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MJ- F2 E4- Neuro > Neuro Infections 1- MJ > Flashcards

Neuro Infections 1- MJ Flashcards

1
Q

Infectious agents can gain access to CNS through what 3 major pathways?

A
  • Invasion of the blood stream
  • Retrograde neuronal pathway
  • Direct contiguous spread
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2
Q

Most CNS infections can be categorized into what 3 types?

A
  1. Meningitis
  2. Encephalitis (involving brain itself)
  3. Brain abscess
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3
Q
  • What are the 3 contraindications for performing a lumbar puncture?
  • If a contraindication is present, what test must you do before LP?
A
  1. Signs or symptoms of increased ICP (papilledema, decreased LOC, focal neuro sxs)
  2. Severe coagulopathy (or on anticoags)
  3. Mass lesion

*if contraindications present, MUST get CT prior to LP*

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4
Q

What is Cushing’s Triad (indication of increased ICP)?

A
  1. Respiratory depression
  2. Bradycardia
  3. HTN
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5
Q

CSF analysis:

  • What would be the appearance of normal CSF? What does abnormal look like?
A
  • Normal: crystal clear and colorless, viscosity is similar to water
  • Abnormal: Cloudy, purulent or pigment-tinged
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6
Q

What are 4 possible causes of RBCs in CSF on a lumbar Puncture?

A
  1. Traumatic LP (CSF clears by the 3rd tube)
  2. Subarachnoid hemorrhage (redness the same in all tubes)
  3. Intracerebral hemorrhage
  4. Cerebral infarct
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7
Q

What should you be concerned for if the CSF is cloudy?

A

Bacterial Meningitis

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8
Q

CSF analysis:

Bacterial infections are usually associated w/ a predominance of what type of cells?

A

PMN leukocytes

(neutrophils)

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9
Q

LP w/ CSF analysis:

What are the 4 possible causes of WBS on a CSF analysis?

A
  1. Bacterial infection
  2. Vasculitis
  3. Lekemic infiltration
  4. “Traumatic tap”
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10
Q

What is encephalitis?

A

Acute inflammation of the brain parenchyma causing abnormalities in brain function

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11
Q

Which of the following describes primary encephalitis vs post-infectious encephalitis?

  • _______= Virus present and can be cultured/identified; (+) neuronal involvement
  • ________= Virus not present; demyelination occurs; (-) neuronal involvement–> this is a secondary inflammation in the brain
A
  • \_Primary_\__= Virus present and can be cultured/identified; (+) neuronal involvement
  • __Post-infectious__= Virus not present; demyelination occurs; (-) neuronal involvement
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12
Q

What is the most common etiology of encephalitis?

A

Viruses (70%)

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13
Q

What puts a person at high risk for encephalitis? (4)

A
  • Outdoors (forestry workers, campers, hunters)
  • Travel to endemic areas
  • Compromised immunity
  • Lack of vaccines
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14
Q

Which virus is associated wtih post-infectious encephalitis?

A

Measles

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15
Q

The following are possible viral etiologies of what condition?

  1. HSV
  2. Arthropod-borne viruses (West Nile, Colorado tick fever, etc)
  3. Rabies
  4. HIV
  5. Enteroviruses (coxsackie, polio)- common
  6. Measles (assoc w/ post-infectious encephalitis)
  7. Influenza, mumps, adenovirus
A

Encephalitis

(basically any virus can cause this)

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16
Q

The following are possible bacterial causes of what condition?

  1. Borrellia burgdorferi (Lyme)
  2. M. tuberculosis
  3. Treponema pallidum (syphilis)
  4. Listeria spp.
  5. Leptospirosis
  6. Bartonella henselae (cat-scratch disease)
  7. Streptococcus spp.
  8. Klebsiella spp.
  9. Staphylococcus spp.
  10. Neisseria meningitides
  11. Rickettsia spp. (Rocky Mountain spotted fever)
A

Encephalitis

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17
Q

What are the 5 non-infectious causes of encephalitis?

A
  1. Paraneoplastic syndrome
  2. Drug Toxicitiy
  3. Autoimmune causes (SLE, sarcoidosis, etc)
  4. Radiation
  5. Metabolic disorders
18
Q

The following is the clinical presentation of what condition?

