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91 Cards in this Set
- Front
- Back
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8 causes of rapid altered mental status
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Anything causing shock
Bacterial meningitis Cerebral malaria Rabies Herpes encephalitis Arboviral encephalitis Typhoid East African trypanosomiasis |
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11 causes of non-infectious acute confusional state
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Alcohol/intoxication
Hypogylcemia Shock Renal failure Hepatic failure Vitamin deficiency Head injury Epilepsy (post ictal) Subdural/trauma CVA |
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8 causes slow onset Altered mental status
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Syphillis
TB meningitis Brucella Prion dz HIV encephalopathy West african trypanosomiasis Heavy metals Cryptococcal dz |
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Causes of mass effect seizure and infection?
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Neurocysticercosis
Hydatid cyst Toxoplasmosis Abscess -- bacterial, TB, fungal, amoeba Neoplasm |
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Causes of seizures from tissue death/damage
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Herpes encephalitis
Arboviruses Bacterial meningitis Free living amoeba |
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Systemic causes of seizures?
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Toxins (pesticides,...)
shigella electrolyte probs hypoglycemia |
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4 causes of acute meningitis?
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Bacterial
Viral Parasites Meningitis-like |
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Common causes of bacterial meningitis 4
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Neisseria
Strep Haemophilus Listeria |
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Common causes of acute viral meningitis
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Echovirus
Coxsackie Enterovirus HSV Arboviruses Colorado tick fever Polio |
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Parasite causes of acute meningitis 3
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Free living amobae
Angiostrogyus Strongyloides hyperinfection -- carrying e. coli |
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Causes of meningitis-like syndromes? 3
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Rickettsia
Ehrlichia Abscess |
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Causes of chronic meningitis (abnormal CSF >4 weeks)
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TB
Syphillis Fungal Brucella Lyme |
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What are common presenations in chronic meningitis?
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Hydrocephalis
Cranial nerve probs Spinal cord signs Wax/wane sx |
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Infectious causes of CVA?
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Endocarditis (septic embolism, mycotic aneurysm)
Rheumatic heart dz (thrombotic embolus) Progression of mass lesion (herniation/bleeding) Infarction due to granuloma (TB, syphillis) |
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Infectious causes of neuritis? 6
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Leprosy
Lyme Herpes simplex Herpes zoster HTLV-1 Toxin mediated (diptheria, tetanus, botulism, konzo, lathyrism) |
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Infectious causes of paralysis (non-Guillan Barre)
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Polio
Rabies (paralytic) West nile (GBS-like) |
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Infectious causes of Guilain Barre
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s/p many GI infections
Yersinia, campylobacter, shigella |
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Common findings in TB meningitis?
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Insidious (often missed in elderly)
Personality change Headache Deentia Cranial nerve deficits (basilar meningitis) May be PPD neg 35% No other TB sx in 25% |
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Pathology of TB meningitis?
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Base of brain
Gellatinous exudate becomes fibrous, entrapping cranial nerves May obstruct ventricles May infarct |
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Classic TB CSF?
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Low glucose
High protein Lymphocytosis Smear + 20% time (87% with 4 serial taps) Cx positive 38-88% PCR: not sensitive/specific |
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Common findings in acute TB meningitis?
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Commonly in kids
Early post-primary event (before immunity) Miliary TB/rupture of subependymal tubercle CSF with predominant PMNs Skin test may convert during course |
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What does BCG vaccine help prevent?
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Acute TB meningitis
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What is a tuberculoma
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Abscess full of tb
Actls like mass lesion |
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Rx for TB meningitis?
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Maybe steroids
Normal TB therapy |
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What is Pott's dz
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TB of spine
Normally thoracic spine Anterior body Forms gibbus -- results in paraplegia |
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What is a Gibbus?
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Spine deformity from Pott's dz (TB) leading to later paralysis as spinal cord stretched
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Treatment for granuloma TB impinging on spinal cord?
