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57 Cards in this Set

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how are brain abscesses spread? which is most common?
contiguous*
hematogenous
post-traumatic
cryptogenic (unknown cause)
mechanism behind continguous spread?
sinus infx spreads to braIN
which organism presents with hematogenous seeding
staph (component of endocarditis)
most common location for brain abscess
temporal/frontal (#1)
frontal/parietal
cerebellar
occipital
what do multiple location imply about brain abscess
hematogenous seeding
what is the most common bacterial etiology of brain abscess
strep (non-pneumococcal)
when is fungal brain abscess seen?
in poorly controlled DM
clinical manifestations of brain abscess?
absent fever
indolent presentation
HA
focal neuro findings/seizures
N/V (from incresaed P)
nuchal rigidity uncommon
when is nuchal rigidity normally seen?
hallmark of meningitis
it only occurs in abscess if it ruptures into ventricular system --> inflammatory changes
Dx tests for brain abscess?
MRI
CT
**LP SHOULD NOT BE PERFORMED**
why should LP not be performed in suspected brain abscess, but should be done in meninngitis
in meningitis: increased P in CSF so LP will release that P, which is good!
in abscess, increased P in cranium, putting P on bony encasement around brain, and swelling in parenchyma --> increasd P in ventricles.

if LP done, P is released and brain comes through and herniates- this is DEADLY!
when should you do LP?
don't do it if CT confirms abscess
tx of brain abscess?
medical and/or surgical
empiric ABx
tx strep and staph, but don't treat others
when should surgery be done in brain abscess?
it there is about to be a rupture --> lots of cerebral edema
then you shouldu open up skull and remove abscess
what will you see on CT of long-term inflammation
ring around abscess, representing chronic inflammation
what is mucor?
a fungus that commonly infects pts with DM (it needs high blood sugar to survive)
leads to DEATH!
what are the other suppurative foci?
which is an emergency situation?
cranial subdural empyema*
spinal subdural empyema*
epidural abscess
sequellae of spinal subdural empyema
permanent paralysis and radicular pain
epidural abscess
in thoracic area
present with cord compression --> bowel/bladder probs (urinary retention) or leg weakness
what is cranial epidural abscess related to?
frontal sinus disease and osteomyelitis
features of cranial subdural abscess
emergency!
bacteremia
HA
Seizures
same bacteriology as in brain abscess
fesatures of paraspinal abscess
how does it spread?
tx?
can be epi or subdural
usually from bacteremia or contiguous spread
surgical drainage required to prevent spinal cord compression
which is the most common organism that --> paraspinal abscess
staph aureus
clinical presentation of spinal subdural abscess
radicular pain
urinary retention
leg weakness
hyperreflexia
tx of spinal subdural abscess
steroids
ABx
surgical decompression
CSF analysis of spinal epidural abscess
small # of polys wiht elevated protein and normal or low glucose
culture usually negative
infectious etiologies of chronic meningitis
TB
cryptococcus
coccidiomycosis
histoplasmosis
lyme dz
syphilis
when to suspect TB meningigits?
in pts who grew up in TB endemic areas or ppl w TB who weren't fully treated
presentation of TB meningitis
fever
HA
change in mental status
population that usually gets cryptococcus
usually immunocompromised
dx of cryptococcus
india ink and crypto ag useful
why is tb meningitis so difficult to dx
PPD often -
AFB usually -
when does lyme meningitis occur
can occur in any stage in lyme
accompanies Bell's palsy
frequency of syphilitic meningitis
40% in secondary
tertiary, more frequently
manifestation of meningovascular syphilis
stroke like syndrome
seizures

if adult has new onset seizures, r/o syphilis
pathophys of parenchymatous neurosyph
destruction of nerve cells in cerebral cortex, manifesting as general "paresis" and tabes dorsalis
uveitis
deafness
optic neuritis or atrophy
what does "paresis" stand for? when is it seen
personality
affect
reflexes
eye
sensorium
intellect
speech

parenchymatous neurosyphilis
what is tabes dorsalis
shooting pains
ataxia
sphincter siturbance
peripheral/cranial neuropathy
presentation of neurocysticercosis
seizures
CSF has lymphocytic pleocytosis
low glucose
dx of neurocytosis
serologies
presentation of encephalitis
presentation of meningitis
confusion initially
no stiff neck or photophobia

no altered sensorium initially, just HA/fever

CSF exam is similar in both
noninfectious etiologies of brain abscess
neoplasm
sarcoid
vasculitis
drug induced (from NSAIDS)
prevention of neurosarcoid
steroids
also start pt on TB drugs b/c dx of TB not excluded for several weeks
whihc viruses will have RBCs in CSF
HSV
CTFV
CEB
where does HSV encephalitis present
tx
frontal/parietal localization

acyclovir
who get st. louis encephalitis
sequelae
adults >50 yo

20% mortality
20% neurologic sequelae
vector for st. louis encephalitis
reservoir
mosquitos
birds
who gets EEE?
sequelae
children, mostly

75% mortality
high amt of neuro sequelae
vector of EEE?
reservoir?
daytime feeding mosquito
birds
who gets WEE?
sequelae?
infants and adults >50
5-15% mortality
few neuro sequellae
who gets CA enceph?
sequelae

vector
reservoir?
children
<1% mortality

mosquito
rodent
vector of WNV (specific)
incubation pd
fatality?
C. pipiens

5-15 days
self limited, but 3-15% fatality in elderly
presentation of WNV
fever >100
altered MS
flaccid paralysis possible
Post infectious encephalitis
demyelination in white matter, no direct infection
follows viral illness by 5-21 days (MMR, mycoplasma, varicell, EBV, other viral URIs)
GB syndrome - when do they occur
66% are post-infectious
5% post surgical
assoc with lymphoma and SLE
>500 cases after swine flu vaccine in 1976
CSF exam of GB?
elevated protein w/o pleocytosis
tx of GB
plamapheresis or IV gammaglobulin