  • Fever
  • AMS (behavior/personality changes, confused, agitated, etc)
  • Seizures
  • Focal neuro sxs (motor/sensory deficits, paralysis, CN palsies, exaggerated DTRs, speech disorders)
  • _**NO SIGNS OF MENINGEAL IRRITATION_ (photophobia or nuchal rigidity)
A

Encephalitis

19
Q

The following are history clues of what condition?

  • Geography
  • Recent travel
  • Recent illness
  • Season
  • Outdoor activities
  • Medical hx (birth hx for neonates)
  • Parotitis (Mumps), hydrophobia (rabies), Zoster rash
A

Encephalitis

20
Q

How do you differentiate between encephalitis and meningitis based on clinical presentation?

A

Meningitis has signs of meningeal irritation (photophobia, nuchal rigiditiy) and encephalitis does NOT

21
Q

What might you see on fundoscopy in a patient with Encephalitis?

A
  • Papilledema
  • Retinitis
22
Q

Why is it important to perform a skin exam on a patient with Encephalitis?

A

You are looking for a rash that could give you a clue to the underlying pathogen.

(Vesicular eruption for HSV, VZV, Erythema nodosum for TB/histo/sarcoid, etc)

23
Q

How do you diagnose Encephalitis?

A

MRI is preferred but start w/ a CT w/wo contrast if patient is SICK

***Negative CT does NOT c/o encephalitis***

24
Q

What might you find on MRI in a patient with encephalitis?

A
  • May be negative
  • +/- hyperintensity in areas of edema
  • +/- demyelination post infectious
25
Q

MRI findings in encephalitis:

In what lobe of the brain would you see hyperintensity in areas of edema if the etiology is herpesvirus?

A

Temporal lobe

26
Q

On CSF analysis of viral Encephalitis, what color would the CSF be?

A

clear or cloudy, straw colored

27
Q

On CSF analysis of viral Encephalitis, what would the opening pressure be?

A

Normal to increased

28
Q

On CSF analysis of viral Encephalitis, What would the WBC count be? (increased or decreased)

A

Increased

29
Q

On CSF analysis of viral Encephalitis, what differential cells woul be seen?

A

Lymphocytes (b/c viral)

30
Q

On CSF analysis of viral Encephalitis, what would the RBC count be?

A

0

(increased if pathogen is herpes)

31
Q

On CSF analysis of viral Encephalitis, would there be normal, increased or decreased proteins?

A

Normal to increased

32
Q

On CSF analysis of viral Encephalitis, would glucose be normal, increased or decreased?

A

Normal

33
Q
A
34
Q

What are the 3 most important diagnostics for Encephalitis?

A
  1. MRI (Textbook- preferred choice)
  2. CT (what you will actually order in practice)
  3. LP
35
Q

What is the gold standard for the diagnosis of Encephalitis?

A

Brain biopsy

(NOT routinely performed)

36
Q

What 2 specialties should get involved STAT if you have a patient with encephalitis?

A
  1. Infectious Disease
  2. Neurology
37
Q

What is the management and treatment of Encephalitis? (6 steps)

A
  1. Stabilize the patient (ET tube, ventilator, circulatory support, monitor electrolytes)
  2. Empiric antiviral treatment- Acyclovir
  3. Identify and tx offending agent (isolate pt until cause is found)
  4. Prevent & manage secondary bacterial infections
  5. DVT/GI (ulcer) prophylaxis
  6. Tx elevated ICP- consider corticosteroids and mannitol
38
Q

What is the empiric medication used to treat encephalitis?

(this will be on exam)

A
  • Start early!
  • _*Acyclovir_ 10mg/kg IV q8hrs
  • (Decreases morbidity/mortality due to HSV/VZV)
39
Q

What is primary prevention for encephalitis? (2)

A
  • Avoid vectors (bug spray, avoid areas, etc)
  • Vaccination
40
Q

What is the prognosis of encephalitis?

A
  • Varies depending on organism
  • Up to 75% mortality within 18 months for untreated HSV encephalitis
  • Up to 90% survival with early acyclovir
  • May have long-term neuromuscular and cognitive deficits
  • Poor prognosis in immunocompromised and extremes of age

MJ- F2 E4- Neuro (19 decks)

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