Block 4 - Cns Infections

Front 1

How can infection get through the intact skull?

Back 1

throught the cribriform plate

Front 2

WHat are examples of PNS infections that can cross into the CNS?

Back 2

rabies, zoster

Front 3

Which bacterial meningitis are neonates at risk for?

Back 3

E. coli

strep B

Front 4

Which bacterial meningitis is most common in toddlers?

Back 4

strep pneumo

Front 5

Which bacterial meningitis is most common in adolescents?

Back 5

Neisseria

Front 6

Which bacterial meningitis is most common in the elderly?

Back 6

Listeria and gram - bacilli

Front 7

Which bacterial meningitis is most common over all?

Back 7

strep pneumo

Front 8

Does viral meningitis cause death?

Back 8

rarely

Front 9

Echo, coxsackie, non-paralytic polio?

Back 9

80% of cases of viral meningitis

Front 10

What is the most common age of viral meningitis?

Back 10

<30 years

Front 11

What is ususally found on microscopic examination of leptomeninges?

Back 11

hyperemia, fibrin, neutrophils or lymphocytes (viral)

Front 12

What is the Kernig sign?

Back 12

pain with straight leg raising

Front 13

a)Meningitis-associated septicemia

b) Hemorragic Infarction of adrenal glands

c)Most common with pneumococcal meningitis

Back 13

Waterhouse Friderichsen Syndrome

Front 14

What are results of an infarction of the adrenal glands?

Back 14

hypotension and shock

petechiae or purpura

Front 15

Labss:

high neutrophils
high protein
very low glucose
culture 90% positive

Back 15

Bacterial

Front 16

Labs:

High lymphocytes
slightly high protein
normal glucose
70% culture positive

Back 16

viral

Front 17

What criteria should be used for Tx of bacterial meningitis prior to completion of culture?

Back 17

Chemical Exam (protein, gluc)

Type of cells present

Gram stain

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Front 18

What is a rare cause of parietal lobe abcssess?

Back 18

suppurative lung disease

Front 19

What are the most common microbes of brain abscess?

Back 19

strep and staph, anaerobes

Front 20

What congenital heart disease can cause brain abscess?

Back 20

R-to-L shunt

Front 21

What is a frequent finding in the brain tissue adjacent to the abscess?

Back 21

vasogenic edema

Front 22

Upon what does the thickness of the fibrogliotic wall depend in an abscess?

Back 22

Duration of the abscess

Front 23

What areas of the brain are prone to abscess?

Back 23

frontal lobe, parietal lobe, cerebellum

Front 24

What is used to confirm a clinical diagnosis of infection?

Back 24

CT or MRI

Front 25

What is the Tx for Brain abscess?

Back 25

surgical evacuation, followed by antibiotics

Front 26

What is the main danger of a subdural empyema?

Back 26

Thrombophlebitis of bridging veins that can lead to an occlussion and then infarction of brain tissue.

Front 27

Bacterial or fungal infection of skull bones or air sinuses?

Back 27

Subdural Empyema

Front 28

What are 3 main causes of Chronic Bacterial Meningoencephlitis?

Back 28

Tuberculosis

Neurosyphilis

Neuroborreliosis (Lyme Disease)

Front 29

A patient presents with headache, malaise, confusion, and vomiting. Lumbar puncture shows both neutros and lymphs. On chemistry, proteins is very high and glucose is just below normal. Bacteria are cultured that are acid fast. What is the most like like cause of this?

Back 29

chronic bacterial meningoencephalitis caused by mycobacterium tuberculosis

Front 30

What can be of concern if a patient has had long term CBM caused by tuberculosis?

Back 30

fibrotic arachnoid mater

infarction due to endarteritis

Front 31

What are the 3 major forms of neurosyphilis?

Back 31

Meningovascular

Paretic

Tabes Dorsalis

Front 32

Which neurosyphilis involves the base of the brain, cortex, and spinal leptomeninges and is characterized by obliterative endarteritis and perivascular inflammation with plasma cells (cerebral gummas) and lymphocytes?

Back 32

Meneingovascular

Front 33

In which neurosyphilis does treponema pallidum invade the brain and cause, mental/physical dysfxn, gliosis, iron deposits and maybe hydrocephalus?

Back 33

Paretic

Front 34

Which tissue gets hit the hardest with spirochete invasion in tabes dorsalis?

Back 34

sensory nerves in dorsal roots and axons o the dorsal columns dorsal columns

Front 35

A patient presents with facial nerve palsies and mild encephalopathy. Upon microscopic examination of the meningeal tissue, micrglial cells and scattered organisms are found. The patient has just com back from a camping trip, what is the likely diagnosis?

Back 35

Lyme Disease (Neuroborreliosis)

Front 36

What is meant by tropism when regarding viral meningoencephalitis?

Back 36

some viruses infect certain cells and/or certain areas of the brain

Front 37

What are pathological features of viral meningoencephalitis?

