Neuroinflammatory Flashcards
Causes of encephalitis (%)
Infections- enterovirus (10%), parechovirus (10%), bacterial (8%), mycoplasma (6%), HSV (6%),
Immune mediated- ADEM (18%), NMDA (6%)
% of encephalitis patients with moderate to severe neurological sequaelae at discharge
33%
Distribution of encephalitis/incidence
Bimodal distribution (~1.7 years, infectious and ~7 years immune)
What is the altered mental status duration required for encephalitis diagnosis?
> 24 hours with no alternative cause
How many criteria must be met for a probable diagnosis of encephalitis?
At least 2 of the following criteria
What fever temperature indicates a criterion for encephalitis diagnosis?
> 38.0°C within 2 hours
What is a new onset seizure considered in encephalitis diagnosis?
A criterion for diagnosis
What type of neurological findings can indicate encephalitis?
Focal neurology
What is the minimum white cell count (WCC) in CSF for encephalitis diagnosis?
5 mm
What imaging technique is part of the encephalitis diagnostic criteria?
Neuroimaging
What diagnostic tool assesses electrical activity in the brain for encephalitis?
EEG
What conditions should be excluded when diagnosing encephalitis?
- Drugs
- Metabolic issues
- Trauma
- Tumor
- Sepsis
- Alcohol
True or False: A confirmed diagnosis of encephalitis requires at least 3 specific criteria to be met.
True
What is neopterin?
CRP of CSF, produced by monocytes, TH1 response
ADEM age of onset, prodrome, trigger
5 to 8 years
Fever, myalgia, vomiting, headache
Triggered by infection or vaccination
Broad diagnostic features ADEM
Rapidly progressive encephalopathy that is not explained by fever, abnormal MRI, focal neurological findings
Common focal neurological findings in ADEM
Unilateral or bilateral pyramidal signs, CN palsies, seizures, acute hemiplegia
Less common neurological findings in ADEM
Speech impairment, optic neuritis, spinal cord involvement, ataxia
CSF findings in ADEM
Mild pleocytosis, oligoclonal bands negative
MRI findings in ADEM
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
Treatment for ADEM
IV Methylprednisone 3 - 5 days, IVIG in steroid unresponsive, PLEX in fulminant not steroid responsive, Surgical decompression rarely if signs of raised ICP
What percentage of ADEM patients make a full recovery vs residual deficits
57 to 89% vs 10 to 20%
Timeframe for recovery ADEM
Rapid improvement over days, full recovery in 1 to 6 months
What percentage of children with ADEM are MOG positive?
60%
What is pathyphysiology of MOG demyelinating disease?
Antibodies against myelin oligodendrocyte glycoprotein
