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Reversible synptoms last less

Transient ischemic attack than 24 hours. Due to platelet
thrombi or atheroemboli

85% of strokes. Can be

thrombotic (atherosclerosis)
white infarct or embolic
Infarction stroke
(thromboemboli or
atheroemboli) hemorrhagic
infarct
Contralateral hemiparesis and
sensory loss, aphasia if Broca
Clinical features of medial
area in the left hemisphere is
cerebral artery stroke
involved, deviation of head and
eyes toward side of lesion
Intraparenchymal, epidural,
subdural, subarachnoid.
Types of hemorrhagic strokes
Hemorrhagic strokes are 15%
of all strokes
Hypertension is MCC due to
formation of microaneurysms
that tend to rupture in basal
Causes of hemorrhagic stroke ganglia or cerebellum.
Arteriovenous malformations,
amyloid, neoplasms,
vasculitides
 Acut onset of severe
Clinical features of
headache, nausea, vomiting
hemorrhagic stroke
and coma

Due to trauma and skull

fracture with tear of middle
meningeal dural artery. "Talk
Epidural hemorrhage
and die" syndrome. Leads to
herniation if not promptly
evacuated
MCC: ruptured berry
aneurysm. Sudden thunderclap
Subarachnoid hemorrhage
headache, nuchal rigidity,
neurological deficits and coma
Thin-walled saccular
outpuchings consisting of
intima and adventitia only.
Berry aneurysms Cause of subarachnoid
hemorrhage. Associated with
Marfan, Ehlers-Danlos and
adult polycystic kidney disease

Spina bifida occulta Bony defect of vertebral arch

Bony defect with outpuching of

Meningocele
the meninges
 Defective bony arch with
outpuching of meninges, spinal
Meningomyelocele cord and spinal roots. May lead
to paraplegia and urinary
incontinence
Defective bony arch with
complete exposure of spinal
Myelocele
cord. May lead to paraplegia
and urinary incontinence
Chronic relapsing-remitting
episodes of demyelination in
brain and spinal cord with
progressive neurological
deficits. Blurred vision or loss
Multiple sclerosis of vision, diplopia and vertigo,
loss of sensation or weakness
in one leg, hemiparesis. TH1
cytokines (IF-g, TNF) facilitate
attack; TH2 cytokines (IL-4, IL-
10) retard attack.
Loss of dopaminergic neurons
in the substantia nigra. Resting
Parkinson disease clinical
tremor, rigidity and akinesia,
features
expressionless face. Rx.:
levodopa
Lewy bodies: intracytoplasmic
round eosinophilic inclusions
Microscopic features of
tha contain alpha-synuclein;
Parkinson disease
EM shows filaments of
cytoskeletal origin

Huntington disease clinical
features
Clinical features of Alzheimer
disease
Microscopic features of
Alzheimer disease
Intracellular and extracellular
edema
ICP sign
psuedotumor cerebri
Degeneration of GABAnergic
neurons of caudate nucleus.
Chrorea, dementia btween
ages 20-40. Triplet repeat CAG
and features of genetic
anticipation and imprinting
MCC of dementia. Insidious
inset of memory impariment,
alterations in mood and
behavior, aphasia and apraxia
Amyloid precursor protein (APP
gene) on chromosome 21
(Down syndrome). AB amyloid
from the APP protein. Senile
plaques: AB amyloid tangled
with neuritic processes,
microglia and astrocytes.
Neurfibrillary tangles:
intraneuronal aggregates of
paired helical filaments protein.
Hypoxia - vasodilation and
Na/K atpase malfunctioning
Papilledema, headache
projective vomitting WITHOUT
NAUSEA sinus bradycardia
hypertension herniation
CSF preassure over 2x
lowered protein
-from decreased reabsorption,
vit A overdose
 Ipsilateral CNIII
Contralateral Peduncle -
>Ipsilateral hemiparesis
Ipsilateral PCA -> Contralateral
Uncal Herniation hemiparesis
Possible durets-> decorticate
DDX- tonsilar ehmorraghe - out
the foramen magnum ->
cardiorespiratory arrest

