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35 Cards in this Set
- Front
- Back
1. In what year was AIDS first given a clinical description?
2. In what year was it recognized that T-lymphocytes with CD4+ markers are the principle target of the virus? |
1. 1981 - originally called GIRD (Gay-related immune deficiency)
2. 1983 |
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1. HIV-dementia is seen in what % of HIV patients?
2. What % of people that get HIV as children eventually develop encephalopathy? |
1. 7-10%
2. 23% |
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What are the 3 main neurological complications of HIV infection?
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1) Toxoplasmosis (most common)
2) Primary CNS lymphoma (most impt for surgeons) 3) Progressive multifocal leukoencephalopathy (PML) --> leads to opportunistic infections |
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What are the most common mass lesions or focal mass lesions seen in AIDS patients?
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primary lymphomas of the brain
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Describe primary infection of the brain with HIV
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*highly neurotropic
*primarily affects microglia and macrophages *NOT A TERMINAL EVENT --> infection is caused by lymphocytesbrought in by opportunistic infections |
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When does primary infection of the brain with HIV occur?
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it occurs early, in the long, asymptomatic phase of HIV
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What does that HIV virus have that is recognized by macrophages?
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glycoproteins, specifically GP120, on the viral envelope
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Describe the two ways HIV can infect human cells
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1) being absorbed into the macrophage
2) GP120 can break off and stimulate the macrophage to produce neurotoxins -->Ca2+ in the neuron is released -->infected macrophages stimulate astrocytes to release NO -->macrophages also release arachidonic acid which inhibits reuptake of Glu **Result: NO and Glu neurotoxicity |
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What 4 conditions has AIDS been directly involved in?
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1) AIDS-dementia comlex (ACD)
2) Distal Symmetrical Polyneuropathy (DSPN) 3) Mononeuritis multiplex 4) Vacuolar Myelopathy |
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What 3 autoimmine disorders are common in dysregulated immune systems?
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1) Guillain-Bare Syndrome
2) Inflammatory Demyelinating Polyneuropathy (IDP) 3) Gliomas |
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How is HIV encenphalopathy characterized?
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1) diffuse myelin damage (spongy myelopathy), gliosis, neuronal loss, vascular damage, microglial nodules, and lymphocytic infiltrates (from the body trying to clear up the debris)
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What is the hallmark of HIV encephalitis?
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multinucleated giant cells
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What does HIV encephalitis look like on MRI?
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increased signal within the periventricular white matter (denotes increased water content surrounding lateral ventricles)
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What type of spinal cord diseases are:
vacuolar myelopathy and necrotizing vasculitis |
primary
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What type of spinal cord diseases are:
spinal cord infection, neoplastic involvement, and epidural spinal cord compression from pyogenic or subacute infection |
secondary
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What is the early phase of infection in the peripheral nervous system involvement?
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acute inflammatory demyelinating polyneuropathy (thought to be an autoimmune disease)
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What is the late phase of infection in the peripheral nervous system involvement?
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*mononeuritis multiplex
*painful sensory neuropathy with axonal degeneration (feel like your hand is on fire) --> common among patients with severe immunodeficiency |
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1. What causes cerebral toxoplasmosis and when does it occur in the AIDS progression?
2. It's thought to be a reactivation of a chronic latent infection in over ____% |
1. Teponemal parasite that forms a cystic mass
--> it occurs early in the disease when CD4+ counts <100 |
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What CD4+ count is considered "immunocompromised"?
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< 200
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1) What MRI finding is diagnostic of cerebral toxoplasmosis?
2) Is this condition encephalitic? |
1) multiple, scattered ring-enhancing lesions
2) yes |
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1) What is the pathological hallmark of cerebral toxoplasmosis?
2) what treatment is there for cerebral toxoplasmosis? |
1) encysted bradyzoites and free tachyzoites
2) Bactrim (trimethoprim), sulfadiazine, or other sulfa drugs --> pts usually respond well |
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T/F - almost all patients with cerebral toxoplasmosis have anti-toxoplasma immuniglobins?
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True
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Describe Primary CNS Lymphoma:
1) when does it affect AIDS patients? 2) How much more common is it in AIDS patients than the general population? |
1) late in the disease progression or in less severely affected patients without toxoplasmosis
2) 1000-4000x more common in AIDS patients |
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1) What MRI finding is diagnostic of Primary CNS Lymphoma?
2) is Primary CNS Lymphoma encephalitic? |
1) ring or solid enhancement with a periventricular location
2) less encephalopathy than toxoplasmosis |
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What is the pathology seen in Primary CNS Lymphoma?
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small cell, lymphocytic cuffing of blood vessels
--> most are B-cell lymphomas |
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1) What CSF findings help for diagnosing?
2) what is the treatment? |
1) Epstein-Barr Virus
2) radiation therapy, and sometimes chemotherapy (Ommaya reservoir) directly into the skull via a catheter |
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What is the difference in prognosis between cerebral toxoplasmosis and Primary CNS Lymphoma?
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Primary CNS Lymphoma is usually fatal, whereas cerebral toxoplasmosis can be successfully treated if caught early enough
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1) What causes progressive multifocal leukoencephalopathy (PML)?
2) What part of the brain is affected? |
1) Infection of oligodendrocytes by JC papovavirus (JC virus or JCV)
2) subcortical white matter (cortex not affected; uncommon in cerebellum and spinal cord) |
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What are the MRI findings for PML?
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scalloped appearance of the subcortical white matter
--> there is NO mass effect --> brain is non-enhancing on CT or MRI |
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1) What is the pathology of PML?
2) How do you test for PML? |
1) Bizarre, giant astrocytes, oligodendrocytes with intranuclear inclusions
2) PCR for JC viral DNA |
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1) What is the treatment for PML?
2) What is the prognosis for PML? |
1) nuceoside analogs or immunomodulation
2) rapid progression to death with the shortest life expectancy and highest mortality rate (3-4 months before death once diagnosed) |
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1) Multiple concurrent pathologies are found in what % of patients?
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1) 5% - e.g., toxo and PML; CMV and lymphoma
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What's the most common neurosurgical procedure in AIDS patients?
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stereotactic brain biopsy
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What are absolute indications for a brain biopsy?
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Only need one of the following:
*Failure of anti-toxoplasma therapy after 2-3 weeks *Non-enhancing lesion(s) *Solitary enhancing lesion on MRI *Unable to tolerate anti-toxoplasma therapy *Impending herniation *Atypical history making other diagnosis more likely (e.g. systemic lymphoma) *Seronegative for toxoplasmosis |
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What are relative indications for a brain biopsy?
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Only need two of the following:
*Large mass effect *Late in the disease process *“Eloquent” location *Absence of encephalopathy *Presentation while on prophylaxis for pneumocystiscarinii pneumonia *Deterioration while on anti-toxo medications *Negative CSF cytology in patients with periventricular lesions |