Cns Infect. Clin Aspects; Path Of Cns Infections

Front 1

If head CT and blood work don't tell the source of AMS, what is then required?

Back 1

Lumbar puncture and CSF analysis

Front 2

Meningitis caused by viruses

Back 2

Aseptic meningitis

Front 3

T/F Fungi and mycobacteria cause a more indolent meningitis than bacteria.

Back 3

T

Front 4

Cerebritis: defn

Back 4

Bacterial infection of brain parenchyma. Forms abscess.

Front 5

Cerebritis: typical patient

Back 5

immunocompromised infant

Front 6

Encephalitis: defn

Back 6

Viral infection of brain parenchyma

Front 7

Meningitis: classic triad

Back 7

Fever

Stiff neck

AMS

Front 8

Which patients are less likely to show the classic meningitis triad?

Back 8

Alcoholics

Elderly

Infants

Front 9

Meningitis: symptoms in infant

Back 9

Irritability

Hypothermia

Front 10

95% of patients with bacterial meningitis will have at least two of these symptoms

Back 10

Headache

Fever

Stiff neck

AMS

Front 11

_____ and meningitis can both be diagnosed by lumbar puncture.

Back 11

Subarachnoid hemorrhage (if it doesn't show up on Head CT)

Front 12

Skin petechiae suggest what meningitis?

Back 12

Neisseria meningitidis (meningococcus)

Front 13

Kernig's sign: defn

Back 13

resistance to extension of knee with hip is flexed

Front 14

Thigh flexion when neck is passively flexed

Back 14

Brudzinski's sign

Front 15

3 indicators of meningeal irritation (cause can be meningitis, SAH)

Back 15

1) Brudzinski's sign
2) Kernig's sign
3) Neck stiffness

Front 16

CSF findings in meningitis

Back 16

1) Opening pressure (reflective of ICP) elevated

2) Protein is elevated

3) WBC: marked pleocytosis with PMNs

4) Graim stain positive in >60%

5) Positive cultures in >75%

Front 17

3 most common bacteria causing meningitis in ADULTS

Back 17

1) Streptococcus pneumoniae (pneumococcus)

2) N. meningitidis (meningococcus)

3) Hemophilus influenzae

Front 18

Bacterial meningitis: abx

Back 18

3rd generation cephalosporin

Vancomycin

Front 19

Subacute and chronic meningitis: symptoms

Back 19

Slow cognitive dysfunction

Seizures

HAs

Mild neck stiffness

Inapparent fever

Front 20

Which area demonstrates severe inflammatory response, leading to hydrocpehalus and CN entrapment in subacute/chronic meningitis (fungi and mycobacteria)?

Back 20

Basilar area

Front 21

4 non-infectious causes of chronic meningitis

Back 21

1) Tumor (leptomeningeal mets)

2) Paraneoplastic syndromes

3) Sarcoidosis

4) AI disease - Wegener's, Behcet's, Lupus

Front 22

Fungal meningitis in immunocompromised: top 3 organisms

Back 22

Candida

Aspergillus

Mucor (in diabetics)

Front 23

Fungal meningitis in immunocompetent: top organisms

Back 23

<b>Cryptococcus</b> is most common.

Histoplasma, Coccidiodies, Actinomycetes also can affect immunocompetent and compromised.

Front 24

Genus causing typhus and RM spotted fever

Back 24

Rickettsiae

Front 25

Mycobacterium tuberculosis: characteristics of meningitis

Back 25

Reactivation of latent infection with M. tuberculosis.

Patients are confused with HAs and stiff necks.

Front 26

Aseptic meningitis: most common agent

Back 26

enterovirus

(polioviruses, Coxsackie A viruses (CA), Coxsackie B viruses (CB), and echoviruses)

Front 27

Aseptic meningitis: CSF findings

Back 27

White cell count between 10-500

Mononuclear (lymphocyte) predominance

CSF Glucose is normal

CSF Protein is slightly elevated

Front 28

Encephalitis: most common agent

Back 28

HSV-1

Front 29

Rabies can cause _________

Back 29

encephalitis

Front 30

How does rabies get to brain?

Back 30

Axonal transport from site of wound (animal bite).

This is why area must be thoroughly cleaned and rabies prophylaxis given.

Front 31

Encephalitis: CNS findings

Back 31

1) Normal or elevated ICP
2) Normal glucose
3) Elevated protein (usually <200)
4) Up to several hundred WBCs (lymphocytes or mononuclear). PMNs can be seen early in the course.

Front 32

Abscess: bacteria implicated

Back 32

Mixed flora with some anaerobic

Front 33

Acute cerebellar ataxia: When is it commonly seen? Course of illness?

