DIP Episode 263 - The Clutch CNS Infection Podcast (+ 2CK course/NBME test taking strategies reminder)

Welcome. My name is Divine. This is episode 263 of the Divine Intervention Podcast. And into this podcast I'm going to be talking about a topic that I consider to be very high yield for all the USMLE exams. Step 1, step 2, see key step 3. You'll very likely find one of more questions on this on an exam. So, you know, God willing we're going to be talking about CNS infections today. We'll just talk about them in different ways and highlight the different ways they are tested. And again, I will try to not just give you facts. I'll try to give you some understanding. We're necessary as to like, you know, some kind of path of physiology so that you understand what's going on. And again, as a reminder, if you're taking steps just a year anytime soon, you may want to participate in the trifecta, cause a course I'm doing from Monday to Wednesday. So, on Monday, we meet from 2 to 4 30 p.m. Pacific time, we'll go over and be in the testing strategies. And then on Tuesday and Wednesday from noon to 5 p.m. Pacific time, we'll meet and cover high yield topics. We'll cover about 800 vignettes across speeds, surgery, all beguine, I am Neuron's Psych. So, if that's something you're interested in, just shoot me an email through the website and then we'll go from there. Okay, so what if they give you a question about a patient and you know, they tell you that this patient is an IV drug user. And, you know, this patient over the last like year has lost like 40 pounds of weight.

And then they tell you that this patient, you know, has been having like severe headache, no coreogenicity for the last three days has very high fever. And then they give you CSF studies and you notice that the protein count is really high. You notice that the CSF opening pressure is amazingly high, it's like 300. This bug I'm about to talk about now, lost to cause like amazing CSF pressures. Right? And then they tell you that this person has like, you know, very low glucose, you know, lessy glucose like 10, right? And an increased white cell count with a preponderance of lymphocytes. If you see that I really hope you, and they ask for your next best step in diagnosis, I really hope you want to perform a longer puncture, right? And with that longer puncture fluid, you know, they want to send it off for like the latex particle like the condition assay. Right? And I mean, if they don't put that as an answer choice, you can subject this to the India in stain. I would hope with that you're thinking about crypto caucus in your form. It's right. Remember crypto caucus, right? It is pretty much the most one of the most common causes of meningitis in HIV patients. Right? And remember, if you want to treat, don't forget, you give the person I'm for terracing B and flu side using to get them over the heart. So, I'm for terracing B and flu side using to get them over the hump. And then for a few months afterwards, they need to be on flu connozoprophylaxis.

It's usually for the month's varies, but let's just see somewhere between six to 12 months, right? When I put them on flu connozoprophylaxis to decrease the risk of recurrence, right? Now, what if they give you a question about a patient and they tell you that this patient, you know, was recently studied on highly active antiretroviral therapy, right? And this patient has been over the last, you know, that initially, you know, his CD4 count was 55, right? And, you know, they noticed that over the last two, three days he has been having like generalized the tonic chronic seizures, right? And then they tell you that EEG is largely remarkable, but that they obtain brain imaging and define calcifications around the cordit and puttamin and things like that. And they ask for your next best step in management, really, really hope that you're thinking of giving that person pyramidamin and sulfidizing, right? This person has toxoplasmosis. Remember, if your CD4 count is less than 100, right? You want to go ahead and give that present TMPSMX to performlexigins, toxoplasmagondia, right? Remember, it's a protozoan, right? So it loves to usually classically present as ring enhancing lesions on our brain imaging, right? In a HIV patient. Don't forget, right? It loves to cause calcifications in the brain, especially in the bizzle ganglia, right? So if you tell you that you see a HIV patient and this person has calcifications around like the cordit, the puttamin, right?

The globus palidos and things like that, right? Then I would really hope that you're thinking about toxoplasmosis on little circumstances. And again, remember, the laxis against toxop is different from protozoan, against like, is different from treatment for toxop, right? It's different from treatment for toxop, right? So toxoprophylaxis, right? To use trimethoprimsophyrometoxazole, toxoprhythmia to use pyramidamin and sulfidizing, right? Although if the person is pregnant, right, then you cannot give pyramidamin and sulfidizing. So that anti-folid agents, right? That would not be very prevent, right? It's not like you're trying to give the child a neuro tube defect here. So in those circumstances, usually the smart protein thing to do is to give spiramycin, you give spiramycin in those circumstances. And one thing I want to say is whenever you're giving a person pyramidamin and sulfidizing, this is actually one of those bizarre questions you can throw your exam. You want to go ahead and add a look of worrying to that treatment regimen, right? So that those people do not get bone marrow suppression, right? So that's what I want to say. So I want to go ahead and add a look of the patient, right? So I want to go ahead and add a look of the patient, right? So I want to go ahead and add a look of the patient, right? So I want to go ahead and add a look of the patient, right? So I want to go ahead and add a look of the patient, right?