Low protein and glucose, no

CSF chacter
cells, high CL-

Aqueduct of Sylvius stricture

MCC in infants - have SC
compression -> paralysis of
upward gaze aka Parinaud
(SC, CNIII EW damage)
Noncommunicating
-Tb base of the brain scarring
Hydrocephalus
-epenymoma or
medulloblastoma
Ddx hydo ex vacuo - from
dementai when brain mass
decrease increases ventricle
Caudal extension of medulla
and cerebellar ermis through
foramen magnum -> noncomm
ARnold Chiari
hydro, platybasia,
meningmyelocele,
sytignomyelia
 Foramen M and L often closed
hypoplasia of cerebellar vermis
Dandy Walker Cystic dilation of 4th venticle
Noncommunicating
hydrocephalus
Capelike loss of pain and Temp
Assoicated with A-C
malformation
Syringomyelgia
Hx: burn without noticing, or
confusion wiht ALS due to
atrophy of hand muscles

Atrophy of caudate putamen

Huntington Disease
GP-loss of GABA ->Excitotoxic

Cerebellum -ataxic gaate

posterior and lateral olums of
spinal cord - diminish jon
sensation, spasticicty
Freidrich's ataxia Peripheral neuropathy
Hypertrophic
cardiomyopathy******and
kyphoscolisis
FRataxin
familial - bad SOD1 -> free
radical injury of neurons
ALS spastic, weaknes and atrophy
eventaully paralyze resporatory
muscles

LMN disoder called SMA in

Wednig hoffman disease children
"floppy baby"
 Neuro dysfucnction - acute
abdomen
Surgical abdomen looking -
Sx of AIP
bellyful of scars
Psychosis neuropathy
dementia
hemorraghe and himsoiderin at
mamillary bodeies, euronal loss
gliosis
wernick - confusion ataxia
W-K vertical ystagmus,
opthalmoplegia
Korsakoff - limbic system
target- antero and retero grade
amnesia
Adult - supratneroial-GBM
meningioma Epndymoma
schwanomma
Chilcren - Cystic cerebllar
Brain tumor astrocytoma medulloblastoma
(both these two in cerebellum)
brainstem glioma
-vascularization effect grade
RF - turcot, NF, cigarette
white matter location - florid
asculatoure, pseuopallisding
snake lie apperance- seed the
neuraxis via CSF but rarely
GBM outside
-often de novo can be
differentation of low grade
- butterfly glioma
GFAP positive
 NF association, arachnoidal
origin, deltion of C22 (NF2
Menigioma gene without NF)**
-only benign psammoma (also
in ovarian and thyroid)
4th ventirlc kids or cadua
equina in adults
Ependyomoma
Perivascular psuedorosstes
with proceses
small cell pnet tumor
-external granular cell layer of
Medulloblastoma cerebellum in the midline-
seeds neuraxis thus FOURTH
VENTRICL DDX

Frontal lobe with calcifiction

Oligodendroglioma fried egg look
slow grower

B cell NHL
CNS lymphoma
AIDS and EBV

MCC - well circubumscribed

Metastasis of the brain -lungs, breast melanoma - grey
white junction

VON HIPPEL LINDAU

ASSOCIATION
-EPO
Hemangioblastoma
foamy cell with high vascularity
also in spine and retina->
vision loss common***
 MCC diabetes
also diphateriae, havy metals,
Peripheral Neuroathy
amyloid, isonazid, vincristine,
hydralyzine
Most common herditar
neurpathy, autosomal dominat
-peroneal nerve atrophay -
Charcot Marie Tooth
lower leg muscle atrophy -
inverted bottle apperance-
CANT DORSIFELX
mC acute peripheral
-mycoplasma, campylobacter
precede it
Guillan Barre -ascending motorweakness
high CSF protein normal cells -
-> oligocolnal bands
Rx plasmapheresis