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Rx with meds
Surgery normally does not help |
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Describe acute syphillitic meningitis
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Part of SECONDARY syphillis
Normally in 1st year of infection Common with HIV Mimics viral aseptic meningitis Hydrocephalus/papilledema Cranial/peripheral nerve sx Mental status changes Seizures |
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Is acute syphillitic meningitis part of tertiary syphillis?
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NO. Secondary. Wierd but true.
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What is asymptomatic neurosyphillis?
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CSF is abnormal with no sx
Elevated protein and WBC |
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Describe meningovascular neurosphyillis
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Vasculitis/Endarteritis
Average 7 yrs after infection Prodrome: mood changes Infarcts small vessels of meninges, brain, spinal cord Causes hemiplegia, seuzres, neuro deficits |
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Describe parenchymous neurosyphillis
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10-20 yrs after infection
Diffuse nerve cell destruction General paresis - psych and neuro Tabes dorsalis (spinal cord damage) Foot slap Ataxia + Romberg due to demyelination of dorsal column Cranial nerve 7 and 8 deficits Argylll Robertson pupil (reacts to focus, but not light) |
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What is an Argyll Robertson pupil?
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Neurosphyillis
Pupil reacts to accomodation but not light |
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What is tabes dorsalis?
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Dorsal column demylenation of neurosphypillis leads to ataxia/foot slap/+ rhomberg, shooting pains
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What is General paresis of the insane?
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The psych and neuro findings of neurosyphillis
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How to dx neurosphyillis?
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+ treponemal antibody in blood
+ VDRL in CSF OR any CSF finding suggestive of syphillis (high protein plus one positive test above) |
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What is the treatment of neurosyphillis?
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Long course PCN IV
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What is the common skin lesion of Lyme Dz (Borrelia burgdorferi)
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Erythema migrans (may not occur)
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What are the neuro sx of Lyme Dz?
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Cranial nerve palsies
Bell's palsy Peripheral neuropathies |
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What is borrelia burgdorferi?
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Spirochete that causes Lyme
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What is Borreliosis?
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Relapsing fever
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How is Relapsing fever spread?
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Epidemic: Body louse (common in overcrowding)
Endemic: Tick borne |
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What are the symptoms of Borreliosis (Relapsing fever)?
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Flu like illness
H/a, myalgias, photophobia, cough conjunctival suffusion, HSM |
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What are lab findings in Borreliosis?
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VERY high bacteremia (visible on blood smear)
Platelet sequestration DIC Hypotension |
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Why does relapsing fever relapse?
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Antigenic variation of the borreliosis
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What are the neuro findings (in 30% of patients) of borrelia?
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Coma
Cranial nerve Hemiplegia Meningitis Seizures |
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Treatment of Relapsing fever?
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PCN
Tetracyclines Chloramphenicol |
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What is a side effect of treatment of relapsing fever?
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Jarish-Herxheimer reaction (kill large bacterial load, toxins released feel worse before better)
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How many phases of leptospirosis?
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1 Flue like illness
2 Aseptic meningitis, possibly liver and renal dz, conjunctival suffusion and hemorrhage CSF findings mimick viral meningitis |
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If you get sick, are better for 2 days, then get hit with meningitis, what might you have?
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Leptospirosis
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What is the 2nd phase of leptospirosis known as?
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Weils disease
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What are the sx of Brucellosis meningoenchephalomyeltitis?
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Headache
Meningial signs Hemianesthesias/paresthesias Depression Dementia |
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What bony problems caused by brucellosis?
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Osteomyeltits/spondylitis
Lytic/blastic lesions POSTERIOR vertebrae in lumbosacral region (opposite of pott's dz) |
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What disease causes "opposite" of a Pott's lesion?
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Brucellosis (lumbosacral posterior dz)
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How do you get brucellosis?
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Unpasteruized milk
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What meningitis causes quick death?
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Meningococal meningitis
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Who gets menigococcal meningitis?
