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39 Cards in this Set

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Meningitis

Infection/inflammation confined to meninges

Bacterial Meningitis: Routes

Spreads through ear or sinus, penetrating injury, or blood (most common)

Bacterial Meningitis: Complications

Inflammation (primary cause of damage)


Vasculitis


Septic Thrombosis


Smaller infarcts


Edema


Increased ICP


HIE


Cranial Nerve defects (8 most common)


ICP leads to CN6 palsy (3,4,7 also possible)

Bacterial Meningitis: Mortality and Morbidity

Worse than viral


10% mortality rate (down from 90% in 50s)


15-25% have long-term neurobehavioral sequalae


Worse in females


11% hearing loss


4% ID


4% spasticity


4% seizures

Bacterial Meningitis: Risk

Age (high or low)


Immunosuppression

Bacterial Meningitis: Course

Acute (several hours): 1. sudden fever 2. severe headache 3. nuchal rigidity


Gradual (several days): "flu-like" symptoms

Bacterial Meningitis: Assessment

Lumbar puncture


Neuroimaging: CT/MRI (absence of meningeal enhancement does not rule out condition)

Bacterial Meningitis: Treatment

Antibiotics


Coritosteroids


Sometimes Rehab

Bacterial Meningitis: NP expectations

IQ - average in adults; low average to average in kids, 4% ID; academic difficulties compared to peers


Attn - decreased in adults (poor stroop and Trails B); increased ADHD Sx in children


PS - decreased RT, cognitive slowness is cardinal symptom


VS/Lang - no issues


Mem - mixed results


EF - one of more common problems; below developmental level in children


SM - hearing loss common (11%)


Emo - no systematic findings in adults; increased behavior problems in kids



Leptomeningitis

inflammation of pia mater and sub arachnoid space

Aseptic Meningitis

Aseptic - nonbacterial (viral, fungal, tuberculous and parasites)


Enteroviruses are by far most common cause of aseptic meningitis (>85%) - single stranded RNS associated with several human and mammalian diseases

Aseptic Meningitis: Mortality

Less than 1%

Aseptic Meningitis: Course

Headaches - most common presenting symptom


Fever - low grade


Irritability, nausea, vomiting, stiff neck, rash, fatigue


Typically has benign course; Sx resolve 1-2 weeks


No long term NP findings

Aseptic Meningitis: Assessment

Lumbar puncture


Blood work


CT/MRI/EEG

Aseptic Meningitis: Treatment

Viral - rest, fluids, pain, anti-inflammatory meds; antiviral meds; (antibiotics don't work)


Fungal - antifungal meds

Encephalitis

Infection of brain tissue


Viruses most common cause


(also caused by bacteria, fungus, parasites)

Encephalitis: Neuropathology

Primary (acute viral encephalitis): refers to a direct infection of the brain


Secondary (postinfective encephalitis): results from previous viral infection or immunization

Encephalitis: Etiology

-More than 100 viruses implicated (HSV, varicella, Epstein-Barr, adenoviruses, enteroviruses, arboviruses, cytomegaloviruses


-Regional outbreaks: Japanese B, Lacrosse


-Four types of mosquito borne in US: Lacrosse, Equine, St. Louis, West Nile


-Precise etiology unknon in 1-2/3 cases


-most reach CNS through bloodstream


-Some through Cranial Nerves (CN5)

Encephalitis: Mortality and Morbidity

5% overall


worse for elderly


100% mortality for rabies and HSV if not treated


1/3 w/ encephalitis will have ongoing neurological or cognitive difficulties at time of d/c from hospital

Encephalitis: Course

Acute (hours to days): headache and fever (flu), altered consciousness, mental status changes, behavioral and speech disturbances


Subacute (weeks): Presents with seizures and speech disturbances after a few weeks of altered behavior


Chronic: Can progress over the course of years and produce acute Sx only occasionally (HIV, Lupus)

Encephalitis: Assessment

Lumbar Puncture/Blood Work


EEG - assess for possibility of seizures


CT/MRI - Edema, abscess, mass effect, signs of inflammatory process

Encephalitis: Treatment

Antiviral


Anticonvulsant


Cotricosteroids


Hemispherectomy (Rasmussen's)

Encephalitis: NP expectations

IQ - typically average


Attn - subtle problems in children (like meningitis)


PS - commonly affected


Lang/VS/SM - no consistent findings


Mem - difficulty common in HSV


EF - most common deficit (40% HSV)


Emo - increased psychiatric symptoms in adults and behavior problems in kids

Intracranial Abscess

Pus collection

Originate in nearby structures (ear infection, sinusitus etc.)