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So again, if you see any big association, think about this, these are causes, right? And again, many times, right? Essentially, the thing that will happen with these boxes, they will keep growing, growing, growing, growing, growing in the brain, right? And then they will form all these cysts that are classified, right? So you can see them on imaging. And many times these cysts can ultimately lead to a person having seizures, person having like a big brain, right? So they can have like some kind of hydrocephalus, right? And again, because it's a warm infection, right? You're going to give those people a bend as all, right? So you give them like, our bend as all, fire bend as all, right? Uh, me bend as all stuff like that, right? So you give them those bend as all, so you give them a steroid, right? You give them a steroid to try to reduce the seizures and also kind of calm down the, calm down the inflammation. And then, uh, what if they give you a question about a patient? And they tell you that all this patient, you know, uh, you know, comes into the, he was found down at home, right? He was comatose, right? And they tell you that he has a very, you know, that he's poorly, okay, let me not see comatose, but he's poorly responsive. He's completely of like severe facial pain, right? And you know, they tell you that his medical history is unknown, right? But that he takes, um, he takes insulin every day. Right?

And then you notice that his glucose is like 465, and his bicarb is like 14, right? And then again, they tell you that it's completely of severe facial pain. He has a very high fever, powerful lucosytosis. If you see this, I really hope you think about me with comatosis, right? I hope you think about me with comatosis, right? Especially like those are rhizoposter species, right? Those rhizoposter species, remember, it can cause like, it usually, basically causes infection that starts in the frontal sinuses and then it can spread to the brain. Especially the frontal lobe, right? Frontal sinuses direct shot to the frontal lobe, right? So those things can ultimately cause problems, right? And again, for these people, unfortunately, they need to de-breed, de-breed, de-breed, de-breed extensively, right? And then give them for teres and B, and then pray for the best, pray for the best outcome. Okay. Now, what if they give you a question about a patient, you know, they tell you that a patient, you know, is like a swimming instructor, right? So this patient is a swimming instructor, and um, this patient, uh, they notice that over the last two days, right? This person has been having like, fevers, right? This person is somalent, right? And then they tell you that this person, uh, then dies two days afterwards, right? If you see this, I'll really hope you think about an aggliria fallorite, right? Remember now, gliria, like, an aggliria, it's spelled like N-A-E-G-L-E-R-I-A, right?

N-A-G-L-E-R-I-A, right? N-A-Ggliria fallorite, right? And then this thing loves to cause problems. It's really people that swim in freshwater, right? So they won't say the patient went swimming in freshwater, right? That'll be too easy on an exam. What they will do is they will give you some water association, right? And then begin to lead you, lead you, lead you there. They'll probably give you like an answer that says, lip to spheroes and some weird stuff, right? Don't, don't fall for those things. Think about my gliria fallorite. It's your person exposed to water and they die very rapidly. Think about it on my gliria fallorite. And again, this thing is pretty fatal, right? But one thing you can do in terms of treatment is you can give them for terracing, be in again, hope for the best. And again, it loves to torch a person's frontal lobes in their brain, right? So again, just one of those extra tidbits when you keep on the back of your mind on exams, right? And then what if they give you a question about a patient and they tell you that this patient, you know, recently immigrated to the US, you know, like 10 days ago, it's like a, it's like an exchange student, right? And they tell you that this patient has been some allent for a couple of days. Like, you know, he came to the US, he was fine initially, but he's been some allent. They can even make this one of these military questions, where there will be a person that has been deployed to like an African country, right?

