Viral CNS Infections

Question 1

acute inflammation of brain parenchyma

Answer 1

encephalitis

Question 2

acute inflammation in the subarachnoid space or leptomeninges

Answer 2

meningitis

Question 3

What kind of meningitis outnumbers all other causes in the US?

Answer 3

viral (aseptic) meningitis

Question 4

What is the MCC of viral meningitis

Answer 4

enterovirus

Question 5

What is the general prognosis of aseptic meningitis

Answer 5

usually self-limiting lasting 7-10 days

Question 6

What is the MCC of acute encephalitis?

Answer 6

HSV 1

Question 7

What are the targets in the CNS of each of these viruses?

polio

VZV

Rabies

HIV and HSV

Answer 7

• motor neurons
• peripheral sensory neurons
• brainstem neurons
• anything

Question 8

In general, what is the MC manifestation of viral CNS infection?

Answer 8

meningitis

Question 9

hallmarks in pediatric viral meningitis include

Answer 9

more malaise and fever

tend not to have neck stiffness

neonates: hypotonia, irritability, poor feeding

Question 10

What are CSF findings in viral/aseptic meningitis?

Answer 10

• WBC - pleocytosis, lymphocytes predominate
• protein - nl to slightly elevated
• glucose - normal
• culture, gram stain, acid fast stain all normal

Question 11

In CSF we are finding increased lymphocytes and normal or decreased glucose. What are we thinking?

Answer 11

cryptococcus or another fungi

Question 12

What will CSF look like with bacterial meningitis?

Answer 12

• WBCs - PMNs predominate
• glucose is low

Question 13

Tx for aseptic meningitis is usually supportive, but if it looks like meningoencephalitis, what should I do?

Answer 13

start empiric abx (for possible bacterial pathogens) and acyclovir (for HSV)

Question 14

What two viruses are known to cause septic shock in babies? What should we do because we know this?

Answer 14

enterovirus and HSV

abxs and acyclovir should be started ASAP

Question 15

What is the MCC of sporadic lethal encephalitis?

Answer 15

Herpes simplex encephalitis (HSE)

Question 16

Where will I see necrotizing inflammation from HSE?

Answer 16

inferior frontal and anterior temporal lobes

Question 17

What are the top five clinical features of HSE?

Answer 17

• change in consciousness
• fever
• change in personality
• headache
• seizures

Question 18

What is the most important study in regards to meningitis/encephalitis?

Answer 18

PCR

Question 19

What is tx for HSE?

Answer 19

IV acyclovir started empirically when suspected

• prolonged oral course following IV course

Question 20

When do most relapses of HSE occur?

Answer 20

within 3 months of completing initial tx

Question 21

What are some primary syndromes a/w HIV in the CNS?

Answer 21

• AIDS dementia complex
• HIV meningitis
• HIV myelopathy (SC)
• HIV sensory neuropathy
• Primary CNS lymphoma

Question 22

My pt has non-AIDs PML, what should I be considering?

Answer 22

malignancy

CT disease

organ transplant

sarcoid

cirrhosis

medications

Question 23

fecal oral route

acute flaccid paralysis via infection of anterior horn cells (proximal worse than distal)

Answer 23

poliomyelitis