Cns Infections & Dementias

Front 1

Define Brain Abscess

Back 1

Focal collection of fluid within the brain parenchyma, which can arise as a complication of a variety of infections, trauma, or surgery

Front 2

In a brain abscess, what are the two methods of invasion of bacteria?

Back 2

Direct Spread
Hematogenous Spread

Front 3

Define direct spread

Back 3

Direct spread of organisms from a contiguous site that usually causes a single brain abscess

Front 4

What are the three examples of direct spread

Back 4

Subacute/chronic otitis media and mastoiditis
Frontal or ethmoid infection spread
Dental infection

Front 5

Define Hematogenous spread

Back 5

Brain abscesses associated with bacteremia that usually result in multiple abscesses

Front 6

Most common location of hematogenous spread

Back 6

Middle Cerebral Artery

Front 7

Examples of an infection causing hematogenous spread

Back 7

Skin infections
Pelvic infections
Bacterial endocarditis
CHRONIC PULMONARY INFECTION

Front 8

Symptoms of a brain abscess

Back 8

Headache = Most common
Localized Headache NOT relieved by NSAIDs

Stiff neck
Change in mental status (late)
Vomiting

Front 9

How do you diagnose a brain abscess

Back 9

CT if always first!!!!
Decide if LP is acceptable
Culture after aspiration
Serology

Front 10

What are the two causes for an LP to be contra-indicated in a suspected brain abscess

Back 10

Unilateral cranial nerve deficits
Papilledema

*These indicate a midline shift on CT*

Front 11

Neurological deficit of temporal lobe

Back 11

Wernike's aphasia

Front 12

Neurological deficit of frontal lobe

Back 12

Inattentive, drowsy, disturbed judgement

Front 13

Neurological deficit of parietal lobe

Back 13

Impaired balance and position sense

Front 14

Neurological deficit of the cerebellum

Back 14

Nystagmus (coarser toward lesion)
Ataxia

Front 15

Neurological deficit of the brainstem

Back 15

facial weakness, dysphagia (swallowing), multiple cranial nerve palsy's

Front 16

Most common organisms for brain abscesses

Back 16

Staph aureus
Streptococci

Front 17

Treatment of brain abscess

Back 17

Intravenous emperical ABX and surgical drainage

ABX include: ceftriaxone, metronidazole, and vancomycin

Front 18

What is the hallmark difference in meningitis v. encephalitis?

Back 18

Meningits have NO LOSS of cerebral function, while those with encephalitis have altered mental status, motor or sensory deficits, altered behavior, and personality changes.

Front 19

Define Aseptic Meningitis

Back 19

Clinical and laboratory evidence for meningeal inflammation with negative routine bacterial cultures.

Front 20

What are the five causes of aseptic meningitis

Back 20

Viral (MOST COMMON)
Spirochetes
Fungal
Tick-borne
Medication induced

Front 21

Number one cause of VIRAL aseptic meningitis

Back 21

Enteroviruses
(coxsacksie, rhinovirus, etc...)

Front 22

When is the most common time for VIRAL aseptic meningitis?

Back 22

Summer and fall due to the nature of enteroviruses

Front 23

What are the clinical signs and symptoms for VIRAL aseptic meningitis

Back 23

ABRUPT onset
Headache
Fever
Stiff neck
Possible nausea, vomiting, photophobia, and malaise

Front 24

What is the diagnosis regimen for suspected meningitis of any kind?

Back 24

CT first to rule out a mass
LP (will be normal)

No treatment indicated
Self-limiting when viral

Front 25

What are the numbers of a normal LP

Back 25

WBC <250
Protein <150
Glucose WNL-within normal limits

Front 26

What are the signs and symptomes of LYME DISEASE aseptic meningitis

Back 26

#1 Rash-erythem migrans- "Bull's eye lesion"
Headache
Stiff neck
Mild fever
Arthralgia
History of tick rash
Rare cranial nerve palsies

Front 27

How long does it take for a tick to transfer disease

Back 27

At least 24 hours

Front 28

What type of organism causes Lyme Disease

Back 28

Spirochete

Front 29

What is the treatment for Lyme Disease?

Back 29

Doxycycline

Front 30

Signs and symptoms for Rocky Mountain Spotted Fever aseptic meningitis?

Back 30

#1 Rash @ wrists/ankles moving proximally (not always)
Severe Headache
Fever
Myalgia
Arthralgia
Nausea w/o vomiting

Front 31

What are three discussed drugs that may cause drug-induced aseptic meningitis

Back 31

NSAIDs
Bactrim
IVIG

Front 32

Treatment for drug induced aseptic meningitis

Back 32

Discontinue drug if needed or symptoms will cease after the drug has ran its course

Front 33

Explain the pathology behind IVIG drug induced aseptic meningitis

Back 33

IVIG pulls water from brain ventricles and from the CSF, this causes an extremely painful headache that presents like aseptic meningitis

Front 34

Drug management for suspected meningitis

Back 34

Bacterial suspected-emperic ABX
Viral suspected with NO risk factors- monitor
Viral suspected with possible risk factors- ABX
*wait for LP culture to discontinue or change ABX*

ALWAYS USE EMPERIC ABX FOR ELDERLY, EXTREMELY YOUNG, AND IMMUNOCOMPROMISED

Front 35

Treatment for:
HSV
RMSF
Lyme
Syphilis

Back 35

HSV- acyclovir
RMSF- doxy
Lyme- doxy
Syphilis- PCN

Front 36

"Bacterial meningitis reflects infection of the..."

