Brain and Behavior: Infections of the Nervous System

Vaccinations in children which have significantly reduced meningitis incidence: … (3)

streptococcus pneumoniae, Neisseria meningitides, Hemophilus influenza

Bacteria reach the subarachnoid space through: … (3)

Hematogenous spread from the respiratory tract, traumatic/mechanical invasion, Parameningeal foci

…: a syndrome of fever, headache, and meningismus with inflammation in the subarachnoid space as evidence by CSF pleocytosis

Meningitis

Symptoms of meningitis: … (6)

Headache, fever, stiff neck, photophobia, vomiting, altered level of consciousness

Sings of meningism: … (3)

meningismus, kernigs, brudzinskis

IN bacterial meningitis, bacteria trigger TNF-a, IL-1B, IL-6, endotoxin, all these inflammatory mediators directly stimulate …

widespread procalcitonin production

… has an NPV of 99% for bacterial meningitis

normal C-reactive protein

…: an acute phase reactant made by the liver in response to inflammatory mediators

C-reactive proteins

CSF findings in bacterial meningitis: … (7)

cloudy, high neutrophils, high proteins, low glucose, positive gram stain, high CRP/procalcitonin, increased opening pressure

CSF findings in viral meningitis: … (6)

clear, moderate lymphocytes, mildly high proteins, normal glucose, negative gram stain, normal CRP/procalcitonin

Lumbar puncture contraindications: … (9)

altered consciousness, focal neurological signs, papilledema, immunocompromised, new-onset seizures, skin infections, septic shock, spinal cord compression, anticoagulants

a CSF … is abnormal after 8 weeks of age

> 5

CSF/blood glucose …

>0.6

Meningitis can be diagnosed only by examining the …

CSF

Bacteria that may cause increased lymphocytes in CSF: …

listeria, monocytogenes

Normal C-reactive protein levels: …

5 mg/L

Bacterial meningitis c-reactive proteins: …

104-333 mg/L

…: used on patients with clinical syndrome of meningitis but negative gram stain or pre-treated with antibiotics

PCR

Oral antibiotics prior to LP: will not significantly alter … (2), decrease … (2)

WBC, Glucose, CSF protein, diagnostic ability

Indications for a CT scan in meningitis: … (4)

coma, focal neurological deficit, papilledema, posterior fossa signs

Adults are commonly infected with: … (2)

strep. pneumoniae, niesseria meningitidis

Children are commonly infected with: … (2)

niesseria meningitis, haemophilus influenza

Older adults are commonly infected with: … (2)

Strep. pneumoniae, gram neg bacilli

Neurosurgical infections: … (2)

staphylococci, gram neg bacilli

underlying infections that may lead to meningitis: … (6)

maxillary sinusitis, endocarditis, nosocomial, penetrating trauma, surgical, encephalitis

If an individual between 3months - 50years with unknow etiology treat with: …

ceftriaxone and vancomycin

If an individual between >50years with unknow etiology treat with: …

ceftriaxone and amoxycillin and vancomycin

Chemoprophylaxis of contacts with H. influenzae: …

rifampicin

Chemoprophylaxis of contacts with N. meningitidis: …

ciprofloxacin

Chemoprophylaxis of contacts with S. pneumonia: … (2)

penicillin, macrolide

Neurologic complications can occur in the first week of infection due to: … (6)

fever, focal ischemia, local cortical vein thrombosis, subdural collections, hyponatremia, antibiotics

There is a risk of … independent or LP

cerebral herniation

Neurological complications in the first week of infection: … (5)

coma, unilateral fixed dilated pupil, decerebrate rigidity, Cheyne-strokes respiration, respiratory arrest

…: acute onset, meningeal irritation, CSF mononuclear pleocytosis, absence of bacteria, no paramenigeal focus of infection, self limitied

aseptic meningitis

In aseptic meningitis check patient CSF for: … (4) using PCR

enterovirus, herpes simplex virus type I/II, varicella zoster virus, HIV

there is … in aseptic meningitis

no altered level of consciousness

Clinical presentation of tuberculosis meningitis: … (2)

acute meningitis, subacute dementing illness

The absence of … does not rule out the possibility of tuberculous meningitis

pulmonary tuberculosis

Mycobacterium tuberculosis has a predilection for …

basal meninges

Mycobacterium tuberculosis may cause: … (3)

hydrocephalus, brain infarcts

Subacute or chronic, insidious presentation of tuberculous meningitis: … (2)

malaise, nonspecific constitutional symptoms (precede neck pain)

