Viral and Prion

Question 1

How many pt w HIV/AIDS get neurologic symtoms?

Answer 1

40-60%

Question 2

What are the 5 most common focal CNS lesions caused by -correlated to AIDS?

Answer 2

• Toxoplasmosis - Toxoplasma Gondhii
• primary CNS lymphoma.
• progressive multifocal leukoencephalopathy - viral
• Cryptococcal abscesses (more commonly manifest as meningitis)
  *TB

Question 3

Progressive multifocal leukoencephalitis in AIDS is caused by?

Answer 3

Polyomavirus, correlated to immunodeficiency.

Question 4

What is the injury caused by Progressive multifocal leukoencephalitis in AIDS and how is the clinical progress?

Answer 4

• Focal myelin loss
• Rapidly progressing to death within a few months.
• no treatment.
• While waiting for death; mental state changes, blindness, aphasia, CN affecteed and coma.

Question 5

What is the difference with syphilis (treponema pallidum) in an immunocompetent person and in someone with AIDS?

Answer 5

Neurosyphilis might develop in 4 mo compared to 15-20 years.

Question 6

Herpes simplex

Question 7

What is Ramsay Hunt syndrome?

Answer 7

It is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis.

Question 8

What is herpes zoster called in english?

Answer 8

Shingles

Question 9

Clinical signs and CSF signs in HSV1?

Answer 9

• H/A, Confusion, DIsorientation, Coma within days
• HIGH monoleukocytosis (500-1000)
• Marked protein increase over disease progression.

Question 10

Which cranial nerves have their nuclei in Pons?

Answer 10

• Vestibulocochlear nerve
• Facial nerve
• Abducens nerve
• trigeminal nerve

Question 11

What is Lyme disease?

Answer 11

A multisystem disease caused by Borrelia spirocheter= Borrelia Burgdorpheri

Question 12

What transferes Borrelia?

Answer 12

Tics.

Question 13

How many pt w Lyme disease get a erythema chronicum migrans?

Answer 13

75%

Question 14

In what stage starts neurologic involvement of Lyme disease?

Answer 14

In stage 3 - late phase - months to years.

Question 15

How is Lyme disease diagnosed?

Answer 15

1. By the history/precsence of migrans.
2. By waiting 2-3 weeks when antibodies to B.Burgdorferi can be reliably found.
   - if the patient has been in an pandemic area, its enough with one of these.

Question 16

What is Creutzfeld Jacob disease?

Answer 16

A prion disease

Question 17

What is the course of CJD?

Answer 17

Encephalopathy with rapidly progressive dementia, ataxia and myoclonus and invariably death.
Seizure usually occur late in the disease

Question 18

What other prion diseases are there?

Answer 18

*Kuru
*Gertman Sträussher
*Fatal familial insomnia

Question 19

What is the recommended sterilization procedure for JCD?

Answer 19

• Steam autoclavation for 1h in 132 degrees
  or
• Immersion in sodium hydroxide NaOH for 1h in room temperature
  or

Question 20

Differential diagnostics to CJD?

Answer 20

• Tertiary Syphilis
• Bismouth, Bromide or LITHIUM intox

Question 21

HOw can intoxes with Lithium, Bromides or Bismouth be differentiated to CJD?

Answer 21

Usually seizures early in the disease.