Bell's pasy - HIV sarcoid or

Unilateral facial paralysis LYME
- lyme can cause bilateral***

NF assoication-
cerebellopontine angle
C-100 positive since neural
crest associated***
Scwannoma CNV chnages due to
impingement, tinnitus and
enlarged meatus
-zerbra pattern with antoni a
and B alternationg
 Endolymph increase in inner
ear -> loss of cochlea -
dizziness vertigo spells
Meniere Disease
Weber lateralize but rhine
normal since bone and air
equal reduction
Fusion of middle ear ossicles-
conduction deafness in elderly
MCC...lateralize and bone > air
Osteosclerosis
Perbyscusis - cohclera hair
degeneration mCC of
sensorinueal deafness in
elderly
MCCC of conduction deafness
in children - SPneumoniae, F
flu, moraxella
Otitis medica
External otitis - outer ear canal
-psuedomona staph aspergillus
Malignant - DM

Neisseria first wek chlymidia

Ophatlmia neonatorum
second

S, pneumona or H flu -
secondary to sinusitis -
Orbital Cellulitis proptosis, periorbital
swelling,opthalmoplegia,
normal retinal exam
 Open - decrease rate of outflow
from schlemm, pathological
CUPPING of disc, night
blindness and tunnel viion
Glaucoma open vs closed
Acute closd - uveitis, maybe
from a mydriatic agent, lens
displcation - PUPIL FIXED and
nonreactive
SARCOID, ulcerative colitis,
ankylosing spondylitis - uveal
uveitis tract (iris ciliary body choroid)
pain blurry vision mitoic pupil,
adhesions, normal presure

Macular Degeneration Permant visual loss in elderly

CMV retinintis - ganciclovir or

Cotton wool exudates
foscarnet

Opacity in lens - advaced age,

Cataracts diabetes, RUBELLA CMV,
corticosteroids

TUmor of the eye RB or melanoma

 To produce respiratory
alkalosis, causes cerebral
vessel constriction which
decreases the risk of vessel
A patient with head trauma is
permeability
purposely hyperventilated b/c
Acidosis; hypoxemia cause
vasodilation of cerebral vessels
which increase permeability
1. Papilledema
2. Headache with projectile
Clinical signs of Cerebral vomiting; NO NAUSEA
Edema 3. Sinus Bradycardia,
hypertension
4. Possible Herniation

Absence of tumor and

Psuedotumor Cerebri
obstruction of CSF with ICP

Uncal herniation compresses Oculomotor nerve, CNIII

Cingulate gyrus herniates thru

Subfalcine herniation
falx cerebri. Herniation?

Subfalcine herniation ACA

compresses ????? and pt Headache and contralateral leg
presents with ???? weakness
 Medial portion of temporal
herniates thru tentorium Uncal herniation
cerebelli

Down and out eye; mydriasis;

midbrain
Uncal/Transtentorial Herniation
hemorrhage;contralateral
hemiplegia

A bioconvex,or lentiform, shape

Epidural Bleed
under MRI

1. Compression of Midbrain
Possible complications of
2. Compression of CNIII
Uncal Herniation
3. Compression of PCA

Subfalcine herniation ACA

compresses ????? and pt Headache and contralateral leg
presents with ???? weakness

Medial portion of temporal

herniates thru tentorium Uncal herniation
cerebelli

Down and out eye; mydriasis;

midbrain
Uncal/Transtentorial Herniation
hemorrhage;contralateral
hemiplegia
A bioconvex,or lentiform, shape
Epidural Bleed
under MRI

1. Compression of Midbrain
Possible complications of
2. Compression of CNIII
Uncal Herniation
3. Compression of PCA

Uncal herniation

Herniation: Produces Duret's Duret's hemorrhage =

hemorrhage hemorrhage into the midbrain
and pontine tegmentum usually
fatal

Cerebellar tonsils herniate thru

Tonsillar herniation;
foramen magnum

Herniation: Produces CV arrest

Tonsillar herniation
and obtundation and death

Choroid plexus from

CSF produced by
ependymal cells

Lateral Vent to foramen Monro

to 3rd ventricle to aqueduct of
CSF flow Sylvius to fourth vent to
foraminea of Magendie and
Luschka
 Arachnoid granulations into
CSF is reabsorbed by
dural venus sinus;

