Neuroimmunology/ID + laughing Flashcards
Generalized MG likely to have what Abs+
59% blocking, 90% modulating and binding
what percentage of pts w/ myasthenia have anti-AChR Abs.
If not check what?
90% (all comers)
If not check anti-MUSK
Ocular MG, what % different antibodies
only 30% blocking, 70% modulating and binding
THe antibody that is often positive in generalized myasthenia WITH thymoma
anti-striated muscle antibody
What % of people with myasthenia are likely to have a thymoma
Who should have surgery?
10-15%
likely beneficial in patients < 65y
Typical dosing of mestinon/Pyridostigmine in Myasthenia Gravis
60mg TID-QID
Meds to use in myasthenia crisis
Can use IV MEstinon which is 2mg q2-3 hrs
(Steroids can worsen)
Typically:
Plasmaphoresis, IVIG, maybe Rituxan or Etanercept
pathology of vasculitic neuropathy?
involvement of vasa nervorum resulting in ischemic nerve damage and axonal loss / degeneration
GBS variant very often assoc with antecedent C jejuni?
AMAN: acute motor axonal neuropathy, rapid progression, motor only variant
antibody associated with the Miller Fischer variant of GBS and what is the presentation
ophthalmoplegia, ataxia, areflexia. only rarely with limb weakness
Anti-GQ1B antibody
assoc w/ Bickerstaff brainstem encephalitis
4 other dx to consider in suspected GBS if there is CSF pleocytosois
- HIV
- Lyme
- neoplasia
- sarcoid
3 main CIDP variants and their clues
- MADSAM: multifocal acquired demyelinating sensory and motor, primarily upper limb
- DADS: distal acquired demyelinating symmetric neuropathy which may or may not be with IgM gammopathy (poor response to meds) or idiopathic which responds to steroids/IVIG
- CIDP w/ gammopathy IgG or IgA MGUS
how does multifocal motor neuropathy typically present and what marker and treatment?
asymmetric limb weakness in males > females, also think conduction block
anti-GM1 antibodies
Responds to IVIG but NOT steroids or plasmapharesis
household member prophylaxis for meningitis with what bug and what tx?
Neisseria meningitis, 2d rifampin or IM Ceftriaxone
bugs seen in brain abscess in immunocompetent (3)
Streptococcus milleri»_space; S. aureus, Enterobacteriaceae
brain abscess pathogens in immunocompromised
listeria, nocardia, Toxo gondi
4 drug tx for TB and main s/e of each
Rifampin: liver INH: neuropathy add B6 Pyrazinamide : liver Ethambutol: optic neuritis (RIPE)
what stage of syphilis may involve meningitis, cranial neuropathies and what time frame after exposure?
secondary 2-12 weeks followed by latent stage
OR
tertiary
possible neurologic complications with tertiary syphilis (4) and their timing
- meningitis and complications (early)
- meningovascular w/ stroke or large vessel aneurysm 4-7yrs after
- paresis and progressive dementia 15-20 yrs later
- tabes dorsalis w/ dysesthsia and autonomic dysfunction and sensory ataxia 15-20 yrs later
nontreponemal tests and their time frame for positivity
nontreponemal: RPR and VDRL: nonspecific, positive after 5-6 weeks
treponemal tests and their time frame for positivity
FTAB positive after 3-4 weeks
things that c can cause false positive treponemal FTAB test?
lyme, herpes, pregnancy, ,mixed CT disorder/SLE
most specific test for neurosyphilis
CSF VDRL (not traumatic tap)
think of what with aseptic meningitis but PMN pleocytosis
What else might you see clinically
West Nile virus
polio like weakness / BG movement d/o