And then you tell him that this person has been some allent, is always sleepy, right? And this patient is refusing food, losing a ton of weight, right? If you see this, I really, really want you to think about sleep in sickness, right? Remember, sleep in sickness, it occurs when a person gets some tri-pano-somo problems, right? So remember, like the big thing one remember is a tri-pano-somer-brousii, right? So BRUCI, right? So this is a tri-pano-somo species that can cause problems, right? And remember that they are transmitted by the CC fly, right? By the CC fly. And remember, they immediately love testing vectors on exams, right? Just one of those things you want to keep at the back of your mind, right? So basically, right, so how does this thing cause issues, right? Pretty much the thing that happens is, you know, the person will get infected, right? And usually it's a blood-borne infection initially, right? And then over time, those bugs will find a way to get to the brain, right? And the thing is you may wonder, like, why do these, why does this thing cause sleepiness, right? Why do these people sleep? The thing is, apparently, these bugs that cause sleepiness, they actually release like some chemicals in the brain, right? That actually cause a person to just fall asleep, right? Cause a person to fall asleep, right? So that's actually why it's called sleepiness to start with.

And again, typically in terms of treatment, you can give these people a, like, pentamidine, right? Remember, pentamidine is also one of those things we can use to treat a nemosisigirvetsi, where you can also give them another drug known as a melastoprol, right? So, M-E-L-E-R-S-O-P-R-O-L, right? So you can give them melastoprol, or you can give them pentamidine, right? So you can give them melastoprol, or you can give them pentamidine. And I mean, typically if you want to make a diagnosis, right, you can, you know, do a lumber bank to get some CSF. And you'll notice, if it's like a acute infection, they will have like elevated IgM against these are tripe and also most species of, in your CSF, right? And again, maybe like, divide why these people are refusing food again, for whatever reason, if you ever see a person that dies of sleeping sickness, they die because they just don't eat, right? Stavation, believe it or not, is actually one of the most common causes of death in these people that have tripe and somal of sleeping sickness, right? So for whatever reason, these people just refuse food, right? And then they ultimately die, right? Again, usually people don't die of this stuff, but if they die, it's because they just did not eat pretty much. If not, it's very treatable, right? Again, pentamidine or you can give a mellastoproly, okay? So you just don't remember for the purposes of exams. Now, what if they give you a question about a patient, right?

And they tell you that this patient, you know, comes in in July, right? And this patient has been having like mental status abnormalities, right? He performed a lumber puncture, right? And you notice that, you know, the CSF has, you know, roughly normal glucose, normal opening pressures, the white count is just a little elevated, and it's like 90% lymphocytes. And they ask you like, what's the next step in management of this patient? I would really hope you're picking the answer that says so, what if care, right? This person has some kind of viral meningitis, right? And if they're trying to get you to pick a specific bug, that's causing this viral meningitis. So until you think about like an enterovirus infection, right? Remember, enterovirus loves, loves, loves to cause a viral meningitis. In fact, it's the most common cause of viral meningitis on USMLA exams, right? So something to watch out for, right? And then, what if they give you a question about a patient, right? And they tell you that this patient, you know, again, IV drug user has HIV. CD4 counts is like 40, right? And they tell you that again, he has been some malignant over the last couple of days, right? Some malignant over the last couple of days. And then they tell you that, you know, again, the obtains CSF studies, right? Like, you notice that opening pressure is normal. Look, cause is roughly normal. And again, remember, CSF glucose is not the same thing as the body's glucose.

Just something I think I maybe should draw your attention to. So, normal body glucose is, you know, right around 100, right? But normal CSF glucose is actually between like 50 to 70, 75 roughly, right? So again, it's a little lower than what is normal, right? So don't say, ooh, the CSF glucose is 60 and it's abnormal. It's really not. It's actually normal, right? So, you notice that, you know, this person again, normal CSF opening pressure, normal protein, normal glucose, slightly a video white count, predominantly lymphocytes, and then they give it like the red blood cells. They show you like zero to five per high power field. So almost no red blood cells, right? I would hope if you see that, they are not thinking about herpes, right? With a person that has this really low CD4 count number, I would really hope you're thinking about Cocsacchi virus. I mean, sorry, I would really hope you're thinking about CMV, right? Or, again, remember, CMV lost to 12 people that have HIV, right? But you may say, define, how do I differentiate this from herpes? I already give you one factor there. People that have herpes meningitis on MBM exams, right? You tend to find a lot of red blood cells in their CSF on Lumber Puncher, right? You may say, okay, define, how do I differentiate this from Cryptococcus? People that have Cryptococcus, they have similar labs in terms of a very white count tons of lymphocytes.

