8, C9 and properdin deficincies)

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34
Q

streptococcal meningitis epidemiologic feature?

A

neonates with PROM, low birth weight. Adults with chronic disease

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35
Q

Epidemiologic features of listeria meningitis?

A

consumption of cole-slaw, raw vegetables, milk, cheese, ice-cream, processed meats, cantaloupes, diced celery.

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36
Q

Epidemiologic features of gram negative bacillary meningitis?

A

isolated from CSF of patients following head trauma/neurosurgical features. Associated with disseminated strongyloidiasis in hyperinfection syndrome

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37
Q

what are the gram negative bacilli that cause meningitis?

A

Serratia, pseduomonas, acinetobacter baumannii, Klebsiella, E.Coli, salmonella (SPAKES)

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38
Q

what are the serotypes associated with meningococcal meningitis?

A

serogroups A, B, C, Y, and W135

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39
Q

which meningococcal meningitis serotype associated with epidemics?

A

epidemics caused by serogroups A and C

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40
Q

Epidemiologic features of Haemophilus influenza Meningitis?

A

concurrent pharyngitis or otitis media in >50% of cases. Capsular type b strain in >90% of serious infections

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41
Q

Bacterial meningitis associated with CSF shunts and drains?

A

Staph epidermidis, Diptheroids (P. Acnes)

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42
Q

Risk factors for Streptococcus suis?

A

Vietnam, eating undercooked pig blood, pig intestine. Pig exposure.

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43
Q

what suggest disseminated disease with coccidioidal meningitis?

A

serum complement-fixing antibody titers >1:43 to 1:64

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44
Q

what CSF findings suggest coccidioidal meningitis?

A

prominent eosinophilia, elevated CSF proteins, + CSF complement-fixing antibodies with CSF coccidiosis antigen

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45
Q

what does naegleria fowleri cause?

A

acute amebic meningoencephalitis

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46
Q

amebic meningoencephalitis illness script?

A

children/young adults during warm weather with contact with fresh/brackish water after 5-7 days has sudden fever, photophobia, headache, stupor and coma.

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47
Q

CSF findings for acute amebic meningoencephalitis?

A

neutrophilic meningitis with RBC and low glucose. Wet mount may reveal trophozoites

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48
Q

Ilness script for angiostrongylus cantonensis meningitis?

A

asian countries + jamaica; rat lungworm, is a parasitic nematode (worm) that is transmitted between rats and mollusks, 6-30 days after ingestion, headache, nstiff neck, parathesias, and vomiting. CSF with eosinophils

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49
Q

Common parasitic causes of eosinophilic meningitis?

A

T-BAG; taenia solium, baylisacaris procynois, angiostrongylus cantonenesis, gnathostoma spinigerum

50
Q

Empiric antibiotic for purulent meningitis <1 month

A

Ampicillin + cefotaxime

51
Q

Empiric antibiotic for purulent meningitis 1-23 months

A

Vancomycin, 3rd generation ceph

52
Q

Empiric antibiotic for purulent meningitis 2-50 years?

A

Vancomycin + 3rd gen Ceph

53
Q

Empiric antibiotic for purulent meningitis older than 50

A

vancomycin, ampicillin, 3rd gen ceph

54
Q

Empiric antibiotic for purulent meningitis for immunocompromised

A

vancomycin + ampicillin + (cefepime or merropenem)

55
Q

Empiric antibiotic for purulent meningitis basilar skull fracture?

A

vancomycin + 3rd generation cephalosporin

56
Q

Empiric antibiotic for purulent meningitis head trauma or after neurosurgery?

