VIRAL INFECTIONS Flashcards
Mumps, measles, and VZV enter via the _________
respiratory passages.
________ AND _________ enter by the
oral-intestinal route, and______ enters mainly via the oral
or genital mucosal route.
Polioviruses and other enteroviruses
HSV
The fetus may be infected transplacentally by
_____, ________ AND ______
rubella virus, CMV and HIIV
viruses that utilize the retrograde axoplasmic transport system
HSV, VZV, and
rabies
Some infections
are confined to meningeal cells, ________being the
most common, in which case the clinical manifestations
are those of aseptic meningitis.
enteroviruses
In __________there is a selective lysis of oligodendrocytes,
resulting in foci of demyelination
progressive multifocal leukoencephalopathy
(PML),
________________that is more severe than that
associated with other febrile states is the most frequent
symptom OF VIRAL meningitis
Headache
mild depression
of the CSF glucose (never below 25 mg/ dL) occurs with
the meningitis caused by ___________
mumps, HSV-2, lymphocytic
choriomeningitis, or VZV.
MC etiology of aseptic meningitis
most common are from
enterovirus-mainly echovirus and Coxsackie virus
It is also recognized that infection with __________ may
present as acute, self-limited aseptic meningitis with an
infectious mononucleosis-like clinical picture
HIV
HSV-1 has
been isolated from the CSF of patients with recurrent
bouts of benign aseptic meningitis so-called_____________
Mollaret meningitis
A number of __________infections are associated with exanthemata and may be associated with the grayish vesicular lesions of oral herpangina
echovirus and Coxsackie virus (particularly group A)
Pain in the back and neck and in the muscles
should suggest ______ or _________
poliomyelitis or dengue.
Lower motor
neuron weakness may also occur with _______________ virus infections, but it is usually mild and
transient in nature.
echo, West Nile, and Coxsackie
present. It should be noted that
orchitis is not specific for mumps but occurs occasionally
with _______, ________ and _________
group B Coxsackie virus infections, infectious mononucleosis,
and lymphocytic choriomeningitis
The natural host of the ______ virus is the common
house mouse, Mus musculus
lymphocytic choriomeningitis
Neurologic manifestation of Parvovirus
brachial neuritis
____ and _____meningitis may be associated with a
cauda equina neuritis
HSV and HIV
LCM should be suspected if there is an intense lymphocytic pleocytosis.
Counts above ______ in the spinal fluid, particularly
if the cells are all lymphocytes,
1,000 cells/mm3
dx of aseptic meningitis
an infection is demonstrated by a
fourfold increase in titer from acute to convalescent serum drawn at least 10 days apart using ELISA
PCR is most sensitive during
the _________, in contrast to serologic
tests, which are more accurate ______
active stage of viral replication
later in the course of the
infection
An idiosyncratic, presumably immunologic meningitis
may result from the use of _______ intravenous____________________(due probably to a carrier
chemical in the solution), and, rarely, from other drugs,
including certain antibiotics
nonsteroidal antiinflammatory drugs,
immune globulin
In the neoplastic group, _____ and _____
are the most common sources of meningeal infiltrations
leukemias and lymphomas
Occlusion of many small cerebral blood vessels by
_________ may also excite a reaction in meningeal
vessels and a pleocytosis that includes eosinophils.
cholesterol emboli
The special problem of chronic neutrophilic meningitis is associated with the ff species:
Nocardia, Aspergillus, Actinomyces, or
certain Mycobacterium species
combinations of iridocyclitis, depigmentation of a thick swath of hair (poliosis circumscripta) and of the skin, vitiligo, around the eyes, loss of eyelashes, dysacusis, and deafness (the pathologic basis of the syndrome is not known);
Vogt-KoyanagiHarada
syndrome,
characterized by episodes of acute meningitis
with severe headache and sometimes low-grade
fever, lasting for about 2 weeks, and recurring over a
period of several months or years
Mollaret recurrent meningitis,
Mollaret recurrent meningitis, is usually assocayed with _____
HSV1
A special
syndrome that has been associated with ______ is that of aseptic meningitis and bladder failure and vaginal
or vulvar pain after a bout of genital herpes
HSV-2
It is essentially a diffuse inflammatory disease of small
blood vessels that has several other characteristic features
such as oral and genital ulcers and is more appropriately
considered with the vasculitides
Behc;et disease
The common practice is to assume
that viral meningitis causes only fever, headache, stiff neck,
and photophobia; if any other CNS symptoms are added,
the condition is generally called __________
meningoencephalitis.