Multiple antituberculosis drugs penetrate the … effectively

intrathecal space

… used to examine 10=20 mls of CSF to help diagnosis of tuberculous meningitis

Ziehl-neelsen stain

fungi that infect the nervous system: … (4)

cryptococcus neoformans, coccidioides immitis, histoplasma capsulatum, candida

…: affects immunocompromised patients, inhalation of the fungus present in soil and pigeon droppings, disseminated hematogenous

cryptococcal meningitis

Cryptococcal meningitis presents with: … (4)

headache, neck pain, confusion, fever

Standard means of testing for cryptococcal meningitis: …

rapid latex agglutination assay

Cryptococcal meningitis is treated with …

amphotericin

…: caused by an intracellular parasite, can be a congenital infection, humans are exposed through cat feces or ingestion of undercooked meat

toxoplasmosis

Aids paiteins with toxoplasmosis present with: … (5)

intracranial infection, headache, mental status changes, focal neurologic signs, fever

… is the in the radiological differential diagnosis of toxoplasmosis

primary CNS lymphoma

CT or MRI of toxoplasmosis shows … in the basal ganglia or the gray-white matter junction

multiple ring-enhancing lesions

…: late following immunosuppression, presents as a subcortical dementia, with cognitive impairment and psychomotor slowing, MRI shoes patchy T2 hyperintensity in the white matter and cerebral atrophy

HIV associated dementia

…: occurs with severe immunosuppression, resembles the subacute combined degeneration syndrome, posterior column signs (loss of vibration and joint position sense with sensory ataxia), corticospinal tract dysfunction (hyperreflexia bilaterally)

vacuolar myelopathy

Opportunistic infections prevalent in HOV infections: … (4)

toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, primary CNS lymphoma

Demyelinating disease caused by infection of oligodendrocytes of HIV paitents by …

JC virus

…: an infection involving the central nervous system, may occur early and asymptomatically or in the form of, syphilitic meningitis, occurs 4-25 years after initial infection

neurosyphilis

Neurosyphilis may present in the form of late meningovascular which causes … (2)

apathy, seizures

Neurosyphilis causes …: bilateral small pupils that constrict with accommodation but not to light

argyll Robertson pupils

…: usually occurs 10-30 years after the initial infection, the most common complication is syphilitic aortitis, which may result in aneurysmal formation

cardiovascular syphilis

…: degenerative incurable and fatal spongiform encephalopathy, caused by prions

Creutzfeldt-Jakob disease

..: misfolded proteins that replicate by converting their properly folded counterparts, in their host, to the same misfolded structure they possess

Prions

CJD causes the brain tissue to …

degenerate rapidly

Iatrogenic CJD: … (4)

blood transfusion, human-derived pituitary growth hormones, gonadotropin hormone therapy, corneal/meningeal transplants

CJD presentation: … (8)

progressive dementia, memory loss, personality changes, hallucinations, psychological changes, speech impairment, myoclonus, ataxia, seizures

…: affects adolescents and presents with psychiatric or sensory symptoms, serological signs include unsteadiness, difficulty walking and involuntary movements, by time of death patients become immobile and mute

variant CJD

CJD diagnosis is based on: … (4)

clinical symptoms, electriencephalgraphy, cerebrospinal fluid analysis, MRI

CJD MRI shows high signal intensity in the : … (3)

cortex, caudate nucleus, putamen

Herpes encephalitis virus spread from … to … (2), can be unilateral or bilateral

trigeminal ganglia, temporal, frontal lobes

Herpes virus encephalitis triad: … (4)

headache, fever, altered mental status, confusion

Seizures of herpes virus enecephalitis are characterized by: … (2)

olfactory hallucinations, gustatory hallucinations

…: present like other focal intracranial lesions, fever may be present, often arise from invasion of intracranial space fron neighboring infections, sinuses, direct open trauma, mechanical brain anscesses

brain abscess

multiple abscesses are caused by organisms that cause …

infective bacterial endocarditis

Diagnosis of brain abscess: … (2)

imaging, blood cultures

Treatment of brain abscesses: … (2)

neurological drainage, prolonged administration of IV antibiotics