Back 33

In children after viral illnesses. Cerebellum is primarily involved. Usually resolves without sequelae.

Front 34

Acute disseminated encephalomyelitis: Clinical manifestations and Neuroimaging

Back 34

AMS with focal findings

Patchy white matter demyelination

Front 35

Leptomeningeal mets: CSF findings

Back 35

Elevated CSF protein

Increased cell count

Low Glucose

Cytology shows malignant cells

Front 36

Spongiform encephalopathy: CSF Findings

Back 36

elevated protein

Front 37

CSF Findings - cloudy fluid

Back 37

Bacterial meningitis

Front 38

CSF Findings of highest protein - what disease?

Back 38

TBC meningitis

Front 39

Meningitis in infants: What organisms?

Back 39

Grp B Strep (S. agalactiae)
Listeria

E.Coli

Front 40

Bacterial meningitis: the major predictor of outcome

Back 40

acute impairment of consciousness

Front 41

CSF protein levels: norms over the lifetime

Back 41

At birth, protein levels are high (mean of 80 mg/dl)
Gradually fall to a low mean of 20 mg/dl at 10 months
In older children and adults, mean protein levels from lumbar fluid is 15 – 45 mg/dl

Front 42

Why is it important to dx Herpes encephalitis?

Back 42

Tx with acyclovir quickly can improve outcome.

Front 43

Arboviruses implicated in _______

Back 43

encephalitis

Front 44

Subacute demyelinating disease; the only human central demyelinating disease of viral etiology

Back 44

Progressive Multifocal Leukencephalopathy (PML)

JC virus

Front 45

Devastating, degenerative condition with prominent myoclonus

Result of latent measles infection

Back 45

Subacute Sclerosing Panencephalitis

Front 46

Prion Diseases: Clinical presentation

Back 46

Cognitive dysfunction

Ataxia

Myoclonus

Front 47

Produces spongiform encephalopathy with vacuoles

Back 47

prions

Front 48

Hydatid Cyst : cause

Back 48

aka echinococcosis

parasitic infestation by a tapeworm of the genus Echinococcus

Front 49

Listeria is acquired ___________ in neonates.

Back 49

Transplacentally

Front 50

Lumbar puncture is performed by need between ____ and _____

Back 50

L4 and L5 (level of iliac crest)

Front 51

Layers crossed in lumbar puncture from superficial to deep

Back 51

Skin > Ligaments > Epidural space > Dura > Arachnoid

Front 52

Most important way microorganisms reach CNS

Back 52

hematogenous spread

Front 53

Which viruses get into the CNS via the PNS (traveling up axons of peripheral nerves)?

Back 53

Herpes, rabies

Front 54

most common CNS infection

Back 54

Acute purulent bacterial meningitis

Front 55

4 routes of infection of CNS

Back 55

Hematogenous
Direct implantation
Local extension
Via PNS

Front 56

3 categories of meningitis

Back 56

aseptic (usually viral)
acute pyogenic (usually bacterial)
chronic (usually tuberculous, spirochetal, or fungal)

Front 57

______ was previously an important cause of meningitis in toddlers but has decreased with vaccination.

Back 57

H. influenzae

Front 58

waterhouse-friderichsen syndrome

Back 58

hemorrhagic adrenalitis or Fulminant meningococcemia, is defined as adrenal gland failure due to hemorrhage into the adrenal glands, secondary to severe bacterial infection (most commonly the meningococcus Neisseria meningitidis).

Front 59

Late complications of meningitis

Back 59

Fibrosed arachnoid granulations - hydrocephalus due to inability to resorb CSF

Vascular thrombosis - infarcts

Front 60

brain abscess: Predisposing conditions

Back 60

Acute bacterial endocarditis

Cyanotic congenital heart disease (R -> L shunts)

Chronic pulmonary sepsis (bronchiectasis, cystic fibrosis)

Front 61

Brain abscess: symptoms

Back 61

Signs / symptoms of increased ICP (mass lesion), progressive focal deficits

Front 62

T/F Brain abscess is only intracranial process in which a true scar (with collagen) is formed.

Back 62

T

Front 63

Brain abscess: Radiologic findings

Back 63

Centrally necrotic lesions with ring enhancement post-contrast and surrounding edema

Front 64

Ring-enhancing lesion: defn

Back 64

On the image there is an area of decreased density surrounded by a bright rim from concentration of the enhancing contrast dye

Front 65

Ring-enhancing lesion: differential dx

Back 65

Bacterial brain abscess

GBM

Mets

Primary CNS lymphoma

Toxoplasma

Occasional demyelinative lesions like in MS

Front 66

Subdural empyema: complications

Back 66

Thrombophlebitis of bridging veins, resulting in venous occlusion and infarction

Front 67

Extradural Abscess: complications

Back 67

Can compress spinal cord - neurosurgical emergency

Front 68

Which bacterial infections result in either lymphoplasmacytic or granulomatous patterns of inflammation?

