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Neurology Week 3 2018/19 > 3: CNS infections > Flashcards

3: CNS infections Flashcards

1
Q

What are consequences of untreated CNS infections?

A

Brain herniation (Monro Kellie)

Cord compression and necrosis

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2
Q

What is the difference between meningitis and encephalitis?

A

Meningitis - meninges affected only

Encephalitis - diffuse infection of brain tissue

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3
Q

What is the difference between encephalitis and encephalopathy?

A

Encephalopathy - broader term meaning any disease of the brain

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4
Q

What does aseptic meningitis mean?

A

No bacteria isolated from culture after two days

Could mean inflammation has viral/other origin

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5
Q

Chronic CNS infections are common in people who are ___.

What is an example?

A

immunosuppressed

TB

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6
Q

Why are brain abscesses particularly dangerous?

A

Focal area of pus in the brain

causing FOCAL SYMPTOMS

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7
Q

What is pyogenic meningitis?

A

Meningitis caused by purulent bacteria

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8
Q

What does Strep. pneumoniae look like on a Gram film?

A

Gram positive cocci in chains

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9
Q

What does Meningococcus look like on a Gram film?

A

Encapsulated Gram -ve cocci

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10
Q

What does Listeria monocytogenes look like on a Gram film?

A

Gram positive bacilli

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11
Q

What does H influenzae look like on a Gram film?

A

Gram negative bacillus

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12
Q

What is the second most common type of meningitis after bacterial?

A

Viral meningitis

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13
Q

When in the year does viral meningitis tend to present?

A

Late summer

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14
Q

How is viral meningitis investigated?

A

Pharyngeal swab for viral PCR

Stool sample (for enterococcus)

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15
Q

What are the important viruses which cause meningitis?

A

Enterococcus

HSV

Mumps (in countries which aren’t vaccinated for it)

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16
Q

How does meningitis tend to present?

A

Fever

Headache

Neck stiffness

+/- meningococcal rash

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17
Q

What is the difference between the presentations of meningitis and encephalitis?

A

Meningitis - classic triad of headache, fever and neck stiffness

Encephalitis - diffuse infection, so widespread mental state changes +/- sepsis

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18
Q

Neck stiffness tends to be a feature of (meningitis / encephalitis).

A

meningitis

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19
Q

What virus should you worry about in people presenting with encephalitis?

A

HSV

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20
Q

Which treatment is given for suspected encephalitis?

A

Aciclovir IV

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21
Q

Which imaging modality is helpful in diagnosing encephalitis?

22
Q

Which organisms should you strongly suspect in patients with bacterial meningitis?

A

Neisseria meningitidis / Meningococcus - most common, accompanied by a rash

Strep. pneumoniae - next most common

Listeria monocytogenes - in those > 60, immunosuppressed

H. influenzae - in children who haven’t been vaccinated

23
Q

How do most cases of bacterial meningitis start?

A

Colonisation of nasopharynx by meningococcus

24
Q

What is the gold standard investigation for bacterial meningitis?

A

Lumbar puncture –> CSF culture

25
In bacterial meningitis, **CSF white blood count is raised.** Which value is typical of bacterial meningitis?
**\>2000**
26
In bacterial meningitis, CSF glucose conc. will be (more than / less than) that of blood glucose.
less than because the bugs are munching it
27
Which investigation amplifies the amount of bug present and helps you to identify the causal agent of a meningitis?
PCR
28
Where does meningococcus colonise?
Nasopharynx
29
What is a cutaneous sign of meningococcal septicaemia?
**Widespread, *non-blanching* purpuric rash**
30
Why is H influenzae meningitis much less common nowadays?
Vaccination
31
Who tends to get Strep meningitis?
Kids Hospitalised patients Patients with cochlear implants
32
Who tends to get Listeria meningitis?
Older patients (\>60) Immunosuppressed
33
What is the antibiotic of choice for a) meningococcal / Strep b) Listeria meningitis?
a) Ceftriaxone b) Ceftriaxone + Amoxicilin (latter is the effective one, keep cef until you eliminate the others)
34
What are some causes of aseptic meningitis?
Viral infection Irritation of meninges by infection elsewhere Amoebic meningitis Chemical-induced Behcets syndrome Drugs
35
What is the antibiotic of choice for bacterial meningitis?
Ceftriaxone | (Chloramphenicol if allergic)
36
What is given alongside Ceftriaxone for most cases of bacterial meningitis?
Dexamethasone proven to help in Strep infection, if confirmed not Strep, stop it
37
Which antibiotic is ADDED in suspected Listeria infection?
Amoxicillin
38
Meningitis is a ___ disease, meaning any new cases must be reported to ___ \_\_\_.
**notifiable** **Public Health**
39
What is given as prophylaxis for bacterial meningitis?
Vaccination
40
How do bacteria reach the meninges?
Direct spread from nasopharynx Invasion from other sites of trauma/infection e.g sinuses, fractures Invasion via bloodstream
41
What are the symptoms of meningitis?
Fever Headache Neck stiffness (In meningococcal infections there may be a widespread purpuric rash)
42
What is Kernig's sign?
**If patient is lying supine and asked to extend knee from 90 degree flexion, they won't be able to** Physically demonstrable sign of meningitis
43
As meningitis progresses, patients experience ___ symptoms like photophobia and a reduced conscious level.
neurological symptoms
44
What biochemical patterns will you see on lumbar puncture of someone with acute bacterial meningitis?
**Raised WBC and neutrophils** **Raised protein** **Low CSF glucose**
45
What biochemical patterns will you see on lumbar puncture of someone with viral meningitis?
No Gram results (not bacteria) Normal glucose
46
What biochemical patterns would you see on lumbar puncture of a patient with chronic tuberculous meningitis?
Raised WBC and lymphocytes (chronic inflammation) Raised protein Reduced CSF glucose (because the bugs are using it)
47
Which antibiotic is given first line for bacterial meningitis?
**Ceftriaxone IV** **2g BD**
48
Which antibiotic is given first line for suspected bacterial meningitis if a patient is allergic to beta lactams?
**Chloramphenicol**
49
What drug is given to every patient with bacterial meningitis in addition to ceftriaxone? Why?
**Dexamethasone** Proven to improve outcomes in *Strep. pnuemoniae* infection, if another bug cultured you would stop it
50
For bacterial meningitis, which drug is added to ceftriaxone + dexamethasone if a patient is \> 60 or immunocompromised? Why?
**Amoxicillin** Ceftriaxone isn't effective on *Listeria*
51
Which drug is given first line for suspected viral meningitis?
**Aciclovir IV**

Neurology Week 3 2018/19 (10 decks)

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