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39 Cards in this Set
- Front
- Back
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Meningitis |
Infection/inflammation confined to meninges |
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Bacterial Meningitis: Routes |
Spreads through ear or sinus, penetrating injury, or blood (most common) |
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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) |
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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 |
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Bacterial Meningitis: Risk |
Age (high or low) Immunosuppression |
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Bacterial Meningitis: Course |
Acute (several hours): 1. sudden fever 2. severe headache 3. nuchal rigidity Gradual (several days): "flu-like" symptoms |
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Bacterial Meningitis: Assessment |
Lumbar puncture Neuroimaging: CT/MRI (absence of meningeal enhancement does not rule out condition) |
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Bacterial Meningitis: Treatment |
Antibiotics Coritosteroids Sometimes Rehab |
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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 |
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Leptomeningitis |
inflammation of pia mater and sub arachnoid space |
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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 |
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Aseptic Meningitis: Mortality |
Less than 1% |
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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 |
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Aseptic Meningitis: Assessment |
Lumbar puncture Blood work CT/MRI/EEG |
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Aseptic Meningitis: Treatment |
Viral - rest, fluids, pain, anti-inflammatory meds; antiviral meds; (antibiotics don't work) Fungal - antifungal meds |
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Encephalitis |
Infection of brain tissue Viruses most common cause (also caused by bacteria, fungus, parasites) |
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Encephalitis: Neuropathology |
Primary (acute viral encephalitis): refers to a direct infection of the brain Secondary (postinfective encephalitis): results from previous viral infection or immunization |
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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) |
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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 |
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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) |
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Encephalitis: Assessment |
Lumbar Puncture/Blood Work EEG - assess for possibility of seizures CT/MRI - Edema, abscess, mass effect, signs of inflammatory process |
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Encephalitis: Treatment |
Antiviral Anticonvulsant Cotricosteroids Hemispherectomy (Rasmussen's) |
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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 |
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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 |
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Intracranial Abscess: Two types |
1. Subdural or epidural empyema 2. Brain abscess - cavity filled with pus in parenchyma |
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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 |
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Prion Diseases |
Caused by infectious proteins called prions Gerstmann-Staussler-Scheinker syndrome, fatal familial insomnia, kuru, Creutzfeldt-Jacob disease |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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) |
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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) |
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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 |
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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 |
