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Semester 5 - Neuro > 12 - CNS Infection > Flashcards

12 - CNS Infection Flashcards

1
Q

What are the possible mechanisms of entry of pathogens into the CNS?

A

1) Direct spread ie otitis media, basilar skull fracture
2) Blood-borne ie sepsis, infective endocarditis
3) Iatrogenic ie VP shunt, surgery, LP

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2
Q

List some non-infective causes of meningitis:

A
  • Malignancy
  • Autoimmune
  • Iatrogenic
  • Sarcoidosis
  • Drugs: NSAIDs, Ranitidine, Co-trimoxazole, Ciprofloxacin, Cephalexin, Metronidazole, Amoxicillin, Penicillin, Isoniazid
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3
Q

What infections are most likely to cause meningitis in a neonate?

A

E.coli

L.monocytogenes

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4
Q

What infection is most likely to cause meningitis in a 2-5yr old?

A

H.influenzae type B

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5
Q

What infection is most likely to cause meningitis in a 5-30yr old?

A

N.meningitides

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6
Q

What infection is most likely to cause meningitis in a 30+yr old?

A

S.pneumoniae

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7
Q

What are some early signs of meningitis?

A
  • Headache
  • Fever
  • Cold peripheries
  • Leg pains
  • Abnormal skin colour
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8
Q

What are some late signs of meningitis?

A
  • Non-blanching/purpuric rash
  • Photophobia
  • Neck stiffness
  • Confusion
  • Reduced GCS
  • Coma
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9
Q

How does meningitis cause photophobia?

A

The optic nerve is surrounded by the meninges, so the optic nerve also becomes inflamed in meningitis, so is sensitive to ^^stimulation ie bright light

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10
Q

How does meningitis cause a non-blanching rash?

A

Meningococci:
1) Have endotoxin which ^prod of TNFα/IL-1 etc
2) Invades vascular endothelium
= haemorrhage skin lesions

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11
Q

How does meningitis lead to limb ischaemia?

A

Meningococci:
1) Have endotoxin which ^prod of TNFα/IL-1 etc
2) Invades vascular endothelium
= haemorrhage skin lesions and thrombosis of arteries = peripheral necrosis

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12
Q

What is the immediate management of a patient presenting acutely, if there are meningitic and septicaemia signs?

A
  • High-flow O2
  • ABG
  • IV access
  • Take blood: FBC, U&Es, LFT’s, glucose, CRP, ESR, culture
  • IV Ceftriaxone + IV Dexamethasone
  • Fluid resus
  • Get senior help

NO NOT DO A LUMBAR PUNCTURE

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13
Q

When should a lumbar puncture NOT be performed in suspected meningitis?

A

If signs of shock or raised intracranial pressure

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14
Q

What is the appearance of normal CSF?

A

Gin clear

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15
Q

What are the layers the needle goes through during a lumbar puncture?

A
  • Skin
  • Subcutaneous tissue
  • Supraspinatous ligament
  • Interspinous ligament
  • Ligamentum flavum
  • Dura mater = POP
  • Sub-dural space
  • Arachnoid mater
  • Sub-arachnoid space = CSF
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16
Q

What is the normal pressure of the CSF?

A

12-15mmHg

17
Q

What is the normal WCC range in the CSF?

A

0-5

18
Q

Describe how the CSF would appear if bacterial meningitis: Why?

A

Cloudy

^^^ WCC + protein

19
Q

What type of infection can cause CSF to form a fibrin web if left to settle?

A

CNS TB

20
Q

Which infective cause of meningitis does IV Ceftriaxone NOT cover? What is the treatment?

A

Listeria monocytogenes

IV Ampicillin + Gentamicin

21
Q

What is the treatment of TB meningitis?

A 
Rifampicin
Isoniazid
Pyrazinamole
Ethambutol
Dexamethasone
Investigate for TB elsewhere
22
Q

What pathogen can cause fibrosis of the meninges = ‘chronic meningitis’?

A

TB

23
Q

Listeria meningitis is more common in which groups of people?

A
  • Alcoholics
  • Pregnant women
  • Elderly
24
Q

What is the most common cause of encephalitis?

A

HSV 1/2

25
Q

What is the main diagnostic differences between meningitis and encephalitis?

A 
Encephalitis has all the features of meningitis 
PLUS:
- Change in behaviour +/- personality
- Acute confusion/amnesia
- Normal viral prodrome usually
May also have:
- Lymphadenopathy
- Hepatosplenomegaly
- Parotid enlargement
26
Q

What is the immediate management of encephalitis?

A
  • High-flow O2
  • IV access
  • Take blood: FBC, U&Es, LFTs, glucose, CRP, ESR, culture
  • Start IV Aciclovir
  • May req sedation/ITU/1:1
  • CT/MRI head
  • If no ^ICP = lumbar puncture
  • Alert senior

Semester 5 - Neuro (14 decks)

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