Open communicating between

ventricles and subarachnoid Communicating hydrocephalus
space

1. Increased CSF production;

eg Choroid plexus tumor
Causes of Communicating
2. Obstruction of reabsorption
hydrocephalus
by arachnoid granulations eg
Postmeningitic scarring or
tumor

Obstruction of CSF flow out of Noncommunicating,obstructive,

ventricles hydrocephalus

Causes of Non-Communicating
Hydrocephalus
1. Stricture of aqueduct of
Sylvius
2. Tumor in fourth vent
3. Scarring at base of brain
4. Colloid cyst
5. Development disorders

The most common cause of

Blockage of Sylvius aqueduct
hydrocephalus in newborns
 Paralysis of upward gaze;
Perinauds syndrome
Stricture of aqueduct of Sylvius

Clinical findings for

Ventricles dilate
Noncommunicating
Enlarged head circumference
hydrocephalus in newborns

Clinical finding for Progressive dementia

Noncommunicating Wide-based gait
Hydrocephalus in ADULTS Urinary Incontinence

Alzheimer disease
Hydrocephalus Ex Vacuo
Dilated ventricles and decrease
brain mass

Frog-like appearance and

Aencephaly
maternal polyhydraminos

Defect in closure of posterior

vertebral arch with dimple or Spina bifida occulta
tuft of hair of L5-S1

Spina bifida and cystic mass

containing meninges in Menigocele
lumbosacral region
 Spina bifida and cysitc mass
containing meninges and spinal Meningomyleocele
cord in lumbosacral region

Hypoplasia of cerebellar vermis

Cystic dilation of 4th vent Dandy-Walker Malformation
Non-communicating hydro

Caudal extension of medulla

and cerebellar vermis thru
foramen mag

Platybasia( Flattening of skull Arnold-Chiari Malformation

base)

Megingomyelocele,
Syringomyelia

Associated with Arnold-Chiari

Syringomyelia
malformation

Decrease pain and

temperature in hands; atrophy Syringomyelia
of intrinsic muscles of hands

Syringomyelia
Degenerative disease of spinal
cord via fluid filled cavity in
Syrinx= fluid filled cavity
spinal cord
Myelia = spinal cord
 Autosomal dominant disorder
Mental retardation and
Tuberous Sclerosis
seizures; harmatomas in brain;
and kidneys

"Ash leaf" lesions,

Tuberous Sclerosis
hypopigmented skin

Best way to identify skin

Wood's Lamp
lesions of tuberous sclerosis

"candlestick drippings" in
Tuberous Sclerosis
ventricles

What are hamartomatous Astrocyte proliferations in

lesions? subependyma

Autosomal dominant disorder;

Cafe-au-lait-macules,Lisch
Neurofibromatosis
nodules; Optic nerve glioma;
meningioma acoustic neuroma

Associated with
pheochromocytoma, and Neurofibromatosis
acoustic neuroma
 Vascular malformation of the
face
Sturge-Weber Syndrome
Ipsilateral arteriovenous
malformation in meninges
Birthmark of the face in the
trigeminal distribution of V1; pia
Sturge-Weber Syndrome
mater malformations in
occipital and parietal lobes
Cavernous Hemangiomas in
Von-Hippel Lindau Syndrome
cerebellum and retina;
increased pheochromocytoma
VHL
and renal cell carcinoma

Encephilits caused by
Mosquitos are the vector; Birds Arbovirus
are the host;

Most common cause of viral Coxsackie virus;

menigitidis; peaks late summer Picornavirus
and early autumn +SS RNA, icosahedral,

Most common viral infection of

Cytomegalovirus
AIDS causing ENCEPHALITIS

Intranuclear basophilic
CMV appearance
inclusions
Causes hemorrhagic necrosis
HSV type 1
of temporal bone

Meningitis and Encephalitis

caused by mouse fecal Lymphocytic Choriomenigitis
contimaniation of food or water