several agents, notably the________, may cause encephalitic
lesions with only mild meningeal symptoms.
arboviruses
expressed by a low-grade fever
and cerebral symptoms such as confusion, seizures, coma,
or ataxia. The spinal fluid shows slight inflammation and
elevation of protein-sometimes a more intense reaction,
and there are usually characteristic confluent, scattered,
bilateral lesions in the white matter in imaging studies,
findings that differ from those of viral encephalitis
ADEM
In viral encephalitis, Death occurs in ________of these patients and residual signs, such as mental deterioration, amnesic defect, personality change, recurrent seizures, and hemiparesis, are seen in approximately another ________
5 to 20 percent
20 percent
age range of HSV enceph
Its age distribution is slightly skewed and biphasic,
affecting persons mainly between ages S and 30 years
and those older than age SO years
Many other viruses,
exemplified by the _____ have a characteristic
geographic and seasonal incidence.
arboviral encephalitides,
__________which is a primary infection
with EBV, is complicated by meningitis, encephalitis facial palsy, or polyneuritis of the Guillain-Barre type in a
small proportion of cases
infectious mononucleosis
various movement
disorders, including parkinsonism, are being seen
as a residua of encephalitis from the ______
Flaviviruses
The incubation
period after Arbovirus bite transmission is_________
5 to 15
days.
A special syndrome of febrile, flaccid, paralytic poliomyelitis resulting from___________
West Nile virus infection
The fever and neurologic signs of arboviral encephalitis
subside after_________ unless death supervenes
or destructive CNS changes have occurred
4 to 14 days
Of the arbovirus infections in the United States, ________________ is among the most serious,
as a large proportion of those infected develop encephalitis
eastern equine encephalitis (EEE)
disabling abnormalities associated with EEE
mental retardation, emotional disorders, recurrent
seizures, blindness, deafness, hemiplegia, extrapyramidal
motor abnormalities, and speech disorders.
Perivascular cuffing by lymphocytes and
other mononuclear leukocytes and plasma cells, as well
as a patchy infiltration of the meninges with similar cells,
are the usual histopathologic hallmarks of ______
viral encephalitis.
In HSV Encephalitis, Between________________ percent are fatal, and the majority of patients who
survive are left with serious neurologic abnormalities.
30
and 70
The ________herpesvirus may also cause acute
generalized encephalitis, usually in the neonate and in
relation to genital herpetic infection in the mother
type 2
site of predilection of HSV enceph
inferomedial or lateral portions
of the frontal and temporal lobes and the insula
Disturbed memory function
can often be recognized, but usually this becomes evident only later in the________ as the patient
awakens from stupor or coma.
