Cerebral Inflammation - Clinical Case

Question 1

What is an infection of the spinal cord known as?

Answer 1

Myelitis

When both the brain and spinal cord are involved, the condition is known as encephalomyelitis

Question 2

What types of infections can cause encephalitis (4) and meningitis (3)?

Answer 2

Encephalitis:
* Commonly viruses:
* Herpes Simplex
* Measles
* Varicella (chickenpox)
* Rubella (German measles)

Meningitis:
* Commonly bacteria which initially cause an upper respiratory tract infection and then travel through the blood to the brain:
* pneumococcal - streptococcus pneumoniae
* meningococcal - Neisseria meningitides
* Haemophilus influenzae meningitis caused by Haemophilus influenzae b (reduced by Hib vaccination, previously a leading cause in children under 5)

Question 3

What are some hallmarks of encephalitis (4) and meningitis (8)?

Answer 3

Encephalitis:
* Fever
* Seizures
* Change in behaviour
* Confusion and disorientation

Meningitis:
* Sudden fever
* Severe headache
* Nausea or vomiting
* Double vision
* Drowsiness
* Sensitivity to bright light
* Stiff neck
* Rash (not always)

Question 4

What diagnostic tests can be performed to dignose meningitis or encephalitis (5)? What might be found on these tests?

Answer 4

• Neurological examination
• CT / MRI:
  
  • Encephalitis shows lesions depending on the cause
• Lumbar puncture:
  
  • CSF is usually clear and colourless
  • Low glucose in bacterial meningitis
  • Raised white blood cell counts are a sign of inflammation
• FBC:
  
  • Meningitis: leukocytosis, anaemia, thrombocytopenia
  • Encephalitis: often elevated WBC
• Urine analysis:
  
  • Meningitis: metabolic abnormalities

Question 5

What treatment options are commonly used for meningitis or encephalitis (4)?

Answer 5

• Antibiotics
• Antivirals
• Corticosteroids (reduces inflammation)
• Immunosuppressors

Question 6

What are some of the long term effects of meningitis (10)?

Answer 6

• Long term learning disabilities
• Memory loss
• Poor concentration
• Clumsiness / co-ordination problems
• Headaches
• Auditovestibular problems: Deafness / hearing problems / tinnitus / dizziness / loss of balance
• Epilepsy
• Weakness / paralysis / spasms
• Speech problems
• Visual problems