Neuro Infections sequalae

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Neuro Infections sequalae

• Quiz

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What are the most common organisms implicated in
bacterial meningitis in children?
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What are the most common organisms implicated in
bacterial meningitis in children?

• a) N. meningitidis, H. influenzae
• b) S. pneumoniae, L. monocytogenes
• c) E. coli, group B streptococci
• d) N. meningitidis, S. pneumoniae
•  

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What CSF findings would be most suggestive of
bacterial meningitis?
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What CSF findings would be most suggestive of
bacterial meningitis?

• Low turbidity, positive latex agglutination test,
  CSF/ serum glucose ratio 0.5
• PMN leukocytosis (400/mm3), CSF/ serum glucose
  ratio 0.3, increased protein, negative culture
• CSF opening pressure 130mmH2O, CSF/ serum
  glucose ratio 0.7, mononuclear leukocytosis
  (200/mm3)
• CSF/ serum glucose ratio 0.4, high protein,
  cells (PMN and mono) 150/mm3

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What are the 3 components of meningismus?
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What are the 3 components of meningismus?

• nuchal rigidity, meningeal irritation, headache
• photophobia, nuchal rigidity, headache
• headache, nuchal rigidity, fever
• fever, photophobia, nuchal rigidity

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Describe Kernigs and Brudzinskis signs.
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Describe Kernigs and Brudzinskis signs.

• Kernigs - leg is bent at the hip and knee at 90
  degree angles, and subsequent extension in the
  knee is painful (leading to resistance)
• Brudzinskis - appearance of involuntary lifting
  of the legs in meningeal irritation when lifting
  a patient's head off the examining couch, with
  the patient lying supine

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Aciclovirs mechanism of action is
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Aciclovirs mechanism of action is

• Prodrug nucleoside analogue that inhibits viral
  DNA polymerase after phosphorylation, resulting
  in chain termination.
• Inhibition of viral protease used to cleave
  nascent proteins for assembly of new virions.
• Binding to viral neuraminidase, rendering the
  influenza virus unable to escape its host cell
  and infect others.
• interference with a viral M2 ion channel which is
  required for the viral particle to become
  "uncoated" once taken inside a cell by
  endocytosis.

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SPOT DIAGNOSIS! A 45 year old female from nimbin
presents with loss of coordination (with high
stepping gait), urinary incontinance, impaired
pupil reaction to light, lower limb areflexia and
lower back pain that shoots down her legs
sometimes. There has been no recent illness or
infections, but she says that 5 years ago she did
have a sore down there.
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SPOT DIAGNOSIS! A 45 year old female from nimbin
presents with loss of coordination (with high
stepping gait), urinary incontinance, impaired
pupil reaction to light, lower limb areflexia and
lower back pain that shoots down her legs
sometimes. There has been no recent illness or
infections, but she says that 5 years ago she did
have a sore down there.

• Guillain Barre Syndrome
• Myasthenia gravis
• Tabes dorsalis
• HIV/ AIDS

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VZV reactivation involving the facial and
auditory nerves is known as
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VZV reactivation involving the facial and
auditory nerves is known as

• Bells palsy
• Ramsay Hunt Syndrome
• Trigeminal neuralgia
• Postherpetic neuralgia

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What is the most helpful clinical triad for
diagnosis of GBS?
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What is the most helpful clinical triad for
diagnosis of GBS?

• Areflexia, lower back pain radiating to legs,
  fever
• Ascending flaccid paralysis, areflexia,
  respiratory distress or autonomic dysfunction
• Respiratory distress, positive Campylobacter
  jejuni serum Ig, areflexia
• Cytoalbumin dissociation, areflexia, ascending
  flaccid paralysis

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SPOT DIAGNOSIS! A new patient, a 40 year old man
presents with left sided ptosis and diplopia. He
also has dysphagia and his wife adds that he is
slurring his speech (you just thought it was
normal for him). All other examinations are
normal.
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SPOT DIAGNOSIS! A new patient, a 40 year old man
presents with left sided ptosis and diplopia. He
also has dysphagia and his wife adds that he is
slurring his speech (you just thought it was
normal for him). All other examinations are
normal.

• Eaton-Lambert syndrome
• Multiple Sclerosis
• Stroke
• Myasthenia gravis

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Why does thymectomy help some patients with
myasthenia gravis?
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Why does thymectomy help some patients with
myasthenia gravis?

• Something about knocking out the activation of
  T-helper cells that activate B-cells to plasma
  cells which then throw out the Ig against the Ach
  receptor.?

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What drugs are used to treat Myasthenia gravis?
Why?
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What drugs are used to treat Myasthenia gravis?
Why?

• Atropine
• Penicillin
• Pyridostigmine
• Oxybutinin