convalescent stage
In HSV enceph, in ______________in some large series, the spinal fluid was normal in the first days of the illness
3 to 5 percent
Pathology of HSV enceph
The lesions take the form of an intense hemorrhagic
necrosis of the inferior and medial temporal lobes and
the mediorbital parts of the frontal lobes
EEG findings of HSV Enceph
lateralized periodic high-voltage
sharp waves in the temporal regions and slow-wave complexes at regular 2 to 3/s intervals
The only alternative way to establish the diagnosis of
acute HSV encephalitis is by __________
and by _______________ obtained from brain
biopsy
fluorescent antibody study
viral culture of cerebral tissue
In HSV encep, acyclovir significantly
reduces both ______ and _______ from the disease
mortality
morbidity
In HSV enceph,
Acyclovir is given intravenously in a dosage of _____and continued for _________ in order to prevent relapse
30 mg/kg/d
10 to 14 days
mechanism of relapse in HSV enceph
including an immune-mediated inflammatory
response, but treatment with too low a dose or for
too brief a period is undoubtedly the main cause of the
rare relapses that occur in adults
In HSV encephalitis,
The outcome of this disease, both mortality
and morbidity, is governed to a large extent by the
patient’s ________, _________ , ________
age and state of consciousness, particularly at
the time of institution of acyclovir therapy
In HSV encephalitis,
if treatment is
begun within 4 days of onset of the illness in an awake
patient, survival is__________
greater than 90 percent
Evaluation of patients 2 years after treatment showed
38 percent to be normal or nearly normal, whereas _________ were dead or severely impaired
53 percent
If there were
seizures during the acute illness, it is advisable to continue
antiepileptic medications for a year or more and
then judge the risk of discontinuing them on the basis of
__________, __________ and _________
further seizures, the EEG, and the patient’s exposure to
situations that pose a danger, such as driving
the cause of a medial temporal
lobe (limbic) encephalitis in adult patients following allogenic
hematopoietic stem cell bone marrow transplantation
H HV-6 Encep h a l itis
H HV-6 Encep h a l itis resembles ______ and _______
limbic encephalitis
paraneoplastic and anti-voltage-gated potassium channel
mundane __________can also produce
a severe medial temporal lobe encephalitis in bone
marrow transplant cases, in one of our patients associated with gray matter damage in the spinal cord
adenoviruses
The other viral agents that appear as causes of
encephalitis with some regularity in stem-cell and organ
transplant patients include ______, _______, _______ and ________
parvovirus, CMV, EBV, adenovirus,
HSV, and varicella zoster virus
Rare cases of rabies have been caused by inhalation of the _________
virus shed by bats;
In rabies infection, The incubation period is usually 20 to 60 days but may
be as short as__________, especially in cases involving
multiple deep bites around the face and neck
14 days
In rabies encephalitis, The main neurologic symptoms, following a _______ of fever, headache, and malaise
consist of apprehension, dysarthria, and psychomotor
overactivity, followed by dysphagia (hence salivation
and “frothing at the mouth”), spasms of throat muscles
2- to
4-day prodromal period
Brainstem structure involved in rabies
tegmental medullary nuclei
The____________ form is
most likely to follow bat bites or, in the past, the administration
of rabies vaccination.
paralytic
In rabies encephalitis, Coma gradually follows the
acute encephalitic symptoms and, with rare exceptions as noted below, death ensues within ___________, or longer
in the paralytic form
4 to 10 days
In Rabies, The disease is distinguished by the presence of cytoplasmic eosinophilic inclusions, the ________
Negri bodies
In rabies, The inflammatory reaction is most
intense in the brainstem. The focal collections of microglia in this disease are referred to as _______
Babes nodules
After a bite by a seemingly healthy animal, surveillance
of the animal for a ___________.
Should signs of illness appear in the animal, it should be
killed and the brain sent, under refrigeration, to a government-
designated laboratory for appropriate diagnostic
tests.
10-day period is necessary.
Post exposure prophylaxis
Human rabies immune globulin (HRlG)
is injected in a dose of 20 U /kg of body weight (one-half
infiltrated around the wound and one-half intramuscularly
Post exposure prophylaxis provides passive immunization for __________, allowing time for active immunization
10 to 20 days
The more recently developed rabies vaccine grown on a human diploid cell line (human diploid cell vaccine [HDCV]) has reduced the doses needed to just 5 (from the 23 needed with DEV); these are given as 1 -mL injections on the day of exposure and then on days_______ after the first dose
3, 7, 14, and 28
acute
ataxia of childhood is most often associated with ______
chickenpox
In meningocerebellitis, The MRI is normal in the
majority of cases but some show enhancement with gadolinium of the _________
cerebellar cortical ribbon.
