Small Group: CNS Infections

Question 1

Which of the Paramyxoviruses causes meningitis?

Answer 1

Mumps (like the mummy wearing the neck brace)

Note: Measles causes encephalitis.

Question 2

Meningitis presents with what pattern of nuchal rigidity?

Answer 2

Inability to flex forward but side to side rotation preserved

Question 3

Do not perform lumbar punctures in patients with _____________.

Answer 3

papilledema

Question 4

True or false: most suspected cases of meningitis can be diagnosed and treated without a CT.

Answer 4

True.

Question 5

True or false: acute bacterial meningitis typically presents with low protein in the CSF.

Answer 5

False. Protein is typically high in the CSF of those with acute bacterial meningitis.

Question 6

Which three pathogens account for most cases of meningitis in college-age patients?

Answer 6

• N. meningitidis (59%)
• S. pneumoniae (25%)
• H. influenzae (8%)

Question 7

______________ are often given to children with acute bacterial meningitis to reduce neurologic sequelae.

Answer 7

Corticosteroids

Question 8

Which of the pneumococcal vaccines is conjugated?

Answer 8

The 13-valent vaccine (conjugated to protein and thus induces IgG response)

Question 9

Compare and contrast the signs and symptoms of bacterial and viral meningitis.

Answer 9

Both present with the same symptoms –neck stiffness, fever, confusion –but bacterial meningitis tends to be more severe and can lead to septic shock.

Question 10

What are the four most common etiologies of viral meningitis?

Answer 10

• Enterovirus (90%)
• Mumps
• Arboviruses (like West Nile)
• HSV

Question 11

What does the JC virus cause?

Answer 11

Progressive multifocal leukoencephalopathy (PML) leading to progressive dementia and focal neurologic deficits

Question 12

What is standard therapy for Toxoplasmosis?

Answer 12

Pyrimethamine/sulfadiazine (clindamycin can be substituted for sulfadiazine in patients allergic to sulfur-containing medications)