Neuro Micro

Question 1

Bacterial meningitis CSF?

Answer 1

Decreased glucose
Increased protein
Increased pressure
Increased PMNs

Question 2

Most important category of arboviruses?
3 examples?
(These are: RNA+ which uses host ribosomes

Answer 2

Flaviviridae

St. Louis Encephalitis
West Nile Virus
Japanese Encephalitis Virus

Question 3

Bunyaviridae, MCC pediatric encephalitis in USA

SS -, 3 segments

Answer 3

LaCrosse

Question 4

Enveloped, non-seg, RNA-, bullet shaped virus

Affected neurons: Negri bodies
Purkinje cells of cerebellum

Answer 4

Rabies

Question 5

dsDNA, circular polyomaviridae
JC virus can causes?

BK virus?

Answer 5

JC –> PML in an HIV pt (demyelination of oligodendrocytes)

BK –> targets kidneys of transplant pts

Question 6

Transmissible Spongiform Encephalopathy

Answer 6

Conversion of normal prion protein (PrPc with an alpha helix) to PcPsc (aggregates, with a beta pleated sheet

Question 7

prion disease
First documented case
Ritual cannibalism of Papua New Guinea

Answer 7

Kuru

Question 8

Sporadic (80%) / iatrogenic (dural graft, corneal graft, human growth hormone/ familial (PrP alterations)
Dementia, Myoclonus, ataxia, mutism near death
Mean survival 5-8 months
Cerebral spongiform changes
Lack of amyloid plaques
Characteristic complexes in EEG

Answer 8

Creutzfeldt-Jacob disease (CJD)

Question 9

AD pattern 
Mutation at codon 102 of PrP
Average age: 48 
Mean time to death is 5 years 
Gait px, ataxia 
Dementia is less common, but may occur late
No EEF 
Amyloid plaques + spongiform changes

Answer 9

Gerstmann-Staussler-Scheinker disease

Question 10

AD pattern; 128 and 178 of Prp
Age of onset is 49, 13 months to death
Sleep disturbance, autonomic dysfunction; neuronal loss but rarely spongiform changes

Answer 10

Fatal familial Insomnia

Question 11

First reported in the UK; protease resistance form of PrP same as BSE
Transmission of contaminated beef
Average age of onset is 29 w/ 14 month survival; anxiety, depression, sensory abnormalities, visual problems are late, akinetic mutism at death
129 codon PrP

Answer 11

Varient CJD

Question 12

Strep pneumo vaccines
Pneumovax?

Prevnar?

Answer 12

Pneumovax: non-conjugated for 23 cell types

Prevnar: conjugated for 7 cell types (memory, give children at 2 y/o)

Question 13

Polio Vaccine
Salk?

Sabin?

Answer 13

Salk - killed, IPV, prevents paralysis but not spread of wild

Sabin - oral, live, prevents spread and paralysis but may revert

Question 14

LCMV (Lymphocytic choriomeningitis virus) – enveloped, segmented ambisense RNA; contains cell ribosomes, endocytpsos, non-conventional ambisense replication, release by budding from the cell; often contains ribosomes; transmitted by inhalation of aerolized rodent excreta & saliva

Answer 14

Arenaviruses

Question 15

N. meningitis vaccines:
Menomune
Menactra:
Neither cover?

Answer 15

Menomune – high risk, unconjugated
Menactra – conjugated, recommended for everyone 11-55 y/o

Group B makes sialic acid, which is very common on our own cells – so we cannot make a vaccine to this

Question 16

85% in HIV patients, pigeons droppings; not dimorphic, always encapsulated
Initial pulmonary asymptomatic
Chronic  meningitis, fatal if untreated
India Ink: halos (polysaccharide capsule)
Tx: Amphotericin B & flucytosine
Always a yeast

Answer 16

Cryptococcus neoformans

Question 17

*steroid associated meningitis 660 cases, 40 deaths
Voriconazole for 3 months
Severe cases or non-responders: Ampho B

Answer 17

Exserohilum rostratum

Question 18

Acute infection > reactivation
MRI – necrosis of temporal lobe (pt presents w/ acute onset of confusion followed by a seizure)
Start acyclovir immediately
For this reason, empiric therapy with IV acyclovir (10 mg/kg IV every 8 hours) should be initiated as soon as the diagnosis is considered. We do not recommend oral antiviral therapy (eg, valacyclovir) for the treatment of HSV encephalitis.
RBCs in CSF -
PCR is definitive but false negatives occur
70% mortality w/o treatment
**MRI can detect edema when CT is normal
(treat very quickly with IV acyclovir) – start while CT is still normal
1/3 of all viral encephalitis; sporadic occurrence

Answer 18

HSV encephalitis