Herpes zoster (“shingles,” “zona”) is a common viral
infection of the nervous system occurring at an overall
rate of ___________1,000 persons per year, with
higher rates in the elderly
3 to 5 cases per
Pathologic changes in Herpes Zoster
inflammatory reaction in the spinal or cranial sensory ganglia and lesser
degrees of reaction in the posterior and anterior roots, the
posterior gray matter of the spinal cord, and the adjacent
leptomeninges
The notion that one attack of zoster provides lifelong
immunity is _________, although recurrent attacks are rare and most localized repeated herpetic eruptions are caused
by HSV.
incorrect
in Herpes Zoster, The
thoracic dermatomes, particularly______ are the most
common sites, accounting for more than two-thirds of
all cases, followed by the craniocervical regions.
T5 to T10,
In ophthalmic herpes, which accounts for 10 to 15 percent
of all cases of zoster, the pain and rash are in the distribution
of the first division of the trigeminal nerve, and the
pathologic changes are centered in the_________
gasserian ganglion.
Herpes zoster of the palate, pharynx, neck, and retroauricular region (herpes occipitocollaris) depends on
herpetic infection of the __________ and the ganglia of the _________
upper cervical roots
vagus and glossopharyngeal nerves
In necrotizing inflammatory myelopathy and vasculitis, involve not just the dorsal horn but also the contiguous white matter, predominantly on the same side and at the same segment(s) as the affected \_\_\_\_\_\_\_\_\_\_
dorsal roots, ganglia, and posterior horns
VZV
has been isolated from the CSF and specific antibody to
________________ has been found in the
CSF and serum, although it is hardly needed for purposes
of diagnosis.
VZV membrane antigen (VAMA)
In Zoster Angitis, Typically, ___________
after the onset specifically of ophthalmic zoster,
the patient develops an acute hemiparesis, hemianesthesia, aphasia, or other focal neurologic or retinal deficits associated with a mononuclear pleocytosis in the spinal fluid and elevated IgG indices in the CSF.
2 to 10 weeks
In VZV, After the lesions have dried,
the repeated application of ________ ointment (derived
from hot peppers) may relieve the pain in some cases by
inducing a cutaneous anesthesia
capsaicin
Acyclovir shortens the _________ and
___________, provided that treatment is
begun within approximately 48 h (some authorities say
72 h) of the appearance of the rash
duration of acute pain
speeds the healing of vesicles
Several studies have suggested that the duration
of postherpetic neuralgia is reduced by treatment during
the acute phase with _____ and ______ but the
incidence of this complication is not markedly affected.
famciclovir or valacyclovir,
favorable results in preventing postherpetic pain by
starting a __________during the acute phase
tricyclic antidepressant
All patients with ophthalmic zoster should receive
acyclovir or valacyclovir orally; in addition, acyclovir
applied topically to the eye, in either a _______ or _______
0.1 percent solution
every hour or a 0.5 percent ointment 4 or 5 times a
day,
PHN follows shingles in _________of patients but occurs almost three times
more often among individuals older than age 60 years.
5
to 10 percent
dose escalation for amitryptiline in PHN
Initially, it is given in doses of approximately
50 mg at bedtime; if needed, the dosage can be increased
gradually to 125 mg daily.
A salve of ___________and
spread on the painful skin, was reported to be successful
in relieving the pain for several hours inPHN
two aspirin tablets, crushed
and mixed with cold cream or chloroform (15 mL)
Retroviruses are a large group o f RNA viruses, s o called
because they contain the enzyme ___________
which permits the reverse flow of genetic information from
RNA to DNA.
reverse transcriptase,
Two families of retroviruses are known to
infect humans: (1) the___________ the most important of
which is the HIV, the cause of AIDS, and
(2) the __________
which include the human T -cell lymphotropic viruses
(HTLV-I), the agents that induce chronic T-cell leukemias
and lymphomas (HfLV-ll) and tropical spastic paraparesis
(HTLV-I).