But the opening pressures will be very high, the glucose will be very low, and the protein will be very high, right? So that's how you differentiate those. So if you're seeing like a viral style picture, in terms of the CSF findings, and you don't see many red blood cells, and again, you're noticing that this person is like CD4 count in the doldrums, right? Less than 50 kind of deal. I want you to think about CMV, right? Think about CMV. And again, don't forget, CMV, they may ask you many different questions on the exam. They can ask you an easy question like treatment, right? Remember, you want to give those people like Gansai clover or Val Gansai clover, right? But remember, if you don't see those as answers or if try those and it's not working, right? Go ahead and give that person a false carnage, right? And the false carnage is that pyrophosphate analog, right? Because remember, drugs like e-cyclover, Gansai clover and stuff like that, right? Those things need activation by a kinase to start working, right? But, um, false carnage does not require activation. It's already a phosphate, right? It's already been phosphorylated, right? So, there is a very low threshold for it. There's very high threshold for resistance with false carnage, right? So, that's what you give to people that have like herpes that's or CMV that's resistant to the standard therapy, right? So, again, you can give this person a false carnage, right?

And again, remember, they can also ask you like, oh, which of the following is most likely the most likely finding on like CSF studies or whatever, right? Remember, you'll find cells that have these intra-nuclear inclusions, right? Those are those, that's the outside nucleus, right? Again, they won't see outside nucleus in the exam. That'll be too easy, right? You'll put intra-nuclear inclusions, right? So, something you want to watch out for an exam. And again, like I said, uh, toxo, right? Again, loves to cause uh, calcifications in the brain in the congenital case. But toxo causes calcifications. You can cause calcifications all through the cortex, right? Or if they want to get specific on your exams, again, you can kind of close around the cordi, it's the putemin, basically parts of your busy ganglia, right? Or you know, around like your thalamus area, right? But again, if the tell you that the person has calcifications around the ventricle, so I want to think more of, know the lines of a congenital CMV, okay? I want to think more of the lines of congenital CMV. And again, like I said, if a person has herpes meningitis, right? Again, remember, it tends to involve the temporal lobes that I show you imaging, right? And the way to know that you're dealing with the temporal lobes on imaging on an in-beam exam is, you'll see the brain stem in that cross section, right? You'll see the brain stem.

If you've seen the brain stem, or you've seen some part of the cortex, the part of the cortex you are very likely looking at is temporal lobe, especially if it's part of the cortex that is flanking the brain stem on either side, right? And again, if you see a lot of white, right? Or whatever, you know, just like this temporal lobe does not look very similar to temporal lobe on the other side, right? Just one of the great things with radiology, right? We have two of most things in the body, right? So compare both, right? If you've seen that one doesn't look as good as the other, right? Then you're like, eh, that's a little worrisome, right? So you want to begin to think about a temporal lobe in different lightest with HSV. And again, remember, HSV loves to cause again a ton of ribloxels in the CSF, right? Tonaribloxels in the CSF. And remember that HSV, again, you're going to treat those people like IV, a cyclover, right? You're going to treat those people with IV, a cyclover, right? Again, don't forget your temporal lobes, don't forget all those high-yield associations there, right? And then one of the things, right, I guess since we're going to talk about viruses here that I can mention, right? Remember, people can also get rebbees, right? I talked about this a fair amount in my vaccine podcast. By the way, that's a high-yield podcast, if you're taking a USM in exams, especially step 2, see you in step 3. But remember that rebbees, right?

Again, it's one of these things that can cause a virus, right? It can cause a CSF problem, right? I mean, it can cause a brain infection, right? Again, remember, people usually get this from some kind of animal bites, right? So we're beating by a raccoon, or a dog, or a bat, or a skunk, or coyote, something like that, right? You get beaten by any of those stings, right? The thing is the virus, right? You'll basically get to the neuromuscular junction, right? That's its first point of call, right? You'll bind to the acetylcholine receptor, get into the neuromuscular junction, and then from there, you'll get into... It'll replicate around the neuromuscular junction, and then it will use retrograde transport to go through the neurons, right? Go through the neurons, and then go all the way, right? So the person's brain, once it gets to the person's brain, the person is pretty much gone. I mean, like, it is 100% for you to want to get to your brain, right? So that's why when a person has rabies, right? Remember, you want to go ahead and give them the rabies email, Glubilin, and again, don't forget, you want to inject it right into the wound, right? So that you can bind up as much of the organism as possible, right? So give them the rabies email, Glubilin, right? And then you need to give the person the vaccine, right, at the same time. But again, give them a contract lateral extremity. You don't want the email, Glubilin to bind up the vaccine, right?