Poliovirus
Encephalitis destroys upper
and lower motor neurons
Picornvirus: +ssRNA,
causes muscle paralysis
icosahedral

Rabies
Neurons contain Negri bodies,
cuases encepahilits
Lassavirus, -RNA, enveloped

Transmitted by corneal
transplants or human brain CJD
contact

Brain has "bubbles or holes"

CJD
spongiform in cerebral cortex

Encephalitis:Occurs in AIDS
Progressive multifocal
pts with CD4 Th less 50
leukoencephalopahty
cells/uL
 Subacute Sclerosing
Panencephilitis
Slow virus encephalitis assoc Intranuclear inclusion in
with Rubeola, measles, virus oligodendricytes
Paramyxovirus
- SSRNA enveloped

Most common benign brain

Meningioma
tumor in adults

Most common primary CNS

Glioblastoma multiforme
tumor in adults

Most common childhood Cystic astrocytoma and

tumors Medulloblastoma

On MRI Syringomyelia will

Cervical Enlargment and Cavity
show

MS
Intranuclear opthalmoplegia is
pathognomonic for Why?
Demylination of MLF

Temporary loss of vision,

Amaurosis Fugax embolic material trapped in
bifurcation of retinal vessels
 Contralateral hemiparesis
Sensory loss in face and upper
MCA stroke results in extremity
Head and eyes deviate towards
the lesion

Contralateral paresis
ACA stroke results in
Sensory loss in lower extremity

Vertigo, Ataxia
Ipsilateral sensory loss of face
Strokes in vertebrobasilar
Contralateral hemiparesis and
arterial system
sensory loss in the trunk and
limbs

Ischemic type of stroke due to

Embolic stroke
embolization

Intraceberal hemorrhage a Hypertension

complication of Rupture of aneurysm

Intracerebral hemorrhage most

Basal Ganglia
commonly affects

Rupture of a berry aneurysm

Subarachnoid hemmorage
causes this bleed
 Most common site of berry ACA and Anterior
aneurysm Communicating

Second most common site for

MCA
berry aneursym

Described as the worse

Subarachnoid bleed
headache in my life

Lacunar Infarcts are Microinfarcts less 1 cm

Hypertension or DM leads to
What causes lacunar infarcts
hyaline arteriosclerosis

CNS (central nervous system)

sepisis
infections are mostly due to?

meingitis = ? inflammation of pia mater

bacterial meningitis the majority
originate in nasopharynx
of organisms originate where?

viral meningitis is most often

fecal-oral route
fransmitted by?

miningitis clinical findings? nuchal rigidity

what happens to the CSF ↑ CSF protein (viral, bacterial,

(Cerebral spinal fluid) protein fungal)
and CSF glucose in ↓CSF glucose (bacterial,
meningitis? fungal)