lentiviruses,
oncarnaviruses,
The related but less common entity of HIV-2 infection
causes a generally less severe illness than HIV-1 but
may include almost any of the features
including _______
dementia
It has already been mentioned that HIV infection
may present as an ____________ with
a mild lymphocytic pleocytosis and modest elevation of
CHON
acute asymptomatic meningitis
In adults, the interval between infection and
the development of AIDS ranges from several months to
15 years or even longer; the mean latency is_________
8 to 10 years
and 1 year or less in infants
Percentage of pts with AIDS who have HAND
3%
survival after the onset of dementia in HAND is
generally _________ but may be considerably longer
if treatment is instituted.
3 to 6 months
Tests of psychomotor speed seem to be most sensitive
in the early stages of dementia like _________________
(e.g., trail making,
pegboard, and symbol-digit testing)
CT scan of pts with HAND
In the CT scan there is
widening of the sulci and enlargement of the ventricles;
MRI may show patchy but confluent or diffuse white
matter changes with ill-defined margins
The pathologic basis of the dementia in HAND appears to be a ____________
diffuse and multifocal rarefaction of the cerebral white
matter accompanied by scanty perivascular infiltrates
of lymphocytes and clusters of a few foamy macrophages,
microglial nodules, and multinucleated giant
cells
In HAND, ________there is widespread astrocytosis
and microglial activation in the cerebral cortex,
with little recognizable neuronal loss
“diffuse poliodystrophy,”
A myelopathy, taking the form of a vacuolar degeneration
that bears a marked pathologic resemblance to subacute
combined degeneration because of vitamin B12 deficiency,
is sometimes associated with the AIDS dementia complex
HIV myelopathy
Described the polyneuropathy associated with AIDS
A distal, symmetrical,
axonal polyneuropathy, predominantly sensory and
dysesthetic in type
this stands as the
first proven viral polyneuritis in humans
AIDS polyneuropahty
In AIDS polyneuropathy,
painful ___________ occurs, seemingly related to a focal vasculitis, or there may be a subacute inflammatory _____________ (a polyradiculitis) that is usually caused by an accompanying CMV infection
mononeuropathy multiplex
cauda equina syndrome
In a rare peripheral neuropathy of AIDS termed_____________________ a variety
of clinical syndromes have been described including
all patterns of the usual AIDS polyneuropathies
diffuse
infiltrative lymphOCijtosis syndrome (DILS),
A____________, taking the form of an inflammatory
polymyositis, has been described in HIV patients
at any stage of the disease
primary myopathy
The original anti-AIDS drug, zidovudine
(AZT), has caused a myopathy, probably because of its
effect on _________
mitochondria
In CNS toxoplasmosis, The spinal fluid usually shows an
elevation of protein in the range of_________
and one-third of patients have a ________
50 to 200 mg/ dL,
lymphocytic pleocytosis.
TX of CNS TOxo
oral pyrimethamine
(100 mg initially and then 25 mg daily) and a sulfonamide
(4 to 6 g daily in four divided doses)
11 percent of AIDS patients developed
a _________ which may, in some cases,
be difficult to distinguish from toxoplasmosis clinically
and radiologically.
primary CNS lymphoma,
Antibody tests
for toxoplasmosis should be obtained; the absence of
_________ mandates that treatment be changed in
order to address the problem of brain lymphoma
IgG antibodies
In those patients with CNS Toxoplasmosis who cannot tolerate
the frequent side effects of pyrimethamine or sulfonarnides
(rash or thrombocytopenia), _______may
be of value
clindamycin
Among the nonfocal neurologic
complications of AIDS, the most common are
CMV
and cryptococcal infections
Its clinical features include an acute confusional
state or delirium combined in a small proportion of cases
with cranial nerve signs including ophthalmoparesis,
nystagmus, ptosis, facial nerve palsy, or deafness
CMV encephalopathy
In CMV encephalopathy, MRI findings show the process
to be concentrated in the _________ especially
evident as T2 signal hyperintensity in these regions
ventricular borders,
TX of CMV enceph
treatment with the antiviral agents
ganciclovir and foscarnet
_______with this fungus
and less often, are the most frequent
fungal complications of HIV infection
Meningitis
solitary cryptococcoma
Varicella encephalitis takes the form of
1.