And then the vaccine does not work, right? So again, give the email, Glubilin to the wound, and then give the vaccine into a different extremity, right? That's very important to know, right? And again, remember, the classic teltyl sign that a person has gotten like, like, like, uh... rabies in the brain, and they're pretty much about to die, right? Is these people, right? They wouldn't want to drink water, right? So if you see a person that has plastic paralysis, refusing water on an in-bim exam, right? Think about rabies, right? Think about rabies, um... Because basically, right, like the person's, uh... throat muscles have become in spastic, right? So they begin to reject fluid, right? So that's why those people, uh... you know, don't want water, they don't want to do any... They don't want anything with water inside their... inside your throat. And then don't forget that, um... If the... let's see the teltyl that all the pressing dies, and then they all say, which of the phones is the most likely biopsy finding, right? Again, don't forget, right? You'll find, uh... Think... Interest atoplasmic inclusions, right? So, again, remember, in CMV, right, when... The cytomegalovirus, you're gonna find intra-nuclear inclusions, right? But in rabies, right, you're gonna find intraceidoplasmic inclusions, right? Intraceidoplasmic inclusions, right? Intraceidoplasmic inclusions. Remember, those are the things that are known as negribuddies, right? Negribuddies.

Again, all these little details. The thing is, the cytosy-k is slowly becoming... I mean, like... It's not a model of slowly becoming, but I mean, you're probably heard of the program director pole... A few weeks ago, right? Where the cytosy-k is now the most important thing to consider. And the presence of application, even over step one scores, right? So the thing is, you hear experiences of people, right? They're taking step two, so you can be a scene like some of these, like, little step one basic signs details, right? I suspect that step two, so you'll begin to go more in that direction for the foreseeable future, right? So again, just something you want to keep at the back of your mind on exams, right? Just something to keep at the back of your mind on exams. And then, in terms of this spinal cord, right, don't forget polio. Remember, there's a vaccine against it, right? That prevents that. So this will likely be an immigrant-style question, right? The person will have, like, muscle paralysis. And, you know, really unfortunate, there's no treatment, right? You could have prevented it by getting the vaccine. I remember that the polio virus loves to go after the, go after the, um, the ventral horn, right? You may see it referred to as the anterior horn of the spinal cord, right? So it causes predominantly low moron neuron problems, right? It causes predominantly low moron neuron problems, right?

So again, just something you want to keep at the back of your mind, for example, right? And then, what if they give you a question about, like, a newborn, right? And you tell them that this newborn, oh, you know, there's one, two days ago, whatever, right? And this person has, like, um, hit this newborn, has, like, no coregidity, very high fevers, and all that stuff, right? And it's septic, right? I would hope you're thinking about group B strep, right? Strepic galactia, right? Remember, it's the most common cause of meningitis in the first 20 days of life, right? Which is what is defined as the neonatal period, right? And again, in terms of treatment for the most parts, these kids, just go ahead and give them a, um, you can give them, um, um, you can give them, like, a third generation of low sparring, or so you can give them something like septic triaxone, but if we don't see that as an answer, you know, you can give them a pysilin, right? And pysilin is fine for treating a group B strep, trapegalactia, right? And again, they can ask you which of the following is the most likely sufferings of infection in this kid, right? Uh, you want to think about the maternal vagina, right? Remember, this is why we screen women that are pregnant between the ages of 35 to 37, right? I mean, 35 to 37 weeks, gestation with screen for group B strep, right? And then again, another thing you may see, right? Again, if they give you like that, this kind of picture, right?

Like, first 20 days of life meningitis, and they don't put strepgalactia as an answer, right? And the next answer is you'll be looking for is equal life, right? Remember, equal life is the second most common cause of meningitis, right? In newborns, right? Again, in first 20 years of life, um, an equal life for the most part, give those people, give those kids a third gen septic low sparring, right? So give something like, uh, safe traxone or cephotoxine, right? Or safe tazidine, that's absolutely fine. Um, but again, let's assume, group B strep is not an answer, equal life is not an answer. And the answer you want to be is listeria, right? Remember, listeria is the third most common cause of meningitis in a newborn, right? And again, listeria, the drug of choice for treating listeria is ampecili, right? I'll say it again. The drug of choice for treating listeria, right? Is ampecili, remember, listeria is that thin that, you know, mom is exposed to like delimits, hot dogs, soft cheeses and all that stuff, where she can get a listeria and transmits you to the baby, right? And remember that that thing can cause granulomas all across the body of the fetus, right? Like that's the thing called a granulomatosis infantisepticum, right? But again, treat listeria with, uh, with ampecili on an mbme exam, right? And then, um, if they give you a question about a person that has meningitis, right? And you see a person, uh, you know, has meningitis and has skin findings, right?