inflammation of brain;
encephalitis = ?
headache; drowsiness; coma

hematogenous; contiguous
cerebral abscess= ?
spread

CSF(cerebrospial fluid)
Bacterial/Fungal:
Feature:
1000-20,000 cells/mm3
Total cell count
Viral:
Bacterial/Fungal?
<1000 cells/mm3
Viral?
 Bacterial/Fungal:
CSF(cerebrospial fluid) >90% neutrophils (>80%)
Feature: Viral:
Differential count First 24-48 hours, neutrophils,
Bacterial/Fungal? then switches to
Viral? lymphocytes/monocytes after
48 hours
CSF(cerebrospial fluid) Bacterial/Fungal:
Feature: Decreased (<40 mg/dL)
CSF glucose Viral:
Bacterial/Fungal? Normal: exceptions-mumps,
Viral? herpes
CSF(cerebrospial fluid)
Bacterial/Fungal:
Feature:
Increased (>50 mg/dL)
CSF protein
Viral:
Bacterial/Fungal?
Increased
Viral?
CSF(cerebrospial fluid) Bacterial/Fungal:
Feature: Frequently positive (60-90%)
Gram stain Culture positive (65-90%)
Bacterial/Fungal? Viral:
Viral? Negative
Disease:
Encephalitis
Comments:
-Mosquitoes are the vector
Virus:
-Wild birds are the reservoir for
Arboviruses
the virus
Disease?
-West Nile virus: crows and
Comments?
other birds have spread the
disease from New York to the
West Coast
-Encephalitis can be fatal
 Disease:
Meningitis
Virus:
Comments:
Coxsackievirus
-Enterovirus: most common
Disease?
cause of viral meningitis
Comments?
-Viral meningitis peaks in late
summer and early autumn
Disease:
Encephalitis
Comments:
-Most common viral CNS
Virus:
infection in AIDS
Cytomegalovirus
-Primarily intranuclear
Disease?
basophilic inclusions
Comments?
-Periventricular calcification in
newborns
-Treatment: ganciclovir +
foscarnet; or valganciclovir
Disease:
Virus: Meningitis and encephalitis
Herpes simplex virus type 1 Comments:
Disease? Causes hemorrhagic necrosis
Comments? of temporal lobes
Treatment: IV acyclovir
Disease:
Encephalitis
Virus:
Comments:
HIV
Most common cause of AIDS
Disease?
dementia
Comments?
Microglial cells fuse to form
multinucleated cells
 Comments:
-Endemic in the mouse
population
-Transmission: food or water
Virus: contaminated with mouse
Lymphocytic choriomeningitis urine/feces
Meningitis and encephalitis -Meningoencephalitis:
Disease? combination of nuchal rigidity
Comments? and mental status
abnormalities (encephalitis)
-CSF findings: increased
protein, lymphocyte infiltrate,
normal to decreased glucose
Disease:
Encephalitis and myelitis-spinal
cord
Comments:
-Destroys upper and lower
motor neurons
Virus:
-Causes muscle paralysisPost-
Poliovirus
polio syndrome: occurs in ∼
Disease?
50% of people with previous
Comments?
poliomyelitis; usually occurs
15-30 years after original
infection; increased muscular
weakness/pain in muscle
groups already affected;
excessive fatigue
 Disease:
Encephalitis
Comments:
-Most often transmitted by
raccoon bite (40% of cases)
Other vectors are dog, skunk,
bat, and coyote
-Viral receptor is acetylcholine
receptor
-Initially replicates at site of the
bite; moves by axonal transport
to the CNS; after CNS
replication, it migrates to the
saliva
-Animal transmits virus when in
the agitated state (encephalitis
stage)
Virus: -Incubation period 10-90 days
Rabies virus -Prodrome: fever, paresthesias
Disease? in and around the wound site
Comments? -Hydrophobia: due to spasms
of throat muscles when
swallowing
-Followed by flaccid paralysis
-Encephalitis: death of
neurons; eosinophilic
intracytoplasmic inclusions
called Negri bodies; seizures,
coma, death
-Treatment: wash wound site
(quaternary ammonium
compound); give passive
immunization (immune
globulin) mostly into wound site
(where virus initially replicates);
give active immunization
 Disease:
Neonatal meningitis
Comments:
-Gram-positive coccus
Bacterium: -Most common cause of
Group B streptococcus neonatal meningitis (49%)
(Streptococcus agalactiae) -Spreads from a focus of
Disease? infection in maternal vagina
Comments? -Empiric treatment (culture
negative): ampicillin +
cefotaxime
-Specific treatment: penicillin G
or ampicillin
Disease:
Neonatal meningitis
Comments:
-Gram-negative rod
Bacterium:
Second most common cause of
Escherichia coli
