Neurological Infections

Question 1

Bacterial Meningitis
Classic Presentation

Answer 1

✅ Triad: Fever + Nuchal Rigidity + AMS (Altered Mental Status)

✅ Severe Headache

✅ Photophobia

✅ + Kernig’s Sign (Pain with knee extension while hip is flexed)

✅ + Brudzinski’s Sign (Neck flexion → Involuntary hip/knee flexion

Question 2

Bacterial Meningitis
Most Common Pathogens

Answer 2

Neonates → Group B Strep, E. coli, Listeria

18-50 years → S. pneumoniae, N. meningitidis

> 50 years,
Immunocompromised → S. pneumoniae, N. meningitidis, Listeria monocytogenes

Question 3

Bacterial Meningitis
TX

Answer 3

Ceftriaxone + Vancomycin + Ampicillin (if Listeria risk) + Dexamethasone

Question 4

Viral (Aseptic) Meningitis
Classic presentation

Answer 4

✅ Mild Fever + Headache + Neck Stiffness
✅ No AMS or Focal Neurological Deficits
✅ + Photophobia, Mild Lethargy

Question 5

Viral (Aseptic) Meningitis
CSF

Answer 5

⬆️ WBCs (Lymphocytes),
⬆️ Protein (Mild),
Normal Glucose,
Normal Opening Pressure

Question 6

Viral (Aseptic) Meningitis
Most Common Causes

Answer 6

Enteroviruses (Coxsackie, Echovirus) – 75% of cases

HSV-2 (especially with first episode of genital herpes)

HIV, Arboviruses (West Nile), VZV

Question 7

Bacterial Meningitis
CSF

Answer 7

⬆️ WBCs (Neutrophils),
⬆️ Protein,
⬇️ Glucose,
⬆️ Opening Pressure

Question 8

Viral (Aseptic) Meningitis
TX

Answer 8

Supportive Care (Fluids, Antipyretics, Pain Control) + Acyclovir (if HSV suspected)

Question 9

Encephalitis
Classic Presentation

Answer 9

✅ Fever + Altered Mental Status + Personality Changes

✅ Seizures, Hallucinations, Confusion

✅ NO Nuchal Rigidity (Unlike Meningitis!)

Question 10

Encephalitis
CSF

Answer 10

⬆️ WBCs (Lymphocytes)
Normal Glucose
⬆️ Protein

Question 11

Encephalitis
Imaging

Answer 11

MRI: Temporal Lobe Involvement

Question 12

Encephalitis
Most Common Causes

Answer 12

HSV-1 (Most Common & Deadly!)
Arboviruses (West Nile Virus, Eastern Equine Encephalitis, etc.)
CMV (Immunocompromised Patients)

Question 13

Encephalitis
TX

Answer 13

IV Acyclovir ASAP
(Do NOT Wait for PCR Results!)

Question 14

Brain Abscess
Classic Findings

Answer 14

✅ Subacute Headache (Gradual Onset)

✅ + Focal Neurological Deficits (Hemiparesis, Aphasia, Seizures)

✅ + Fever (May Be Mild or Absent)

Question 15

Brain Abscess
Imaging

Answer 15

MRI: Ring-Enhancing Lesion with Surrounding Edema

Question 16

Brain Abscess
CSF

Answer 16

CSF is usually NORMAL (NO LP Needed!)

Question 17

Brain Abscess
Most Common Causes

Answer 17

Sinusitis → Streptococcus spp., Anaerobes

Dental Infections → Anaerobes

Post-Surgical or Trauma → Staphylococcus aureus

Question 18

Brain Abscess
TX

Answer 18

MRI + IV Vancomycin + Ceftriaxone + Metronidazole + Neurosurgical Evaluation

Question 19

Spinal Epidural Abscess
Classic Presentation

Answer 19

✅ Triad: Fever + Severe Back Pain + Neurological Deficits 🚨

✅ Urinary Retention, Bowel Dysfunction

✅ Midline Spinal Tenderness

Question 20

Spinal Epidural Abscess
CSF

Answer 20

CSF is NORMAL (NO LP Needed!)

Question 21

Spinal Epidural Abscess
Imaging

Answer 21

MRI Spine with Contrast (Gold Standard!)

Question 22

Spinal Epidural Abscess
Most Common Cause

Answer 22

Staphylococcus aureus (Most Common, Especially in IV Drug Users!)

Question 23

Spinal Epidural Abscess
TX

Answer 23

IV Vancomycin + Ceftriaxone + Neurosurgical Evaluation (Drainage if Needed)