2.
3.
1.like those of progressive multifocal leukoencephalopathy,
2. a cerebral vasculitis with hemiplegia (usually in
association with ophthalmic zoster),
3. or, rarely, a myelitis
T or F, in NSY
Cell counts in the CSF are umeliable
as signs of activity; diagnosis depends entirely upon
serologic tests
T
Indeed, a category of ________ has emerged
that consists of an aggressive and rapidly progressive
necrotizing process that causes strokes and dementia as
a result of involvement of brain parenchyma and vessels
quaternary syphilis
Other rare organisms, such as __________
the cause of cat scratch fever, are found rarely in AIDS
patients and have been implicated in an encephalitis.
Bartonella henselae,
A special result of HlV antiretroviral treatment
may induce an intense inflammatory response to a
coexistent infection. What is this called?
IRIS
Transmission of HTLV 1
from mother to child, across the
placenta or in breast milk; by intravenous drug use or
blood transfusions; or by sexual contac
There is a
high rate of infection with HTLV-II among ______who are coinfected with HIV
drug users
___________ has been
associated with a severe and persistent asymmetrical
flaccid poliomyelitis
West Nile virus
The poliomyelitis agent i s a small RNA virus that i s a
member of the enterovirus group of the _______ family.
picornavirus
In Polio,
In the inapparent infections, and those i n which there are
only mild systemic symptoms with pharyngitis or gastroenteritis
had been called ________
abortive poliomyelitis
What type of Polio.
Weakness becomes manifest
while the fever is at its height, or, just as frequently,
as the temperature falls and the general clinical picture
seems to be improving.
Paralytic Poliomyelitis
In Paralytic polio,
______ and _________ during the period of
asymptomatic infection were thought to favor the development
of paralysis of the exercised or injected limbs
Excessive physical activity
local injections
In Paralytic polio,
Atrophy
of muscle can be detected within ________of onset of
paralysis, is maximal at _______, and is permanent
3 weeks
12 to 15 weeks
In Polio,
The most frequently involved cranial muscles
are those of deglutition, reflecting involvement of the
_______
nucleus ambiguus
I n fatal polio infections, lesions are found i n the _______, _________ and ______
precentral
(motor) gyrus of the brain (usually of insufficient severity
to cause symptoms), brainstem, and spinal cord
In polio,
The earliest
histopathologic changes in the anterior horns of the cord
are __________of the nerve cells, along with an
inflammatory reaction
central chromatolysis
Disturbances of swallowing, respiration, and vasomotor
control are related to neuronal lesions in the ___________ centered in the region of the nucleus
ambiguus,
medullary
reticular formation,
pain in the neck and back, attributed to “meningeal
irritation,” are probably related to the mild inflammatory
exudate in the meninges and to the generally mild lesions in the _____ and _______
dorsal root ganglia and dorsal horns
Abnormalities of autonomic function
are attributable to lesions of autonomic pathways in
the _________ of the brainstem and in the _______ of the SC
reticular substance
lateral horn cells in the spinal cord.
Mortality from acute paralytic poliomyelitis i s between____________higher in the elderly and very young
5
and 10 percent-
The established human slow infections of the nervous
system caused by conventional viruses include
1.
2.
3.
subacute
sclerosing panencephalitis (measles virus), progressive
rubella panencephalitis, and progressive multifocal leukoencephalopathy
What condition?
Children and adolescents were affected for the most
part, the disease rarely appearing beyond the age of 10 years.
Typically there is a history of primary measles infection at
a very early age, often before 2 years, followed by a 6- to
8-year asymptomatic period.