So this person has like ptki or purpera or whatever on the skin. They want to think about meningococcal meningitis, right? From my seramine meningitis, meningitis, right? And again, my seramine meningitis, remember, you treat this with, uh, with, uh, third gen cephalospory, again, like ceptraxone, for example. But you don't just treat the patient, you need to treat your close contacts, right? You can use ceptraxone, you can use rifampine, you can use ceprofloxacine, right? Of all those three genes, remember, the one that is actually the most preferred, believe it or not, is rifampine, right? But obviously, if the person is pregnant, that was a close contact, right? You clearly cannot give rifampine, right? You clearly cannot give ceprofloxacine to a pregnant woman, right? So the drug of choice in that case will be ceptraxone, right? And remember that, um, if a person has, uh, one thing I guess, let me just go ahead and see now, because they can, I can totally see the end in the evening going after this on exams. Remember that if you want to protect a person, let's see your healthcare worker, right? And the person is, uh, going to be working with patients that have TB or is a put is in, is going to be going into a potential TB environment or potential COVID-19 environment. Then those people need to be placed on in the need to get respirators, right? They need to get an N95 mask, right?

That's very important to know is just one of those weird bizarre things that you see on the newer end being examples. You should pretty much draw that to your, to your attention, right? And one thing I will say for sure is if you see a meningitis question, right? My sermon in jid is who classically again, cause meningitis with skin findings, right? Again, classical, cause meningitis with what skin findings, right? And then don't forget, right? Um, strepnumum is another bug that can cause a meningitis, right? Again, they will tell you the presence of meningitis, you check their css, because it's a bacterial infection, right? You'll find low glucose, high css protein, right? Ton of white blood cells, but it will be neutrophils you'll find, right? You'll find a ton of neutrophils, you'll find a ton of neutrophils, right? And again, the opening pressures will be supremely high, right? You'll be supremely high. And then, you know, they'll tell you to, if you do, they will show, tell you that, oh, gramsthina of bloody, bloody, bloody blood, right? Show, um, gram positive diplococça, right? If you see stuff like that, right? You want to think about strepnumum. Remember, if it's a nice sermon in jiditis, it will be gram negative diplococça. Remember that nice sermon in jiditis can be treated with, uh, uh, these actually of vaccine against that, right? This vaccine against that, right?

So if a person has the mococominitis, uh, typically, what do you want to do is, you want to give them streaxone, right? And vancomycin, right? I'll see this again. You want to give streaxone and vancomycin, right? But in addition to that, you need to add a steroid, right? To decrease the morbidity associated with it infection, right? So just remember the term CVS, right? Like the pharmacy, right? Safe traaxone, vancomycin, and a steric, right? That's how you treat mococola meningitis, right? And then you might TB podcasts, right? Which I mean, I think like yesterday, um, or two days ago. I can remember which one again. Um, we talked about how TB can cause meningitis, right? But again, even if TB is a bacteria, right? Remember, it can cause meningitis in a format where you notice that, wow. Um, the CSF open pressure is really high. Um, protein is really high. Glucose is really low. White cells are elevated. But again, even if it's a bacteria infection, you find the predominance of lymphocytes, non-neutral fills, I'll say that again, predominance of lymphocytes, right? Not neutrophils, right? And again, remember that TB, right? If you tell you that all the performing meningitis of the brain, you notice that all these enhancement are the base of the brain, right? There's enhancement of the base of the brain. Think about TB, right? TB loves to cause, uh, hyperintensity at the base of the brain, right?