A

vancomycin + ceftazidime or cefepime or merropenem

57
Q

Empiric antibiotic for purulent meningitis CSf shunt or drain

A

vancomycin + ceftazidime or cefepime or merropenem

58
Q

antimicrobial therapy for bacterial meningitis - Strep pneumo

A

Vancomycin + 3rd generation cephalosporin

59
Q

antimicrobial therapy for bacterial meningitis - Neisseria meningitidis

A

3rd generation cephalosporin

60
Q

antimicrobial therapy for bacterial meningitis - Haemophilis influenza

A

3rd generation cephalosporin

61
Q

antimicrobial therapy for bacterial meningitis - Listeria monocytogenes

A

ampicillin or Pen G

62
Q

antimicrobial therapy for bacterial meningitis -Enterobacteriaceae

A

3rd generation cephalosporin

63
Q

antimicrobial therapy for bacterial meningitis - pseudomonas

A

ceftazidime or cefepime

64
Q

antimicrobial therapy for bacterial meningitis - acinetobacter baumanii

A

meropenem or colistin or polymyxin

65
Q

antimicrobial therapy for bacterial meningitis -strep agalactiae

A

ampicillin or Pen G

66
Q

antimicrobial therapy for bacterial meningitis - Listeria monocytogenes

A

ampicillin or Pen G

67
Q

antimicrobial therapy for bacterial meningitis - MRSA

A

Vancomycin

68
Q

antimicrobial therapy for bacterial meningitis - MSSA

A

nafcillin or oxacillin

69
Q

antimicrobial therapy for bacterial meningitis -Mycobaterium TB

A

RIPE

70
Q

antimicrobial therapy for bacterial meningitis -cryptococus neoformans

A

ampho B + 5-Flucytosine

71
Q

antimicrobial therapy for bacterial meningitis - candida species

A

ampho b

72
Q

antimicrobial therapy for bacterial meningitis - coccidioides immitis?

A

fluconazole

73
Q

antimicrobial therapy for bacterial meningitis - naeglieria fowleri

A

ampho B + rifampin + doxycycline +/- miltefosine +hypothermia protocol

74
Q

antimicrobial therapy for bacterial meningitis - naeglieria fowleri

A

ampho B + rifampin + doxycycline +/- miltefosine +hypothermia protocol

75
Q

what is the role of dexamethasone for bacterial meningitis?

A

attenuates subarachnoid space inflammatory response response resulting from antimicrobial-induced lysis

76
Q

when is dexamethasone indicated in adults meningitis?

A

pneumococcal meningitis

77
Q

when is dexamethasone indicated for infants and children meningitis?

A

Indicated in haemophilis unfluenza type b meningitis and considered for pneumococal meningitis

78
Q

dose of dexamethasone for meningitis?

A

0.15mg/Kg q6 hours x 4 days with or just before antimicrobial dose

79
Q

In addition to antifungal treatment, what other adjunctive treatment would be necessary for cryptococcal meningitis?

A

reduction in ICP with serial LP/CSF shunts. Dexamethasone associated with more harmful events and disability.

80
Q

what are the 3 predisposing conditions for brain abscess?

A

continguous focus of infection, hematagenous spread, or cyrptogenic.

81
Q

empiric antibiotic therapy for bacterial brain abscess in otitis media or mastoiditis predisposing condition?

A

metronidazole + 3rd gen Ceph

82
Q

empiric antibiotic therapy for bacterial brain abscess in for sinusitis predisposing condition?

A

vanc + metro+ 3rd gen ceph

83
Q

empiric antibiotic therapy for bacterial brain abscess in dental sepsis predisposing condition

A

pen + metronidazole

84
Q

empiric antibiotic therapy for bacterial brain abscess in penetrating trauma or post- NS predisposing condition?

A

vanc + 3rd gen ceph

85
Q

empiric antibiotic therapy for bacterial brain abscess in patient with lung abscess, empyema, bronchiectasis predisposing condition

A

pen + metronidazole + sulfonamide

86
Q

empiric antibiotic therapy for bacterial brain abscess with bacterial endocarditis predisposing condition

A

Vancomycin

87
Q

empiric antibiotic therapy for bacterial brain abscess in unknown predisposing condition

A

Vanc + metronidazole + 3rd/4th gen ceph

88
Q

empiric antibiotic therapy for bacterial brain abscess in transplant patient predisposing condition?

A

add voriconazole, plus bactrim + vanc, metro, 3rd/4th gen ceph

89
Q

empiric antibiotic therapy for bacterial brain abscess in HIV infected patient predisposing condition?

A

add pyrimethamine + sulfadiazine. COnsider RIPE for possible TB

90
Q

Antimicrobial therapy of brain abscess with an organism of actinomyces sp?

A

pen G

91
Q

Antimicrobial therapy of brain abscess with an organism of bacteroides fragilis?

