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1 - pbs2 > 30 - CNS Infections > Flashcards

30 - CNS Infections Flashcards

1
Q

Types of CNS infections

A 
Meningitis (most important) 
Encephalitis (second-most important)
Myelitis (spinal cord)
Neuritis (nerves)
Brain abscesses
Subdural empyema
Epidural abscess
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2
Q

Proportion of meningitis cases in less-developed countries

A

~96%

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3
Q

Case fatality of meningitis in less-developed countries

A

~50%

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4
Q

Age group in which meningitis is most common

A

Under one eyar

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5
Q

Age group in which meningitis case fatality ratio is highest

A

Over 65 years old

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6
Q

Aseptic meningitis

A

Inflammation of the meninges not caused by bacteria (mostly viral).
Can be non-infectious: malignancy, drugs (NSAIDs), inflammatory conditions.

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7
Q

Main viral causes of meningitis

A

Enteroviruses (coxsackie, echo)

Herpes viruses are less common (HSV, CMV, VZV, HHV6, EBV)

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8
Q

Are bacteria or viruses more likely to cause meningitis?

A

Viruses

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9
Q

Treatment of viral meningitis

A

Self-limiting, no long-term consequences. Wait for it to subside.

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10
Q

Dangerous meningitises

A

Those caused by bacteria.

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11
Q

Three most common bacterial causes of meningitis

A

H influenzae, N meningitidis, S pneumoniae (all capsulated, can evade immune system)

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12
Q

N meningitidis morphology

A

G- diplococcus

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13
Q

Most common N meningitidis causing meningitis in the world

A

Type A.

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14
Q

Most common N meningitidis causing meningitis in developed countries

A

B and C

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15
Q

Bacteria causing meningitis encountered by neonates (meningitis in first 3 months of life)

A

E coli
Group B streptococcus
Listeria monocytogenes

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16
Q

Broad stages of bacterial invasion of meninges and resulting meningitis
1 - 10

A
  1. Colonisation of nasopharngeal mucosa
  2. Invasion of bloodstream
  3. Survival and multiplication
    4 Crossing of BBB
  4. Invasion of meninges
  5. Increased permeability of BBB
    7/8. Pleocytosis and increased ICP
  6. Release of proinflammatory compounds
  7. Neuronal injury
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17
Q

Pleocytosis

A

Abnormal numbers of lymphocytes in CSF

18
Q 
Symptoms of meningitis in children
1
2
3
4
5
6
7
A 
Headache
Nausea
Stiff neck
Photophobia 
Fever
Seizures
Altered mental state
19
Q

Meningitis that can also present with rash

A

Meningococcaemia.

Gives a purpuric (non-blanching) rash

20
Q

Diagnosis of bacterial meningitis

A

Look for bacteria in CSF

21
Q

Normal CSF pressure

A

Under 150mm H2O

22
Q

White cell count of normal CF

A

5x10^6/L

23
Q

Protein in normal CSF

A

Under 0.4g/L

24
Q

Glucose in normal CSF

A

Over 60% of that in blood

25
Q

Good animal model for meningitis

A

Ferrets

26
Q

Appearance of CSF in viral meningitis

A 
Normal pressure and appearance.
Increased white cel count
Negative Gram stain
Slightly increased protein
Normal glucose
27
Q

Appearance of CSF in bacterial meningitis

A 
Raised ICP
Cloudy appearance
Very elevated white cell count
Positive Gram stain
Raised protein
Decreased glucose
28
Q

Appearance of CSF in TB meningitis

A 
Raised ICP
Cloudy CSF
Elevated white cell count
ZN positive stain
Very increased protein
Very decreased glucose
29
Q

White cell count at which CSF becomes cloudy

A

Extremely elevated

30
Q

Why can’t CSF samples be delayed?

A

Neutrophils and other white cells die off

Glucose decreases significantly with time

31
Q

Gram stain in those with bacterial meningitis

A

Normal 40% of the time (bacteria just aren’t detected)

32
Q

Can CSF values alone be used to diagnose bacterial meningitis?

A

No

33
Q

Effect of antibiotic treatment on CSF

A

Normalise values except for white cell count, which remains elevated

34
Q

Four things to consider when treating meningitis patients (in order of when to perform)

A

Resuscitation / Life support
Fluids (SIADH->moderate restriction)
Antibiotics
Steroids

35
Q

Most common deficit on surviving bacterial meningitis

A

Hearing loss

36
Q

What is not affected in meningitis?

A

Brain is not inflamed

37
Q

Symptom of encephalitis that is almost always present

A

Altered mental state

38
Q

Most common, and important cause, of encephalitis

A

HSV

39
Q

How is HSV encephalitis treated?

A

Acyclovir

40
Q

Meningoccus that is vaccinated against

A

Group C.

New vaccine for B (not given routinely in Australia)

1 - pbs2 (96 decks)

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