Can spread through blood


Can occur after depressed skull fracture


Penetrating brain injury


Neurosurgery


Meningitis



may cause mass effect and increased ICP



Intracranial Abscess: Two types

1. Subdural or epidural empyema


2. Brain abscess - cavity filled with pus in parenchyma

Intrauterine and Intranatal Infections

TORCH


Toxoplasmosis - parasite mother to fetus causes necrotic lesions and cysts


Other - cross placental barrier enter fetal circulation: Polio, syphilis, Coxsackie virus


Rubella - rare, if in 1st trimester - severe birth defects


Cytomegalovirus - unnoticed in healthy - causes problems in fetus


Herpes simplex virus 2 - can be transmitted through birth canal

Prion Diseases

Caused by infectious proteins called prions


Gerstmann-Staussler-Scheinker syndrome, fatal familial insomnia, kuru, Creutzfeldt-Jacob disease

Creutzfeldt-Jacob disease

Prion Disease


Transimissible spongiform encephalopathies - brain tissue develops holes that give it a sponge-like appearance. Rapidly progressive and fatal; dementia, memory issues, personality change, hallucinations

HIV Encephalitis

HIV infection leads to macrophages and microglia to cause gradual destruction of neuronal integrity


CNS pathology can be related to both HIV infection and associated opportunistic infections

HIV Encephalitis: MRI findings

-Small areas of bilateral, subcortical signal hyperintensity


-Large hyperintensities consistent with discrete and generalized lesions


-Global and diffuse atrophy (sulcal and ventricular enlargement)


-Isolated focal lesions


-MRI abnormalities have been found in asymptomatic people

HIV Encephalitis: More Severe

Dementia: AIDS dementia complex (ADC) and HIV associated dementia


"subcortical dementia" mimics PD


Sx: psychomotor slowing, motor weakness, poor attn/WM, EdF, decreased learning and free recall

HIV Encephalitis: Less Severe

HIV-1-Associaed Minor Cognitive/Motor Disorder


Similar "subcortical" profile


0.5-1 SD impairment in at least 2 cognitive domains



Progressive Multifocal Leukoencephalopathy (PML)

Rare and usually fatal viral disease that results in progressive and multifocal WM damage


Caused by JC virus and typically affects individuals who are immunocompromised


JC virus is present in most individuals but is kept under control by the immune system

Cerebral Toxiplasmosis

Infection caused by one-celled protozoan parasite Toxoplasma gondii

Opportunistic infection typically affects HIV/AIDS patients


Most common cause of brain abcess in these patients


Acute Disseminated Encephalomyelitis (ADEM)

Inflammatory demyelinating condition of the CNS

Resembles MS


Cause believed to be postinfectious or postvaccination


Typically occurs 1-2 weeks following


Can be single or multiphasic


Subtle deficits in attn, PS, EF


Paraneoplastic Encephalitis

Group of neurologic disorders associated with systemic cancer


Sx may precede Dx of cancer in some cases


Autoimmune reaction initiated in response to tumor


Can be associated with antibody-related syndromes (anti-NMDA receptor)

Anti-NMDA receptor Encephalitis

Involves antibodies that decrease the number of cell-surface NMDA receptors in postsynaptic dendrites


Can be associated with tumors (ovarian teratomas in females); not always the case


NP impairments in EF (inattention, disorganization, poor planning, disinhibition, lack of impulse control)

Anti-NMDA receptor Encephalitis: Stages

1. Prodromal phase - flu-like illness with fever, malaise, headache, and fatigue


2. Psychotic phase - acute psychosis or schizophrenia type symptoms


3. Unresponsiveness phase - hypoventilation, autonomic instability, dyskinesias, dystonic postures may occur


4. Recovery phase - Recovery is generally slow; hospitalized for several months

Paraneoplastic Limbic Encephalitis (PLE)

Inflammatory process localized to structures of the limbic system


Results in impairments of cognition (anterograde amnesia) and psychiatric symptoms (depression, anxiety, agitation, hallucinations)


Subacute onset up to 12 weeks.


Tx includes oncological treatment for the tumor


Steriods, immunoglobulins, immunosuppressive drugs or a combo