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acute bacterial meningitis
headache, fever, neck stiffness. emergency!
- kernig's sign - pain upon attempted passive extension at the knee when hip is flexed
- brudzinski's sign - involuntary flexion at hips when neck is flexed
CSF analysis - elevated WBC with predominance of PMLs
, elevated protein, low glucose
Tx: antibiotics immediately, corticosteroids often used in kids to prevent long term damage
diagnostic workup for brain abscess
CT or MRI with IV contrast shows mass lesion, often rounded with ring enhancement and signs of central necrosis. Must consider malignant neoplasms
Spinal epidural abscess
- present with neck or back pain and focal neurologic signs consisten with spinal cord compression or cauda equina involvement.
- thoracic or lumbar abscesses - lower extremity weakness, sensory loss with detectable sensory level, urinary and sexual dysfunction
- cervical abscesses - upper extremeties may be involved.
fever not always present. usually due to staph from skin or from vertebral body osteomyelitis or diskitis
lumbar puncture is contraindicated because might seed the subarachnoid space
- M. tuberculosis has predilection for affecting basal meninges, so present with cranial nerve palsies with usual features of acute bacterial meningitis. Also a basal meningitis can lead to hydrocephalus or brain infarcts from inflammation affecting cerebral vessels.
- More insideous presentation than acute bacterial meningitis
CSF - leukocytosis with lymphocytic
predominance and very low glucose
mass lesions causing headache, focal neurologic symptoms, seizures. Can calcify, sometimes cause hydrocephalus
signs of potts disease
when vertebral body infection extends into the epidural space, causes subacute spinal cord or cauda equina compression. fever and back pain are common. spread to adjacent vertebral bodies often suggests potts vs mets cancer
rash 1 week post bite, weeks after bite neuro symptoms. headaches, neck stiffness, and myalgias which may then cause cranial nerve palsies (esp facial nerve), polyradiculopathy, polyneuropathy, or encephalopathy
CSF - lymphocytic pleocytosis with elevated protein and normal glucose
- commonly caused by enteroviruses (coxsackie) or arboroviruses (west nile).
- presentation similar to acute bacterial meningitis, but CSF shows WBCs with lymphocytes, elevated protein w/o low glucose.
caused by HSV-1. Prediliction for base of brain (esp medial temporal lobes and orbitofrontal regions of cortex). lymbic dysfunction (partial seizures, olfactory hallucinations, memory distubrances).
CSF often elevated RBC and WBC (distinguish from traumatic tap). Tx with IV acyclovir
inhalation of fungus (soil and pigeon droppings) dissemenated hematogenously
presents with headache, neck pain, confusion, maybe fever
CSF - lymphocytic predominance of WBC, elevated protein, low glucose (all typical of fungal infections)
dx: india ink staining of CSF, rapid latex agglutination assay for cryptococcal antigen
intracellular, congenital or intracranial infection in aids pts
- intracranial mass lesion with headache, mental status changes, and focal neurologic signs that depend on lesion location.
- Multiple ring-enhancing lesions in basal ganglia or at gray-white matter junction.
- Primary CNS lymphoma is differential diagnosis in AIDS pts with these lesions
from pork tapeworm Taenia solium
one of most common causes of new-onset forcal seizures. Also headache, signs of increased ICP. Multiple cystic lesions with ring-enhancing or calcified lesions and surrounding edema.
Tx: albendazone, steroids
subcortical dementia, with cognitive impairment and psychomotor slowing. MRI shos patch T2 hyperintensity in white matter as well as cerebral atrophy
complication of HIV infections, resumbles subacute combined degeneration syndrome associated with vit B12 deficiency (posterior column symptoms) and coticospinal tract dysfunction bilatterally
progressive multifocal leukoencephalopathy
- demyelinating disease of CNS caused by infection of oligodendrocytes by JC virus.
- subacute or chronic progression of focal neurologic signs
cause of primary CNS lymphoma
often in HIV pts, EBV infection