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09- Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

what is another name for bacterial meningitis?

A

pyogenic

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2
Q

what can be seen microscopically in the subarachnoid space if bacterial meningitis?

A

neutrophils

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3
Q

what are the methods of infection in bacterial meningitis?

A

nasopharyngeal colonisation

direct extension of bacteria

remote foci of infection e.g. endocarditis, pneumonia, UTI

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4
Q

what are the clinical signs of bacterial meningitis?

A

fever

stiff neck

alteration in cosciousness

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5
Q

what are the symptoms of bacterial meningitis?

A

headache

N&V

photophobia

lethargy

rash

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6
Q

what is the likely causitive organism of bacterial meningitis in

1) neonates
2) children
3) 10-21yrs
4) >21yrs
5) >65yrs

A

neonates = listeria, Group B strep, E.coli

children = H. influenza

10-21yrs = neisseria (meningococcus)

>21yrs = streptococcus > neisseria

>65yrs = streptococcus > listeria

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7
Q

Neisseria is also known as?

A

meningococcal

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8
Q

where is neisseria found in healthy carriers?

A

fund in throats

(proabably gains access to meninges through bloodstream)

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9
Q

why do symtposm occur in neisseria?

A

due to endotoxin produced

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10
Q

what vaccine is given to cover children/teens from neisseria?

A

MenACWY vaccine

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11
Q

what does H. influenza look like on microscopy?

A

small gram -ve rods

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12
Q

what is the most common type of H. influenza in children under 4yrs old?

A

type b

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13
Q

what does H. influenza require for growth?

A

blood

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14
Q

is there a vaccine against H. infulenza?

A

yes- conjugated vaccine directed against the capsular polysaccharide antigen

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15
Q

where is strep pneumoniae commonyl found?

A

nasopharynx

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16
Q

who is most susceptible to strep pneumococcus (pneuomococcal) meningitis?

A

diabetics

alcoholics

young children

pts w CSF skull fractures

17
Q

what gram stain is listeria monocytogenes?

A

gram +ve bacilli

18
Q

who is commonly affected by listeria monocytogenes?

A

neonates

>55yrs

immune suppressed

19
Q

what should be done on arrival in patient w suspected meningitis?

A

blood culture and coag screen

throat swab

disrupt and swab/aspirate any skin lesion for miscroscopy andn culture

20
Q

all adult patients with suspected meningitis undergo LP- why would LP not be performed?

A

contraindicated

confident clinical diagnosis of meningococcal infection w meningococcal rash

21
Q

who would require a CT prior to LP in suspected meningitis?

A

immunocomprised state

history of CNS disease- mass lesion/stroke

new onset seizure- within 1 week of presentation

focal neurological deficit

abnormal level of consciousness

22
Q

what is generally seen in CSF if bacterial meningitis?

A

high white cell count

neutrophilia

high protein

low glucose

23
Q

what is the initial therapy given in bacterial menigngitis?

A

ceftriaxone IV + dexamethasone IV

if >60yrs add in amoxicillin

vancomycin if pen allergic

24
Q

if allergic to penicillin/cephalosporns what should be given as initial therapy for bacterial meningitis?

A

chloramphenicol + dexamethasone

add in co-trimoxazole if >60yrs

25
Q

what is the specific treatment for bacterial menignitis caused by Meningococcud (neisseria)?

A

5 days ceftriaxone + stop dexamethasone

26
Q

what is the specific treatment for bacterial meningitis caused by pneumococcus (strep)?

A

10 days ceftriaxone + 4 days Dexamethasone

27
Q

what is the specific treatment for bacterial meningitis caused by pen resistant pneumococcus?

A

14 days ceftriaxone + 4 days dexamethasone + vancomycin

28
Q

what is the treatment for bacterial meningitis caused by listeria?

A

at least 21 days of amoxicillin + stop dexamethasone

(co-trimoxazole if pen allergic)

29
Q

what is the treatment for bacterial meningitis caused by H. influenza?

A

10 days ceftriaxone + stop dexamethasone

30
Q

what is given as contact prophylaxis in bacterial meningitis?

A

250mg ceftriaxone IM as single dose in adults, 125mg IV in children <12

500mg ciprofloxacin orally in adults and chlildren >12

31
Q

what is the CSF like in aspetic (non-bacterial) meningitis?

A

low WBC

minimally elevated protein

normal glucose

32
Q

when is viral meningitis more common?

A

summer/autumn

33
Q

how is viral meningitis diagnosed?

A

viral stool culture

throat swab

CSF

treatment supportive as self-limiting

34
Q

what is inflammation of the brain itself?

A

encephalitis

09- Neurology (16 decks)

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