CNS infections Flashcards Preview

Neurology > CNS infections > Flashcards

Flashcards in CNS infections Deck (53)
Loading flashcards...
1

What can an untreated CNS infection lead to?

Brain herniation and death
Cord compression and necrosis with subsequent permanent paralysis

2

What are the different types of CNS infections?

Encephalitis
Meningitis
Meningoencephalitis
Encephalomyelitis
Epidural abscess
Neuritis
Sepsis syndrome

3

What is meningitis?

Inflammation of the meninges

4

What is encephalitis?

Inflammation of brain parenchyma

5

What are the different types of meningitis?

Acute pyogenic
Acute aseptic (viral)
Acute focal suppurative (brain abscess, subdural and extradural empyema)
TB

6

What will pyogenic meningitis show?

Thick layer of suppurative exudate covering the leptomeninges over the surface of the brain
Exudate in the basal and convexity surface

7

What will meningitis show microscopically?

Neutrophils in the subarachnoid space

8

Are neutrophils present in viral meningitis?

NO - it is aseptic

9

What is the basic treatment for bacterial meningitis

Ceftriaxone IV 2g bd
AND
Dexamethasone IV 10mg qds (3ml of 3.3mg/ml base injection)

10

What are the risk factors for listeria infection?

Over 60 years
Immunocompromised including alcohol dependency and diabetes

11

What should be added to the empirical antibiotics if there are risk factors for listeria?

Amoxicillin IV 2g hourly

12

What is used instead of ceftriaxone in penicillin allergy?

Chloramphenicol IV 25mg/kg qds

13

What is used instead of amoxicillin cover for listeria in penicillin allergy?

Co-trimoxazole IV 120mg/kg divided into 4 doses/day

14

What should be added to empirical antibiotic therapy if there has been recent travel to a country with high rates of penicillin resistant pneumococci?

Vancomycin IV aiming for a pre dose level of 15-20mg/L OR rifampicin IV/PO 600mg bd

15

What are countries with high rates of pneumococcal resistance?

Canada
China
Croatia
Pakistan
Poland
Spain
Mexico
Italy
USA
Greece
Turkey

16

Should you continue dexamethasone in the case of a confirmed meningitis that is not pneumococcus?

No - stop

17

How long should dexamethasone be given?

4 days

18

What virus commonly causes meningitis?

Enteroviruses
Coxsackie
HSV
VZV
Paromyxovirus

19

How is viral meningitis diagnosed?

Viral stool culture
Throat swab
CSF PCR

20

What is encephalitis?

Diffusely inflamed cerebral cortex

21

What are the common signs of encephalitis?

Mental status changes
Confusion
Coma
INSIDIOUS ONSET

22

What investigations are performed for encephalitis?

LP
EEG
MRI

23

What is the treatment for encephalitis?

IV aciclovir 10mg/kg 8hrly

24

What is the treatment for viral meningitis?

Early management for bacterial meningitis then when viral confirmed STOP antibiotics, antivirals and steroids if enteroviral or mumps - supportive management
If HSV or VZV then antivirals continued

25

What are CT findings that are contraindications to an LP?

Significant brain shift/ swelling
Tight basal cisterns

26

What are the CSF findings for a bacterial infection?

Opening pressure: high
Colour: cloudy
Cells: high/v high (100-50,000)
Differential: neutrophils
CSF/plasma glucose: low <40%
Protein (g/l): High >1

27

What are the normal CSF findings?

Opening pressure: 10-20 cm
Colour: clear
Cells: <5
Differential: lymphocytes
CSF/plasma glucose: 50-66%
Protein (g/l): <0.45

28

What are the CSF findings for a viral infection?

Opening pressure: normal/high
Colour: "gin" clear
Cells: Slightly increased (5-1000)
Differential: lymphocytes
CSF/plasma glucose: normal
Protein: normal-high (0.5-1.0)

29

What are the CSF findings for TB meningitis?

Opening pressure: high
Colour: cloudy/yellow
Cells: slightly increased (<500)
Differential: lymphocytes
CSF/plasma glucose: low-very low (<30%)
Protein (g/l): High-very high (1.0-5.0)

30

What are signs and symptoms of meningitis?

Headache
Vomiting
Pyrexia
Neck stiffness
Photophobia
Lethargy
Confusion
Rash