Back 37

mononuclear infiltrates
microglial nodules
neuronophagia
inclusion bodies
hemorrhage
cerebral edema

Front 38

A patient presents with a fever that was of rapid onset, and is complaining of a headache. Patient is also complaining of a stiff neck. On exam papilledema is evident. Suddenly the patient has a convulsion. What would be the next step?

Back 38

lumbar puncture, with a suspicion of viral meningoencephalitis

Front 39

What can be given to alleviate cerebral edema?

Back 39

corticosteroids

Front 40

What often happens in viral meningoencephalitis if it is not caught soon?

Back 40

irreversible neuronal necrosis

Front 41

What would the CSF of a patient with arthropod borne encephalitis look like?

Back 41

neutrophils then lymphocytes, protein elevated, glucose normal

Front 42

What are two main areas affected by arthropod borne encephalitis?

Back 42

cortex

basal ganglia

Front 43

What needs to be done for a pregnant woman with active herpes genitalis?

Back 43

C-section to protest fetus from HSV encephalitis

Front 44

What viral encephalitis can be rapidly fatal and is particular to the temporal and inferior frontal lobes?

Back 44

HSV encephalitis

Front 45

How long does HSV encephalitis often take to present?

Back 45

4-6 weeks

Front 46

What is diagnostic for HSV encephalitis?

Back 46

Brain Bx with Intranuclear Cowdry A bodies in the neurons and glia

PCR of CSF

Front 47

Which virus can reactivate in immune suppressed patients and cause acute encephalitis, with possible demyelination then necrosis?

Back 47

zoster

Front 48

What can result from CMV infection in last trimester of preganacy?

Back 48

microcephaly

mental retardation

Front 49

What is the most opportunistic viral pathogen in aids patients, that has a predilection for paraventricular subependymal regions?

Back 49

CMV

Front 50

What is the likely diagnosis of a person with eosinophilic intracytoplasmic inclusion bodies found in pyramidal neurons of the hippocampus or purkinje cells (with no inflammation)?

Back 50

Rabies

Front 51

Which areas of the CNS are the most susceptible to damage by the Rabies virus?

Back 51

Midbrain

Medulla

Basal Ganglia

Front 52

What question should be asked of the person who arrives with a patient that is febrile, undergoing generalized convulsions as a result of slight sensation and contracture of the pharyngeal muscles?

Back 52

was this person bitten by an animal

Front 53

Where is HIV found in the CNS?

Back 53

CD4+ macrophages and microglia

Front 54

What nutrient deficiency does HIV induced vacuolar myelopathy resemble?

Back 54

B12 deficiency

Front 55

What muscular finding can clue to AIDS-associated myopathy?

Back 55

HIV + macros, elevated CK, muscle fiber necrosis and phagocytosis

Front 56

What is a disease that is caused by a polyoma virus, which infects oligodendrocytes (which will have large intranuclear inclusions) and giant atypical astrocytes, and will cause widespread focal demyelination of white matter of the entire brain that is rapid and fatal?

Back 56

Progressive Multifocal Leukoencephalopathy

Front 57

Which patients are most at risk for PML?

Back 57

AIDS and Cancer patients

Front 58

What could be considered as a cause of death in a patient(upon autopsy) that shows wide spread gliosis, demyelination, intranuclear inclusion and neurofibrillary tangles, who for the last 1.5 years had shown cognitive decline, limb spasticity, and seizures and having noted a positive diagnosis for measles some years back?

Back 58

Subacute Sclerosing Panencephalitis (SSPE)

Front 59

When is fungal meningoencephalitis most often seen?

Back 59

immunicompromised patients

Front 60

cryptococcus
candida
mucor
aspergillus fumigatus
histoplasma capsulatum
blastomayces dermatiditis
coccidiodes immitis

Back 60

causes of fungal meningoencephalitis

Front 61

What are the 3 patterns of fungal meningoencephalitis?

Back 61

chronic meningitis

vasculitis

parenchymal invasion

Front 62

What would be a differential diagnosis (if not a first) of an AIDS patientspresenting with a fever, sx of acute cerebral dysfxn and upon CT you find multiple ring-enhancing mass lesions?

Back 62

Toxoplasmosis gondii

(most frequent cause of neuro disease in AIDS patients)

Front 63

What does the tissue surrounding a previous toxo lesion look like after treatment?

Back 63

well demarcated coagulative necrosis, adjacent pseudocysts and tachyzoites

Front 64

When does congenital toxo usually occur?

Back 64

3rd trimester

Front 65

Besides necrosis, calcification and gliosis of the brain, what else is infected in the fetus with toxo?

Back 65

fetal retina

Front 66

What does naegleria cause?

Back 66

rapidly fatal encephalitis

Front 67

What does acanthamoeba cause?

Back 67

chronic granulomatous meningitis

Front 68

What percentage of CJD is sporadic?

Back 68

85%

Front 69

What is the difference between vCJD and CJD?

Back 69

CJD happens in 7th decade, usually faster onset than vCJD which is slower and happens mainly in young adults

Front 70

Which CJD may be linked to mad cow?

Back 70

vCJD