neonatal meningitis (18%)
Disease?
-Empiric treatment (culture
Comments?
negative): ampicillin +
cefotaxime
-Specific treatment: ceftazidime
+ gentamicin
 Disease:
Neonatal meningitis
Comments:
-Gram-positive rod with
tumbling motility; actin rockets
Bacterium: help organism to move from
Listeria monocytogenes cell to cell
Disease? -Pathogen found in soft
Comments? cheese, hot dogs
-Empiric treatment (culture
negative): ampicillin +
cefotaxime
-Specific treatment: ampicillin ±
gentamicin
Disease:
Meningitis
Comments:
-Gram-negative diplococcus;
locates in posterior
Bacterium:
nasopharynx
Neisseria meningitidis
-Most common cause of
Disease?
meningitis in those between 1
Comments?
month and 18 years of age
-Treatment: ceftriaxone
-Prophylaxis for people in close
contact: ciprofloxacin or
rifampin or ceftriaxone
 Disease:
Meningitis
Comments:
-Gram-positive diplococcus
Bacterium: Most common cause of
Streptococcus pneumoniae meningitis in patients > 18
Disease? years of age (some authors say
Comments? N. meningitidis is the most
common and S. pneumoniae
the 2nd most common)
-Treatment: penicillin G or
ampicillin
Disease:
Meningitis
Comments:
-Complication of primary
Bacterium: tuberculosis
Mycobacterium tuberculosis -Involves base of brain
Disease? -Vasculitis (infarction) and
Comments? scarring (hydrocephalus)
-Treatment: isoniazid, rifampin,
ethambutol, pyrazinamide,
dexamethasone (prevent
scarring)
 Disease:
Meningitis, encephalitis,
myelitis
Comments:
-Spirochete
~Types of neurosyphilis:
-Meningovascular: vasculitis
causing strokes
Bacterium:
-General paresis: dementia
Treponema pallidum
-Tabes dorsalis: involves
Disease?
posterior root ganglia and
Comments?
posterior column; causes
ataxia, loss of vibration
sensation, absent deep tendon
reflexes, Argyll-Robertson pupil
(pupils accommodate but do
not react)
-Treatment: penicillin G
(difficult to treat)
Disease:
Meningitis and encephalitis
Comments:
-Occurs in
Fungus/Parasite: immunocompromised host
Cryptococcus neoformans -Most common fungal CNS
Disease? infection in AIDS
Comments? -Budding yeasts visible with
India ink
-Treatment: fluconazole non-
AIDS, amphotericin +
flucytosine
 Disease:
Fungus/Parasite: Frontal lobe abscess
Mucor species Comments:
Disease? Occurs in diabetic ketoacidosis;
Comments? spreads from frontal sinuses
Treatment: amphotericin B
Disease:
Meningoencephalitis
Fungus/Parasite: Comments:
Naegleria fowleri -Protozoa (amoeba)
Disease? -Involves frontal lobes
Comments? -Contracted by swimming in
freshwater lakes
-Treatment: amphotericin B
 Disease:
Encephalitis
Comments:
-Protozoa (hemoflagellate)
-Transmission: bite of an
infected tsetse fly (Glossina)
-Trypanosomes invade the
blood and lymphatics early in
the disease; initial drainage into
the posterior cervical nodes
produces lymphadenopathy
(Winterbottom's sign);
encephalitis occurs in later
Fungus/Parasite: stages
Trypanosoma -Diffuse encephalitis:
gambiense/rhodesiense somnolence ("sleeping
Disease? sickness") due to the release of
Comments? sleep mediators by the
organisms
-Trypanosomes are capable of
antigen variation (cyclical fever
spike)
-Starvation is the most
common cause of death
-Diagnosis: trypanosomes in
blood, CSF; serologic tests;
characteristic increase in IgM
early in the disease
-Treatment: pentamidine early
in the disease; melarsoprol in
encephalitis stage
 Disease:
Cysticercosis
Comments:
Helminth (tapeworm; cestode);
pig transmitted disease
Fungus/Parasite: Patient (intermediate host)
Taenia solium ingests food or water
Disease? containing eggs; eggs develop
Comments? into larval forms (cysticerci)
that invade brain, producing
calcified cysts causing
seizures; hydrocephalus
Treatment: albendazole +
dexamethasone
Disease:
Encephalitis
Comments:
-Protozoa (sporozoan)
-Most common CNS space-
Fungus/Parasite:
occupying lesion in AIDS; ring-
Toxoplasma gondii
enhancing lesions on CT
Disease?
-Congenital toxoplasmosis
Comments?
produces basal ganglia
calcification
-Treatment: pyrimethamine +
sulfadiazine + folinic acid
(leucovorin)