SSPE
In SSPE
The course is usually steadily progressive, death
occurring within _______
1 to 3 years
In SSPE, Nevertheless, the progressive
______________ in a ci:tild is
so typical that bedside diagnosis was usually possible
ataxic-myoclonic chronic dementia
EEG of SSPE
The EEG shows a characteristic abnormality consisting of periodic (every 5 to 8 s) bursts of \_\_\_\_\_\_\_\_\_\_
2 to 3 / s highvoltage
waves, followed by a relatively flat pattern
In SSPE
The
CSF contains few or no cells, but the protein content is
increased, particularly the __________, and
agarose gel electrophoresis discloses _______
gamma globulin fraction
oligoclonal bands of
IgG.
T or F
Histologically, the lesions involve the cerebral cortex
and white matter of both hemispheres and the brainstem.
The cerebellum is usually involved
F
PATHOLOGY OF SSPE
In the white matter there
is degeneration of __________(both myelin and
axons), accompanied by perivascular cuffing with mononuclear
cells and ________ (hence the term sclerosing
encephalitis).
medullated fibers
fibrous gliosis
IN SSPE
__________, the histopathologic
hallmark of the disease, are found in the cytoplasm and
nuclei of neurons and glia cells
Eosinophilic inclusions
_______ thought to be
measles nucleocapsids, have been observed in the inclusion-
bearing cells examined electron microscopically
Virions,
The differential diagnosis of SSPE includes the
childhood and adolescent dementing diseases such as
1.
2.
3.
lipid storage diseases , prion disease
(Creutzfeldt-Jakob ), and Schilder-type demyelinative disease
.
No effective treatment is available. The administration
of _______ and ____________ was found by some investigators to lead to
improvement and prolonged survival
amantadine
inosine pranobex (formerly inosiplex)
The lesions are similar to those of SSPE (eosinophilic inclusions in neurons and glia, with varying degrees of necrosis) except that inflammatory changes are lacking. WHAT condition?
Su bacute Measles Encep h a l itis with
I m m u nosu ppression
The relatively __________ and onset of neurologic disease, the
_________, and _________distinguish this form
of subacute measles encephalitis from both SSPE and postmeasles
(postinfectious) encephalomyelitis
short interval between exposure
rapid course
lack of antibodies
The deficits associated with congenital rubella infection
of the brain are nonprogressive at least after the second or third year of life
Progressive Rubella Pa nence p h a l itis
Progressive Rubella Pa nence p h a l itis signs and symptoms
Clumsiness of gait was an early
symptom, followed by a frank ataxia of gait and then of
the limbs. Spasticity and other corticospinal tract signs,
dysarthria, and dysphagia ensue.
It is characterized
by widespread demyelinating lesions, mainly of the
cerebral hemispheres but sometimes of the brainstem and
cerebellum, and, rarely, of the spinal cord
Prog ressive M u ltifoca l Leu koence p h a l opathy
An uncommon disease of late adult life, PML usually
develops in a patient with a _______ or _____
neoplasm or chronic immunodeficiency
state.
in patients with AIDS in whom the incidence
of PML approaches_________
5 percent
In PML,
In most cases, death occurs in ________from the
onset of neurologic symptoms and even more rapidly in
patients with AIDS unless aggressive antiretroviral treatment is undertaken
3 to 6 months
Microscopic findings of PML
crystalline arrays of particles resembling
papovaviruses in the inclusion-bearing oligodendrocytes.
In AIDS patients, aggressive treatment using ___________
greatly slows the progression of PML and has led to
remission in almost half of cases for a year
antiretroviral
drug combinations, including protease inhibitors,
Several retrospective
series found that a CD4 count below ___________/ ,uL is
a poor prognostic sign for recovery from PML
100 cells
The unique symptoms were ophthalmoplegia
and pronounced somnolence and a third
group manifested a disorder of movement in the form of
bradykinesia, catalepsy, mutism, chorea, or myoclonus.
Encep h a l itis Letharg i ca (vo n Eco n o m o
Disease, Sleep i n g Sickn ess)
lesions in Enceph lethargica:
midbrain, subthalamus, and hypothalamus.
