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NEUROLOGY > Infections of the CNS > Flashcards

Infections of the CNS Flashcards

1
Q

What is the difference between encephalitis, meningitis and myelitis?

A

encephalitis - inflammation of entire brain parenchyma
meningitis - inflammation of all 3 layers of meninges
myelitis - inflammation of the spinal cord

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2
Q

Would confusion due to SEPSIS be a direct or indirect infection of the brain?

A

Indirect

- infection started elsewhere

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3
Q

What can be seen macroscopically in pyogenic meningitis?

A
  • thick layer of suppurative exudate (PUS) covers the meninges
    over the surface of the brain
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4
Q

What is seen microscopically on lumbar puncture in pyogenic meningitis?

A

Lots of neutrophils in CSF

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5
Q

During what time of the year does viral meningitis usually present?

A

Late summer/ autumn

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6
Q

What investigations are used to diagnose viral meningitis?

A
  • viral stool culture
  • throat swab
  • CSF PCR
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7
Q

How is viral meningitis treated?

A

generally supportive as self limiting

- e.g anti-emetics for nausea

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8
Q

What questions should you consider asking the patient if they present with symptoms of encephalitis?

A
  • Recent flu-like illness?
  • Anybody in the family recently ill?
  • Travel?
  • Recent vaccinations?
  • Insect bites?
  • Immunocompromised?
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9
Q

What are the common clinical features of encephalitis?

A 
Insidious onset
Stupor, coma
Seizures
Confusion
Speech, memory symptoms
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10
Q

What investigations are useful in encephalitis?

A

LP
electroencephalogram (EEG - electrodes on head)
MRI

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11
Q

What bacterium is most likely to cause bacterial meningitis in each age group?

A 
Neonates: listeria, group B Streptococci, E. coli
Children: H. influenza
Ages 10 to 21: Neisseria meningitidis
Age over 21: Streptococcus pneumoniae
Over 65 : Streptococcus pneumoniae
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12
Q

What bacterium is likely to cause meningitis after neurosurgery or trauma?

A

Staphylococcus - due to penetration from outside world

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13
Q

What life-altering effects can occur after meningococcal infection?

A
  • limb loss
  • deafness
  • blindness
  • cerebral palsy/quadriplegia
  • severe mental impairment
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14
Q

Where do bacteria usually colonise to start a meningococcal infection?

A

Nasopharyngeal colonization

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15
Q

How is CSF from a lumbar puncture analysed?

A

Haematology - WCC
Microbiology - Gm stain/culture
Chemistry - glucose/protein
PCR

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16
Q

When is it acceptable to delay a lumbar puncture?

A

if raised ICP/ seizures

then CT can be completed before lumbar puncture

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17
Q

What findings in the CSF would indicate a bacterial meningitis?

A

WCC > 2000
Neutrophils > 1180
Protein > 220
Glucose CSF:Serum ratio <0.23

18
Q

Where is neisseria meningitides usually found in a healthy carrier individual?

A

Throat

19
Q

What groups of patients are particularly susceptible to strep pneumo. infections?

A

CSF skull fractures
diabetics/ alcoholics
young children
Pts with Cochlear implants

20
Q

What is fulminant septicaemia?

A

End stage of meningococcal infection likely to increase mortality

21
Q

Where can Haemophilus Influenzae be found in a healthy person?

A

part of the normal throat microbiota

22
Q

What patients are badly infected by strep. pnuemoniae?

A

Asplenic pts

23
Q

Describe the gm stain appearance of Listeria?

A

Gram positive bacilli

24
Q

Who normally gets listeria?

A
  • Neonatal
  • > 55 years
  • immuno-suppressed especially malignancy;
25
Q

WHat antibiotic is used to treat listeria?

A

Amoxicillin

as listeria is intrinsically resistant to Ceftriaxone

26
Q

What bacterial infection can reactivate in the elderly and cause meningitis?

A

TB

27
Q

How does TB meningitis usually present?

A

Elderly patient
non specific ill health
Previous TB on CXR
Poor yield from CSF

28
Q

What is cryptococcal meningitis and in who does it normally present?

A
  • FUNGAL
  • present in HIV DISEASE
  • CD4< 100
29
Q

When can bacterial meningitis be culture negative?

A

If patient was given oral antibiotics prior to their admission

30
Q

What is an aseptic meningitis?

A

Non-pyogenic => no pus or bacteria

31
Q

What antibiotics are given for a suspected meningitis where the patient is NOT penicillin/cephalosporin allergic?

A

Ceftriaxone (+ dexamethasone)

If >60 years:
Add amoxicillin for listeria cover

If recently travelled to penicillin resistant country:
Add vancomycin

32
Q

What antibiotics are given for a suspected meningitis where the patient IS penicillin/cephalosporin allergic?

A

Chloramphenicol (+ dexamethasone)

If >60 years:
Co-trimoxazole for listeria cover

33
Q

What are the main clinical signs of bacterial meningitis ?

A 
Fever
Stiff neck
Headache
Photophobia
Vomiting
Lethargy
Confusion
Non-blanching Rash
34
Q

What viruses can be cultured on PCR when narrowing the differential of meningitis?

A
  • Enteroviruses
  • Herpes Simplex Virus 1, HSV2
  • Varicella zoster virus
35
Q

What infective causes can trigger an aseptic meningitis?

A 
HSV 1 and 2
Syphilis
Listeria (occasionally)
Tuberculosis
Cryptococcus
malaria
Lyme disease
36
Q

What non-infective causes can trigger an aseptic meningitis?

A
  • Cancer
  • Sarcoid
  • Vasculitis
  • Dural venous sinus thrombosis
  • Drugs
37
Q

What are the warning signs when admitting a patient with a suspected meningitis?

A
  • Marked depressive conscious level (GCS <12)
  • Focal neurology
  • Seizure before/at presentation
  • Bradycardia and hypertension
  • Papilloedema
38
Q

In what groups of patients would steroids not be given as well as antibiotics in meningitis?

A
  • post-surgical meningitis
  • severe immunocompromise
  • meningococcal or septic shock
    OR if patient is hypersensitive to steroids
39
Q

How is meningitis prevented?

A

Public health notified of new cases to allow close contacts of meningitis patients to be aware that they made need prophylaxis

40
Q

What oral therapies are used for prophylaxis?

A

Ciprofloxacin

Rifampicin

NEUROLOGY (29 decks)

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