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39 Cards in this Set

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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)


Septic Thrombosis

Smaller infarcts


Increased ICP


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)


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



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


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


Aseptic Meningitis: Treatment

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

Fungal - antifungal meds


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




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



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


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