So there's just one of those rhythms you want to give out the back of your mind, for exams. And again, for the most part, again, if your presence has TB meningitis, right? You're going to give them right, fat pain, right? Isolized it, preazenomite, and ethymbutal, plus vitamin B6. But one other thing I'm going to throw in here is you're going to give them steroids as well, right? You're going to give them steroids. You're going to give them steroids. You're going to give them steroids. Remember, you give steroids, uh, for pneumococcal meningitis, but you also give steroids for TB meningitis, right? You also give that for TB meningitis, right? And then to wrap up this conversation, what like CNS infections? Don't forget, right? Cipolis can cause a bunch of stuff in the CNS, right? Remember, it can cause a TB's or salads, right? So that's where your dorsal columns are all messed up, right? So you have problems with like fine-todged vibration, perception, right? Remember, essentially your dorsal columns are gone, and those people have like a positive rumberg sign, right? And they don't forget that it can also cause like the argol, rubber, simple pill, right? So remember, those people, right, like these essentially like a kind of, uh, cranial nerve problem, right? We're essentially ready, the apopillalt, right? They are able to accommodate, right? So they can, they have that good accommodation response, right? But they do not necessarily react to light, right?

So they don't have that consensual, papillary response, right? And again, remember, cipolis, we treat it with a penicillin, right? We treat cipolis with a penicillin. So, um, you know, hopefully you found this podcast to be helpful. If you listen to this again, I will be surprised if you're not able to knock out the CNS infection questions you see on your exam. And again, please subscribe to the You Tube channel, Divine Intervention US Emily Podcasts and Videos. And then I also have this podcast on Apple Podcasts and Google Play on Spotify. Please subscribe. Any positive feedback you leave always helps, right? Always always helps. And also you can subscribe to the website, Divine Intervention Podcast.com. Basically whenever I make a podcast, you get a notification or something like that, right? So, um, so thank you for listening to this podcast. And one thing I guess I'll just see in terms of our life lessons, um, is this. It kind of dovetails of a life lesson I've talked about before, right? It's a very classic scene in where I'm from. So I'm from Nigeria, by the way. And it's this thing that don't count your chickens before they are hatched, right? In fact, there is this pastor that I know he loves to use this. They shouldn't share your testimony until it's complete, right? So again, it's just kind of coming off of lessons I've learned from life, right? Don't boast too early, right? Don't share your results too early. Just wait, right?

Let the thing come to fruition before you start sharing, right? Because again, if you share, share, share, share, share, and that thing ends up not happening, right? Or something weird happens, right? And boom, you're completely north of balance, right? If you didn't share, then you don't have any shame to hide, right? But if you shared, then you have a ton of shame to hide, you will be like, you know, what happened, right? And then you have to start telling another story. And then sometimes they will leave people to start lying, right? So that you can still keep, essentially, keep it up with the Joneses, keep impressing people, right? So again, until something has completely come to an end, you don't need to share it, right? Again, I feel like we live in this generation where people just love to share, share, share, share, share, share. Like social media, like some people's lives, you can literally cut log, you can literally find out where they live, where they are married to, every part of their lives. How much they're having their bank account, just like going on their social media pages, right? So again, just be smart, be prudent, right? You see how social media can be so destroyed people these days. You can make a post on something, so I'm picks it up, post it all over the news, destroys your life, right? So again, just be careful with how much you share, right? Just be wise with your sharing. So thank you for listening to this podcast. I'll see you next time.

God bless you. Have a wonderful night and have a great week ahead. Thank you.

Very high opening pressure, very low glucose, and very high protein count.

Toxoplasmosis (Toxoplasma gondii).

Enterovirus.

Presence of red blood cells (RB Cs) in the CSF.

Herpes Simplex Virus (HSV).

Pyrimethamine/Sulfadiazine; Spiramycin.

Cryptococcus.

It uses retrograde transport, moving from the peripheral nerves to the brain.

Intra-nuclear inclusions.

The Rabies Immune Globulin (RIG) itself, to bind up as much of the organism as possible locally.

Streptococcus agalactiae (Group B Strep).

Ceftriaxone (since Rifampin and Ciprofloxacin are contraindicated in pregnancy).

Enhancement/hyperintensity at the base of the brain.

Cryptococcus.

It uses retrograde transport, moving from the peripheral nerves to the brain.

Intra-nuclear inclusions.

The Rabies Immune Globulin (RIG) itself, to bind up as much of the organism as possible locally.

Streptococcus agalactiae (Group B Strep).

Ceftriaxone (since Rifampin and Ciprofloxacin are contraindicated in pregnancy).

Enhancement/hyperintensity at the base of the brain.

Cryptococcus.