Hdm Test 4, Viral Cns Infections

Front 1

most common causes of acute meningitis/encephalitis

Back 1

Enterovirus, Strep pneumo, Neisseria meningitis

Front 2

most common causes of chronic meningitis/encephalitis

Back 2

Mycobacterium, fungi, sarcoid, malignancy

Front 3

most common causes of reccurent meningitis/encephalitis

Back 3

Strep pneumo, HSV2

Front 4

encephalopathy

Back 4

altered consciousness with no evidence of inflammation in the CNS on imaging or CSF analysis (i.e. CSF white cell count <5/ml)

Front 5

encephalitis

Back 5

altered consciousness with no other cause identified and evidence of CNS inflammation on imaging or CSF analysis (i.e. CSF white cell sount 5/ml)

Front 6

'virologically confirmed' encephalitis

Back 6

Altered consciousness with a pathogen identified by culture or PCR of the CSF

Front 7

meningism

Back 7

only headache with neck stiffness and/or photophobia without evidence of altered consciousness and no evidence of inflammation on imaging or CSF analysis

Front 8

purulent meningitis

Back 8

meningism (headache with neck stiffness and/or photophobia) with a CSF white cell count >1000/ml or between 100 and 1000/ml with a predominance of PMN cells and a CSF:plasma glucose ratio <0.5 (or an unpaired CSF glucose <5mmol

Front 9

'microbiologically confirmed' purulent meningitis

Back 9

purulent meningitis with a pathogen identified by culture or PCR of the CSF or blood

Front 10

aseptic meningitis

Back 10

meningism in a conscious patient, with a normal CSF:plasma glucose ratio (>0.5) and either a CSF white cell count of 5-20 or 20-1000/ml with a lymphocyte predominance

Front 11

'virologically confirmed' aseptic meningitis

Back 11

aseptic meningitis with a viral pathogen identified by culture or PCR of the CSF

Front 12

'microbiologically confirmed' TB meningitis

Back 12

aseptic meningitis with Mycobacterium tuberculosis identified by culture or PCR of the CSF

Front 13

differential diagnosis of meningitis and encephalitis

Back 13

non-infectious diseases
viral
bacterial
fungal
mycobacterial
parasites

Front 14

non-infectious causes of aseptic meningitis

Back 14

lymphomatous meningitis (malignancy), connective tissue disease (i.e. lupus), sarcoidosis, Behcet's syndrome, drugs (NSAIDS, antibiotics), post-vaccination/post-infectious virus

Front 15

enteroviral meningitis -- clues

Back 15

exanthem, myopericarditis, conjunctivitis, hand-foot-mouth disease, herpangina, pleurodynia

Front 16

enterovirus -- risk factors

Back 16

fecal-oral (swimming in sewage contaminated water)
season (summer-fall in temperate climates, year-round in tropical climates)
infants, young children w/o immunity
congenital or acquired immune deficiency

Front 17

chronic enteroviral meningoencephalitis in agammaglobulinemia (CEMA) -- symptoms

Back 17

unique clinical syndrome
headache, seizures, hearing loss, coma, weakness, ataxia, paresthesias, loss of cognitive skills

Front 18

initial signs/symptoms of CNS mumps

Back 18

fever 72-96 hrs, vomiting, headache, salivary gland swelling, meningismus, lethargy
[abdominal pain, seizures]

Front 19

Features of HSV encephalitis

Back 19

abnormal CSF (protein>40 mg/dl, glucose<50%, CSF leukocytes, erythrocytes), focal EEG/brain/CT scan

Front 20

West Nile Virus: % asymptomatic/fever/neuroinvasive disease

Back 20

80% asymptomatic
20% West Nile fever
<1% Neuroinvasive disease: Aseptic meningitis, Meningoencephalitis, Acute flaccid paralysis
(Rarely movement disorders, cranial neuropathy, optic neuritis)

Front 21

Features of CMV encephalitis

Back 21

HIV & transplant patients
signs: acute deterioration in mental status (4 weeks)
benign CSF except elevated protein
nearly 100% PCR-positive, rarely culture-positive
periventricular inflammation or focal hypodensities

Front 22

Subacute sclerosis panencephalitis (SSPE)

Back 22

associated with measles
insidious, personality changes, periodic axial myoclonic jerks with recurrent falls, then generalized rigidity with unresponsiveness

Front 23

Features of VZV encephalitis

Back 23

55% preceding rash
50% co-morbidities
disorientation, confusion, meningeal signs, focal neurological signs, apathy, cranial nerve palsy
CSF mod. elevated, low glucose & protein

Front 24

JC Virus (Polyoma virus)

Back 24

seroconversion in 50% by age 6 , 90% by middle age
kidney harbors virus
disease in immunocompromised- due to reactivation

Front 25

Progressive Multifocal Leukoencephalopathy (PML) -- pathogenes

Back 25

due to cytolytic replication of JC polyomavirus in the oligodendrocytes of the brains of immunodeficient patients; the oligodendrocytes synthesize the myelin protein that sheaths the axons of neurons in the CNS --> demyelinating

Front 26

Progressive Multifocal Leukoencephalopathy (PML) -- symptoms

Back 26

no "usual" course; symptoms depend on which areas of brain are affected
-- focal motor and sensory deficits
-- gait abnormalities
-- speech and language disturbances
-- cognitive disorders
-- headache
-- visual impairment

Front 27

spongiform encephalopathy -- cause; name

Back 27

Transmissible protein (prions, no nucleic acid content of the infectious particle) can cause a disease known as Creutzfeldt Jakob Disease (CJD).

Front 28

spongiform encephalopathy -- transmission

Back 28

Can be transmitted by infected cattle (Bovine spongiform) new variant CJD, contaminated neurosurgical instruments (iatrogenic CJD), sporadic mutations, and genetic

Front 29

normal vs. pathogenic prions

Back 29

Normal cellular prions are monomeric, non infectious, soluble in mild detergents.
Pathogenic prion protein aggregates in sheets, is infectious and not soluble and forms fibrils seen on EM of brain.