Back 36

"ARACHNOID mater and the CSF in both the subarachnoid space and the cerebral ventricles"

Front 37

Two epidemiologies of bacterial meningitis

Back 37

Community acquired
Healthcare- associated

Front 38

What are the three main pathogens of community-acquired bacterial meningitis

Back 38

Strep. pneumoniae
Neisseria meningiditis
Listeria monocytogenes

Front 39

What are the two main pathogens of hospital-acquired bacterial meningitis

Back 39

Staph. aureus
Aerobic gram-negative bacilli

Front 40

What is the triad of bacterial meningitis

Back 40

Fever
Nuchal Rigidity
Altered Mental Status

Front 41

What are the laboratory features of a CBC of bacterial meningitis

Back 41

High WBC
Elevated neutrophils
High protein
Low glucose (<40)

Front 42

Treatment for bacterial meningitis:
Streptococcus pneumoniae

Back 42

Vancomycin PLUS
Ceftriaxone (or other 3rd gen. cephalosporin)

Front 43

What does Strep. pneumoniae look like in a gram stain?

Back 43

gram positive dipplococci

Front 44

Treatment for bacterial meningitis:
Neisseria meningiditis

Back 44

Ceftriaxone (or other 3rd. gen cephalosporin)

switch to PCN is culture shows sensitivity to PCN

Front 45

What does Neisseria meningiditis look like in a gram stain?

Back 45

gram negative dipplococci

Front 46

Treatment for bacterial meningitis:
Listeria monocytogenes

Back 46

Ampicillin with the added effects of
Gentamicin

Front 47

What does Listeria meningiditis look like in a gram stain?

Back 47

gram positive rod with motility
facultatively anaerobic

Front 48

Treatment for bacterial meningitis:
Staphylococcus aureus

Back 48

Start with Vancomycin
If culture shows methicillin susceptibility switch to
Nafcillin

Front 49

What does Staph aureus look like in a gram stain

Back 49

Gram positive cocci

Front 50

Define Dementia

Back 50

Progressive intellectual decline.

Not due to delerium or psychiatric disease.

Age is the main risk factor, followed by family history and vascular disease risk factors.

Front 51

Define the signs and symptoms of normal pressure hydrocephalus

Back 51

Gait apraxia ("magnetic gait")
Urinary incontinence
Dementia

Front 52

What would a CT reveal in normal pressure hydrocephalus?

Back 52

Enlarged ventricles of the brain that are disproportionate to overall brain atrophy

Front 53

Treatment options for normal pressure hydrocephalus

Back 53

Nothing
Brain shunt (only in clear-cut cases w/ minimal risk)

Front 54

Pathology of Alzheimer Disease

Back 54

Plaques containing beta-amyloid peptide
Neurofibrillary tangles containing tau proteins located throughout the neocortex

Front 55

Clinical features of Alzheimer Disease

Back 55

-MOST COMMON age related neurodegenerative disease- (incidence doubles every 5 yrs after 60)
-Short-term memory impairment is early and prominent in most cases
-Variable deficits of executive function, visuospatial function, and language

Front 56

Treatment for Alzheimer Disease

Back 56

Cholinesterase inhibitors
(ex: donepezil)

Front 57

Pathology of Vascular dementia

Back 57

Multifocal ischemic change

Front 58

Clinical features of vascular dementia

Back 58

-Stepwise or progressive accumulation of cognitive deficits in association with repeated strokes
-Symptoms depend on localization of strokes

Front 59

Treatment for Vascular dementia

Back 59

Treat underlying symptoms due to stroke

Manage behavior with Selective Serotonin Reuptake Inhibitors (SSRIs)

Front 60

Pathology of Dementia with Lewy Bodies

Back 60

Histologically indistinguishable from Parkinson's:
alpha-synuclein containing Lewy bodies occur in the brainstem, midbrain, olfactory bulb, and neocortex.

*Alzheimer pathology may coexist

Front 61

Clinical features of dementia with lewy bodies

Back 61

-Cognitive dysfunction with prominent visuospatial and executive deficits
-Psychiatric disturbance with anxiety, hallucinations, and fluctuating delerium
-Parkinsonian motor deficits with other symptoms

Front 62

Treatment for dementia with Lewy Bodies

Back 62

Cholinesterase inhibitors (donepezil)

Poor tolerance of psychoactive medications

Front 63

Pathology of Frontotemporal dementia (FTD)

Back 63

Neuropathology is variable
Tau protein and DNA-binding proteins found in intraneuronal aggregates.

Front 64

Clinical features of FTD

Back 64

-Behavioral variant: deficits in empathy, insight, abstract thinking. Behavior disinhibited. Change in personality
-Semantic Dementia: deficits in word-finding, comprehension, and knowledge. Behaviors rigid.
Progressive nonfluent aphasia: speech is effortful with disarthria, sound distortions, poor grammar. Signs of apraxia on the right due to left sided atrophy