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Commonly kids and young adults
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What might you catch at the Hajj?
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Meningococcus meningitis
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When might you catch meningitis in Africa's meningitis belt?
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Dry season (epidemics of meningitis)
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Which meningitis causes petecchia and purpura?
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Meningococcal meningitis
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What is the CSF finding of meningococcus meningitis?
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Positive gram stain 80-90% of time
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Does CSF of drug induced meningitis have WBC elevation?
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Yes, WBC > 1000, PMNs, High protein, glucose normal
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Drugs that cause meningitis
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Bactrim
NSAIDS Azathioprine, OKT3 (transplant drugs) |
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Neuro sx of polio?
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Flu like illness, fever then sudden flaccid paralysis, assympetrical, unilateral
SEVERE muscle pain No sensory loss No bladder dysfunction |
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What neuro syndrome develops years after measles?
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SSPE (Subacute sclerosing pan-encephalitis)
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What are the sx of SSPE (from measles)
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Personality/behavioral change
Progressive intellectual impairment chorioretinitis Convulsions Myoclonic movements Coma Death |
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What causes Tropical Spastic Paraparesis?
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HTLV-1
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What are sx of tropical spastic paraparesis?
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From HTLV1 infection prior in life
Weakness/stiffness lower extremities Urinary sx Mild sensory involvement -- peripheral numbness/back pain |
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What disease commonly is lined to Adult T-cell leukemia/lymphoma?
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HTLV-1
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How long after a bite does rabies present?
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2-3 months average (7 days to 19 years)
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Neuro sx of rabies?
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Early: paresthesias at infection, aches in involved limb
Later: Furious (CUJO) rabies Paralytic (dumb) rabies - like a stroke Autonomic dsfxn (brady/tachy, hypotension) |
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How to dx rabies?
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Negri bodies in brain
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What causes the hydrophobia of rabies?
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Pharyngeal spasm with minor stimuli
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What is the milwakee protocol?
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Protocol for treating rabies (success x 1)
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What are the common neuro findings of HSV encephalitis?
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Bizarre behavior
Hallucinations Olifactory hallucinations Aphasia |
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What is the common CSF finding of HSV encephalitis?
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Blood in CSF
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What is neurocysticercosis?
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Pork tapeworm larvae in brain, leading to cyst formation (after human ingests eggs)
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What is the common presentation of neurocysticercosis?
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Seizure
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What is the treatment for neurocysticercosis?
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Antiseizure meds
Antiparasitics (???) maybe if worm alive with steroid with caution |
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What parasite causes eosinophilic meningitius?
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Angiostrongylus cantonensis (rat lungworm)
From snail contamination |
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What does Neagleria fowleri cause?
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Amoebic meningitis
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What does the CSF look like in Amoebic meningitis
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Mimicks bacterial meningitis
If you do a wet mount for amoba, might see one |
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How to treat amoebic meningitis?
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Amphotericin
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What are the common features of Guillain Barre?
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Ascending paralysis
Miller Fischer variant -- ataxia, oculomotor dysfunction |
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What does pellagra cause? (3 Ds)
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Dermatitis
Diarrhea Dementia |
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Neuro signs of pellagra
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Dementia
Depression Motor paresis Sensory neuropathy |
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What causes pellagra
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Niacin deficiency
From protein malnutrition, alcohol, isoniazid |
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What causes Konzo?
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Cyanide poisoning from improperly processed bitter manioc (cassava)
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Sighs of Konzo?
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Sudden onset trembling, weakness, leg spasticity
Generalized weakness Symmetrial spastic paraparesis |
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What causes lathyrism?
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Neurotoxic amino acid
ODAP Overconsumption of lathyris sativus (from grass pea, chickling pea, vetch) -- famine food |
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What are the symptoms of lathyrism?
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Sudden onset weak legs, then on to spastic paraparesis
Subacute -- 10-15 days of myalgias |
