Viral infections of the Nervous System Flashcards by kat remigio

natural host of LCM virus (lymphocytic choriomeningitis)

Mus musculus

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causes fifth disease in young children characterized by high fever and markedly flushed cheeks, irritability and sometimes febrile seizures

in adult may cause brachial neuritis

Parvovirus

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may be associated with cauda equina neuritis

HSV and HIV

HVS- with preceding genital infection with the virus

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causes encephalitis in immunocompromised patients

HIV, chemo for neoplasm, organ transplantation or hematologic or lymphoid malignancy

HHV-6
CMV
VZV

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Vogt-kayanagi-Harada syndrome

iridocyclitis
depigmentation of a thick swath of hair and of skin
vitiligo aorund eyes, loss of eyelashes, dyacusis, deafness

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Most serious among the arbovirus infections In the US

eastern equine encephalitis (EEE)

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predilection of lesions in Herpes Simplex Encephalitis

inferomedial or lateral portions of the frontal and temporal lobes, and insula

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T/F Lesions in HSE are usually bilateral and always symmetrical.

False
usually bilateral but not symmetrical
p751

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T/F
In the acute stages of HS encephalitis, intranuclear eosinophilic inclusions are found in neurons and glia cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis.

True

p751

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EEG findings in Herpes Simplex Encephalitis

lateralized periodic high-voltage sharp waves in the temporal regions and slow-wave complexes at regular 2-3/s intervals

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T/F

In HSE, False-negative tests for HSV PCR are most likely to occur in the first 72 hrs of febrile infection.

False
48 hrs
p752

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Dose and duration of Acyclovir in HSE

30mg/kg/d

10-14 days

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Main cause of relapses in HSE in adults

treatment with low doses for a brief period

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prognosis in Herpes Simplex Encephalitis

if treatment begun 4 days of onset of illness, survival is greater than 90%

in an evaluation after 2 yrs, 53% were dead or severely impaired

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Neurologic sequelae in HSE

korsakoff amnesic defect or global dementia
seizures
aphasia

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causative agent in roseola

exanthemia subitum

HHV-6

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viral agents that appear as causes of encephalitis with some regularity in stem-cell and organ transplants pts

parvovirus
CMV
EBV
adenovirus
HSV
VZ virus

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incubation period for Rabies

10-20 days, as short as 14 days

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main neurologic symptoms for rabies include apprehension, dysrathria, psychomotor overactivity, followed by dysphagia, spasms of throat muscles, dysarthria, numbness of the face, diplopia, spasma of facial muscles indicate involvement of

tegmental medullary nuclei

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Rabies is distinguished by the presence of cytoplasmic eosinophilic inclusions called

Negri bodies

most prominent in the pyramidal cells of hippocampus and Purkinje cells

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Focal collections of microglia in Rabies are called

Babes nodules

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Dose of Human Rabies immune globulin HRIG for postexposure prophylaxis

20 U/kg

provides passive immunnization for 10-20 days

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Acute ataxia of childhood is most often associated with

chickenpox

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most common causative organisms to cause acute ataxia in adults

varicella, EBV, mycoplasma

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characterized clinically by radicular pain, vesicular cutaneous eruption, segmental sensory and delayed motor loss

Herpes Zoster

VZV DNA is localized primarily in which ganglia

trigeminal | thoracic

Lipschutz inclusion bodies are seen in

herpez zoster multiplication of virus in epidermal cells causes swelling, vacuolization, lysis of cell boundaries, leading to the formation of vesicles

how long does pain and dysesthesia usually last in Herpes Zoster

1-4 weeks | in others - pain persists for months or years

what to look for in Tzanck smear

multinucleated giant cells in scrapings from the base of an early vesicle

thoracic dermatomes frequently involved in herpes zoster

T5 - T10 | followed by craniocervical regions

complication of VZV 2-10 weeks after onset of ophthalmic zoster, patient develops an acute hemiparesis, hemimanesthesia, aphasia or other focal neurologic or retinal deficits associated with mononuclear pleocytosis in the spinal fluid and elevated IgG in CSF

cerebral angiitis

in Zoster angiitis Acyclovir shortens the duration of acute pain and speeds the healing of vesicles provided that treatment started within approximately how many hrs?

