Neuroinflammatory

Question 1

Causes of encephalitis (%)

Answer 1

Infections- enterovirus (10%), parechovirus (10%), bacterial (8%), mycoplasma (6%), HSV (6%),

Immune mediated- ADEM (18%), NMDA (6%)

Question 2

% of encephalitis patients with moderate to severe neurological sequaelae at discharge

Answer 2

33%

Question 3

Distribution of encephalitis/incidence

Answer 3

Bimodal distribution (~1.7 years, infectious and ~7 years immune)

Question 4

What is the altered mental status duration required for encephalitis diagnosis?

Answer 4

> 24 hours with no alternative cause

Question 5

How many criteria must be met for a probable diagnosis of encephalitis?

Answer 5

At least 2 of the following criteria

Question 6

What fever temperature indicates a criterion for encephalitis diagnosis?

Answer 6

> 38.0°C within 2 hours

Question 7

What is a new onset seizure considered in encephalitis diagnosis?

Answer 7

A criterion for diagnosis

Question 8

What type of neurological findings can indicate encephalitis?

Answer 8

Focal neurology

Question 9

What is the minimum white cell count (WCC) in CSF for encephalitis diagnosis?

Answer 9

5 mm

Question 10

What imaging technique is part of the encephalitis diagnostic criteria?

Answer 10

Neuroimaging

Question 11

What diagnostic tool assesses electrical activity in the brain for encephalitis?

Answer 11

EEG

Question 12

What conditions should be excluded when diagnosing encephalitis?

Answer 12

• Drugs
• Metabolic issues
• Trauma
• Tumor
• Sepsis
• Alcohol

Question 13

True or False: A confirmed diagnosis of encephalitis requires at least 3 specific criteria to be met.

Answer 13

True

Question 14

What is neopterin?

Answer 14

CRP of CSF, produced by monocytes, TH1 response

Question 15

ADEM age of onset, prodrome, trigger

Answer 15

5 to 8 years
Fever, myalgia, vomiting, headache
Triggered by infection or vaccination

Question 16

Broad diagnostic features ADEM

Answer 16

Rapidly progressive encephalopathy that is not explained by fever, abnormal MRI, focal neurological findings

Question 17

Common focal neurological findings in ADEM

Answer 17

Unilateral or bilateral pyramidal signs, CN palsies, seizures, acute hemiplegia

Question 18

Less common neurological findings in ADEM

Answer 18

Speech impairment, optic neuritis, spinal cord involvement, ataxia

Question 19

CSF findings in ADEM

Answer 19

Mild pleocytosis, oligoclonal bands negative

Question 20

MRI findings in ADEM

Answer 20

T2 hyperintensities in white matter (deep and subcortical) and deep grey matter (thalami and basal ganglia. Sparing of callosum and periventricular white matter (MS). Optic nerve, brain stem, cerebellum and spinal cord can be involved but asymptomatic

Question 21

Treatment for ADEM

Answer 21

IV Methylprednisone 3 - 5 days, IVIG in steroid unresponsive, PLEX in fulminant not steroid responsive, Surgical decompression rarely if signs of raised ICP

Question 22

What percentage of ADEM patients make a full recovery vs residual deficits

Answer 22

57 to 89% vs 10 to 20%

Question 23

Timeframe for recovery ADEM

Answer 23

Rapid improvement over days, full recovery in 1 to 6 months

Question 24

What percentage of children with ADEM are MOG positive?

Answer 24

60%

Question 25

What is pathyphysiology of MOG demyelinating disease?

Answer 25

Antibodies against myelin oligodendrocyte glycoprotein