A

metronidazole

92
Q

Antimicrobial therapy of brain abscess with an organism of enterobacteriaceae?

A

3rd gen ceph

93
Q

Antimicrobial therapy of brain abscess with an organism of fusobacterium?

A

metronidazole

94
Q

Antimicrobial therapy of brain abscess with an organism of pseudomonas?

A

ceftrazidime or cefepime

95
Q

Antimicrobial therapy of brain abscess with an organism of staph aureus?

A

naf or vanc

96
Q

Antimicrobial therapy of brain abscess with an organism of streptococci?

A

pen G

97
Q

Antimicrobial therapy of brain abscess with an organism of nocardia asteroides?

A

bactrim or sulfadiazine

98
Q

Antimicrobial therapy of brain abscess with an organism of mycobacterium TB?

A

RIPE

99
Q

Antimicrobial therapy of brain abscess with an organism of aspergillus?

A

voriconazole

100
Q

Antimicrobial therapy of brain abscess with an organism of candida

A

amphotericin +/- 5 flucytosine

101
Q

Antimicrobial therapy of brain abscess with an organism of mucorales?

A

amphotericin

102
Q

Antimicrobial therapy of brain abscess with an organism of scedosporium spp

A

voriconazole

103
Q

what is cavernous sinus thrombosis?

A

clot in the cavernous sinuses either aspetic or septic (most common) by commonly staph (60-70%)or strep (17%), dx with MR venogram?

104
Q

most common clinical features of septic cavernous sinus thrombosis?

A

periorbital edema (73%), headache (52%), double vision, oculomotor palsies

105
Q

Risk factors for cavernous sinus thrombosis?

A

paranasal sinusitis, facial or dental infection

106
Q

General management of septic cavernous sinus thrombosis?

A

culture and drainage of infected sinuses, vanc + flagyl + 3rd/4th gen cephalosporin. ?anticoagulation/?steroids

107
Q

Risk factors for cranial subdural empyema and cranial epidural abscess?

A

Streptococci (25-45%), staphylococci (10-15%), GNB 3-10%

108
Q

Management of cranial subdural empyema?

A

best to worst mortality: craniotomy, craniectomy, burr hole

109
Q

most common epidemiology of spinal epidural abscess?

A

hematenous dissemination (50%), unidentified source (20-40%), continugous focus (33%)

110
Q

Organism associated with a spinal epidural abscess?

A

Staph and strep mostly

111
Q

clinical stages of a spinal epidural abscess?

A

back pain and tenderness, radicular pain and paresthesias, transverse myelitis, then complete paralysis

112
Q

Empiric management of spinal epidural abscess?

A

anti staphylococcal agent + gram negative bacilli

113
Q

Normal CSF findings?

A

OP 6-20; CSF<5cm lymphocyte predominant, CSF protein<60 (40mg (>40%)

114
Q

Bacterial CSF findings?

A

15-50cm, neutrophil predominant, WBC>1K, CSF glucose decreased <40, CSF protein elevated 80-500

115
Q

Viral CSF findings?

A

6-30cm, WBC <1K, CSF protein <200, CSF glucose>45

116
Q

TB CSF findings?

A

OP 15-50, CSF WBC 50-300, mononuclear, CSF protein 50-300, glucose <45

117
Q

When would you give penicillin only for strep pneumo meningitis?

A

If penicillin MIC<0.06 or add ampicilin.

118
Q

what is the treatment for strep pneumo meningitis?

A

Pen MIC<0.06, penicillin only. If Pen MIC>0.12, Ceftriaxone MIC<1.0, ceftriaxone. If Pen MIC>0.12 and Ceftriaxone MIC>1.0, vancomycin + ceftriaxone/cefotaxime. If ceftriaxone MIC>4.0, consider adding rifampin.

119
Q

what is the treatment for Neisseria meningitides meningitis?

A

If PCN MIC<0.1, pen G or ampicillin. If 0.1-1.0, 3rd generation cephalosporin

120
Q

what is the treatment for haemophils influenza meningitis?

A

Beta lactamase negative - ampicillin. Beta lactamase postiive - 3rd generation cephalosporin

121
Q

Name the types of enterovirus?

A

Echovirus, enterovirus, coxsackie, poliovirus, rhinovirus

General ID 2019 (19 decks)

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