48 hrs | some say 72

Zoster angiitis | for immunocompromised patients, what is the treatment

intravenous acyclovir given for 10 days

Treatment for Toxoplasmosis in AIDS

pyrimethamine 100mg initially then 25 mg daily | sulfonamide 4-6g daily

Nonfocal complication in AIDS presenting with retinitis, 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

Cytomegalovirus

Early histopathologic changes in poliomyelitis

anterior horn cells - central chromatolysis of the nerve cells along with an inflammatory reaction

Prion encephalopathy or all types has now been firmly associated with the conversion of a normal cellular protein PrPc to

an abnormal isoform, PrPsc

True or False in prion encephalopathy The transformation involves a change in which its helical proportion diminishes and the proportion of Beta pleated sheet increases.

True p770

In CJD Several competing classification systems have been devised that are based on both the presence of what two amino acids at codon 129 of the prion protein

methionine | valine

which of the ffg is the most common variant in spongiform enceph a. MM1 b. MM2 c. MV1 d. VV1

MM1

rapidly or subacutely progressive and profound dementia is associated with diffuse myoclonic jerks early stages of neurologic disease are characterized by a great variety of clinical manifestations, changes in behavior, emotional response, intellectual function followed by ataxia and abnormalities of vision such as distortions of shape and alignment of objects or impairment of visual acuity early phase: confusion, hallucinations, delusion, agitation

CJD

EEG pattern in CJD

distinctive and changing over the course of disease from diffuse and nonspecific slowing to one of stereotyped high-voltage slow 1-2Hz and sharp-wave complexes on an increasingly slow and low-voltage background

In CJD EEG | the high-voltage sharp waves which give the appearance of periodicity are synchronous with

myoclonus but the pattern may persists even without myoclonus

MRI findings in CJD

hyperintensity of lenticular nuclei on T2 and DWI when disease is fully established long contiguous segments of cortex as well as various parts of BG also show these alterations

what parts of the brain are mostly affected in CJD | major neuropathologic changes are found in:

cerebral and cerebellar cortices

in CJD | the microscopic vacuoles, which gives the brain tissue the typical sponge appearance are found in

cytoplasmic processes of glia cells and dendrites of nerve cells

how viruses gain entrance to the body VZV, measles and mumps - polioviruses, enteroviruses - HSV -

VZV, measles and mumps - respiratory polioviruses, enteroviruses - oral-intestinal HSV - oral or genital mucosal route

intermediate step to seeding in the brain/CSF

viremia

viruses which utilize the peripheral nerve pathway

VZV rabies HSV

In Progressive multifocal leukoencephalopathy, there is a selective lysis of

oligodendrocytes

clinical syndrome of aseptic meningitis

fever, headache, signs of meningeal irritation | predominantly lymphocytic pleocytosis in the spinal fluid with normal glucose

mild depression of CSF glucose (nerve below 25mg/dL) occurs with meningitis caused by

mumps HSV-2 lymmphocytic choriomeningitis VZV

most common cause of aseptic meningitis

viral | mostly enteroviruses - mainly echovirus and Coxsackie virus

Elsberg syndrome

associated with HSV2 aseptic meningitis bladder failure vaginal or vulvar pain after a bout of genital herpes

Most common sporadic cause of encephalitis and has no seasonal or geographic predilections

HSV

primary infection with EBV, complicated by meningitis, encephalitis, facial palsy, or polyneuritis of the GBS

infectious mononucleosis

T/F | Status epilepticus in Herpes Seimplex Encephalitis is common.

False rare p751

pathologic lesions in Herpes Simplex Encephalitis

intense hemorrhagic necrosis of the inferior and medial temporal lobes and the mediorbital parts of the frontal lobes region of necrosis may extend upward along the cingulate gyri and sometimes the insula or the lateral parts of teh temporla lobes or caudally into the midbrain but always contiguous with areas of mediotemporal lobe necrosis

route of entry of HSV into the CNS

latent in trigeminal ganglia and with reactivation may infect the nose and then the olfactory tract may also soread along nerve fibers that innervate the leptomeninges of the anterior and middle fosaee

imaging findings in Herpes Simplex Enceph

CT - hypodensity of the affected temporal lobe areas in 2/3 of cases MRI - increased signal in T2 weighted images T1- low signal intensity with surrounding edema and sometimes scattered areas of hemorrhage occupying the inferior parts of the frontal and temporal lobes ehancement to some degree with contrast: indicates cortical and pial abnormalities of BBB

T/F Antiviral treatment seems to affect PCR assay results in cases of herpes simplex encephalitis.