Back 68

mycobacterial and spirochetes

Front 69

Granulomatous infection: Characteristic

Back 69

Chronic exudate of mononuclear, histiocytic, Epithelioid, Giant cells admixed with CT

Front 70

Three forms of neurovascular syphilis

Back 70

1) Meningovascular syphilis
2) Parenchymal neurosyphilis
3) Tabes dorsalis

Front 71

Meningovascular syphilis: defn

Back 71

chronic inflam of meninges, Subarachnoid spaces and vessels.

Sparing of brain and spinal cord.

Meninges and small blood vessels are thickened with lympho-plasmocytic infiltrate

Front 72

Parenchymal neurosyphilis: defn

Back 72

"General paresis (of the insane)" = chronic meningoencephalitis

Psych disturbances, alterations of mood, dementia, and eventually death.

Brain is severely atrophied with astrocytosis and microglial proliferation.

Front 73

Tabes dorsalis: defn

Back 73

Degeneration of bilateral posterior columns.

Damage by spirochetes seems to be on dorsal roots rather than spinal cord itself.

Loss of sensory fibers carried in posterior columns.

Front 74

Lyme Disease (Neuroborreliosis) is similar in brain manifestations as _____

Back 74

neurosyphilis

Front 75

General features of viral meningoencephalitis

Back 75

Perivascular and parenchymal mononuclear cell infiltrates (lymphocytes, plasma cells, and macrophages)
Microglial proliferation with microglial nodules
Neuronophagia

Front 76

viral meningoencephalitis: dx

Back 76

Definitive diagnosis made by direct identification of viral infection

Front 77

Most common form of acute necrotizing encephalitis

Back 77

HSV-1 encephalitis

Front 78

HSV-1 encephalitis: age and brain location

Back 78

Localizes to temporal lobes / limbic system

Young adults

Front 79

Effects of HSV2 in neonates and immunocompromised

Back 79

generalized severe necrotizing encephalitis

Front 80

Cytomegalovirus (CMV): effects of in utero (transplacental) infection

Back 80

Severe encephalomyelitis. See calcific lesions around ventricles. See inclusion bodies in neurons and glia.

Front 81

Poliomyelitis: pathophys

Back 81

Polio (and other enteroviruses) attack motor neurons, causing flaccid paralysis with potential respiratory compromise

Front 82

______ neurons most affected by polio.

Back 82

Anterior Horn Motor Neurons

Front 83

Rabies: course of infection

Back 83

10 days - 1 year post inoculation, flu-like symptoms develop with agitation, excruciatingly painful throat muscle spasms, violent convulsions, death.

Front 84

Rabies: inclusion bodies

Back 84

Negri bodies

Front 85

Arboviruses are spread how?

Back 85

by mosquitoes and ticks

Front 86

HIV Subacute Encephalitis: defn

Back 86

AIDS-dementia complex (ADC)- Insidious mental slowing, memory loss, and mood disturbances, rarely seizures

Front 87

HIV vacuolar myelopathy: defn

Back 87

Motor abnormalities, ataxia, bladder and bowel incontinence

Front 88

PML: histology

Back 88

Glassy, plumb-colored nuclear inclusinos in oligodendroglia

Front 89

Most common granulomatous CNS infections

Back 89

Fungal infections of CNS

Front 90

Fungal infections: route to CNS

Back 90

hematogenous dissemination

Front 91

Where are the following fungi indigenous?
A) Cryptococcus
B) Coccidioides
C) Histoplasma

Back 91

A) Southeast
B) Southwest
C) Ohio River Valley

Front 92

Cryptococcus: testing

Back 92

india ink, crytococcal antigen test

Front 93

2 main patterns of CNS fungal infection

Back 93

1) Chronic meningitis

2) Vasculitis with brain parenchymal invasion

Front 94

Cerebral Toxoplasmosis: imaging

Back 94

one or more ring-enhancing lesions on MRI

Front 95

Congenital toxoplasmosis: triad

Back 95

hydrocephalus

cerebral calcifications

chorioretinitis

Front 96

cerebral malaria: what's seen?

Back 96

Many petechial hemorrhages throughout brain

Front 97

Cysticercosis is caused by ____

Back 97

Taenia solium

Front 98

3 ways abnormal prion proteins are acquired

Back 98

1) Sporadic spontaneous mutation

2) Inheritance of mutant form of prion protein

3) Iatrogenic exposure

Front 99

T/F Inflammatory cells are seen in prior diseases

Back 99

F