Viral CNS infections

Question 1

What is meant by aseptic meningitis

Answer 1

Meningitis with negative bacterial cultures

= viral meningitis

Question 2

What are the most common etiologic agents of aseptic meningitis

Answer 2

Enteroviruses are the most common- coxackie, echo, polio.
WNV, VZV, Mumps
HSV2
HIV
Lymphocytic Choniomeningitis virus

Question 3

Signs and Symptoms of aseptic meningitis

Answer 3

drowsiness
stiff neck
HA, fever, fatigue
Seizures
Irritability

Question 4

What is the status of cognitive function in aseptic meningitis

Answer 4

Cognitive function is normal

Question 5

How is aseptic meningitis diagnosed

Answer 5

History- seasons= summer/ fall

CSF culture, analysis, and PCR

Question 6

How helpful are CSF analysis in viral meningtis for differentiating from encephalitis

Answer 6

not helpful for differentiation

Question 7

How is aseptic meningitis treated

Answer 7

Generally self limiting and resolves on its own w/o therapy

Question 8

HSV 2- meningitis how many also have genital lesions

Answer 8

85% have genital lesions

Question 9

what is mollarets syndrome?

What normally causes it

Answer 9

recurrent meningitis at least 3 times

normally caused by HSV 2

Question 10

HSV2- meningitis diagnosis

Answer 10

Pap stain of CSF shows large granular plasma cells

Question 11

HSV2- meningitis tx

Answer 11

Acyclovir especially in newborn
most of the time it spontaneously resolves
benign compared to HSV encephalitis

Question 12

HIV- meningitis how does the primary infection present

Answer 12

similar to mono

Question 13

HIV- meningitis dx

Answer 13

requires increased suspicion to look for it

Question 14

Lymphocytic Choriomeningitis virus is what type of virus

Answer 14

Arenavirus

Question 15

lymphocytic choriomeningitis virus- symptoms

Answer 15

presents with flu like symptoms

may have another inflammation somewhere- orchitis, parotitis, arthritis, pericarditis

Question 16

lymphocytic choriomeningitis virus- dx

Answer 16

h/o exposure to rodents
inc lymphocytes
low glucose in CSF

Question 17

what is viral encephalitis

Answer 17

viral infection of brain parenchyma

Question 18

what is the etiology of viral encephalitis

Answer 18

WNV
St. Louis virus
Rabies
HSV1

Question 19

symptoms of viral encephalitis

Answer 19

altered mental status
seizures
focal neuro abnormalities

Question 20

viral encephalitis- dx
WBC- when do which rise
Protein
glucose
RBC

Answer 20

serology
CSF
WBC inc
PMN's- inc early
lymphocytes- inc later
protein- inc 
glucose- normal
RBC- none (except in HSV 1)

Question 21

what is normal CSF protein level

Answer 21

> 150 mg/dL

Question 22

West Nile Virus is what type of virus

Answer 22

Flavivirus

Question 23

What are the vectors for WNV

Answer 23

birds and mosquitoes all over the world

Question 24

What populations are at increased risk of developing WNV encephalitis

Answer 24

old

immunocompromised

Question 25

How many infected people develop the encephalitis

Answer 25

1/150

Question 26

WNV- encephalitis symptoms

Answer 26

``` flacid paralysis maculopoular rash parkinsonian beh tremor As well as: altered mental status, seizures, focal neuro deficits ```

Question 27

WNV encephalitis tx

Answer 27

supportive care | avoid mosquitoes

Question 28

St. Louis encephalitis- symptoms

Answer 28

Tremor

Question 29

Rabies- Signs and Symptoms

Answer 29

Pharyngeal spasms--> hydrophobia | agoraphobia

Question 30

what is the MCC of fatal sporatic encephalopathy

Answer 30

HSV1

Question 31

HSV1 encephalitis symptoms

Answer 31

``` Primarily effects the temporal lobe which will be apparent on an EEG Rapid onset with fever and HA altered mental status seizures focal neruo deficits ```

Question 32

HSV1 encephalitis- tx

Answer 32

Acylovir

Question 33

what should you give a patient w/o clear cause of encephalitis

Answer 33

Acylovir should be tx for all causes of encephalitis without an apparent cause b/c this is the only treatable cause of encephalitis and it will decrease morbidity and mortality

Question 34

What is post-infections encephalitis

Answer 34

encephalitis that was caused by the same etiologic agent as a previous infection

Question 35

What are the etiologic agents of Post-infectious encephalitis

Answer 35

``` Autoimmune Measles Mumps Rubella Influenza VZV ```

Question 36

What is the post infectious encephalitis for Rubella

Answer 36

Pan Sceloring encephalitis

Question 37

What will you see if the post infectious encephalitis is caused by mumps

Answer 37

parotitis

Question 38

what will you see if the post infectious encephalitis is caused by VZV

Answer 38

grouped vesicles.

Question 39

What type of viruses are St. Louis Virus, WNV, Easter/Western Venezuelan Equine viruses?

Answer 39

Arbo viruses

Question 40

what carries STLV, WNV, E/W Venezuelan Equine Virus

Answer 40

mosquitos- arthropods (Arbo... Airborne) viruses