False antiviral treatment did not appear to affect the results. p752

establishes cause of a medial temporal lobe (limbic) encephalitis in adult patients following allogenic hematopoeietic stem cell bone marrow transplants

HHV-6

T/F | One attack of zoster provides lifelong immunity.

False p755

hazard in ophthalmic herpes

herpetic involvement of cornea and conjunctiva resulting in corneal anesthesia and residual scarring

syndrome | facial palsy in combination with a herpetic eruption of the external auditory meatus

Ramsay Hunt Syndrome

takes the form of a slowly or subacutely progressive dementia accompanied variably by abnormalities of motor function treatment with antiretroviral drugs can result in cognitive improvement

AIDS Dementia Complex

``` sensitive tools in the early stages of AIDS dementia complex except trail making CDT pegboard symbol-digit testing ```

except CDT test of psychomotor speed seem to be most sensitive in the early stages of dementia

pathologic basis of dementia

diffuse and multifocal rarefaction of teh cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, multinucleated giant cells

pathologic description of HIV myelopathy

vacuolar degeneration with pathologic resemblance to subacute combined degeneration because of vitamin B12 deficiency

antiretroviral drug that can cause myopathy

zidovudine because of its effect on the mitochondria p760

MRI findings in CMV in AIDS

T2 hyperintesities in the periventricular regions may extend more diffusely in the white matter and be accompanied by meningeal enhancement by gadolinum

Shingles involving several contiguous dermatomes is known to occur in AIDS with CD4 counts

below 500

T/F Poliomyelitis Inclusion bodies can be seen in the spinal cord.

False p764 No inclusion bodies

T/F | Acyclovir or famciclovir can be given to patients with poliomyelitis.

False p764 The authors know of no systemic study of the potency of antiviral agents in this disease.

mortality from acute paralytic poliomyelitis

5-10%

in polio, the return of muscle strength occurs mainly in the first ___ months

3-4 months p765 probably the result of morphologic restitution of partially damaged nerve cells

history of primary measles infection at a very early age, before 2 years followed by a 6-8 year asymptomatic period initially, decline in proficiency at school, temper outbursts, changes in personality, difficulty with language, loss of interests in usual activities progressive intellectual deterioration, focal or generalized seizures, widespread myoclonus, ataxia, visual disturbances, progressive chrorioretinitis

Subacute sclerosing panencephalitis

EEG in SSPE

periodic (every 5-8s) bursts of 2 to 3/s high voltage waves, followed by a relatively flat pattern

T/F | Cerebellum is usually affected in SSPE.

false usually spared p766

develops several days to weeks personality changes, intellectual impairment combination of hemiparesis progressing to quadriparesis visual field defects, cortical blindness, aphasia, ataxia, dysarthria, , dementia, confusional states, coma seizures are infrequent develops in patient with a neoplasm or chronic immunodeficiency state CSF - normal CT and MRI - nonenhancing demyelinating lesions

Progressive Multifocal Leukoencephalopathy

Prognosis in PML

death occurs in 3-6 months

causative agent in PML

JC virus | human polyomavirus

a CD4 count of _______ is a poor prognostic sign for recovery from PML

100 cells /uL

ophthalmoplegia and pronounced somnolence 1/3/ bradykinesia, catalepsy, mutism, chorea, myoclonus 20% died within a few weeks, survivors have varying degrees of impairment of mental function most extraordinary feature: parkinsonian syndrome after an interval of weeks or months

Encephalitis Lethargica | von Economo Disease, Sleeping Sickness

T/F Prion diseases may be both genetic and infectious.

True p769

outstanding neuropathologic changes in CJD

widespread neuronal loss and gliosis accompanied by a striking vacuolation or spongy state of the affected regions subacute spongiform encephalopathy

Prion encephalopathy has now been firmly associated with the conversion of a normal cellular protein PrPc to an abnormal isoform PrPsc - the transformation involves a change in conformation of the protein - describe the change in number of helical and beta pleated sheets

the helical proportion diminishes and the proportion of beta pleated sheets increases

test of CSF in CJD - finding by immunoassay of peptide fragments of normal brain proteins termed

14-3-3