CNS

Question 1

Summary of CNS infections

Answer 1

Meningitis
-Bacterial/ Viral/ TB/ Cryptococcus/ Neonatal

Encephalitis

Brain abscesses

VPS & EVD infections

Question 2

Which CNS infection is called by Viral (HSV1), Bacteria or autoimmune?

Answer 2

Encephalitis

Question 3

What are the 3 components of meningism?

Answer 3

Neck stiffness
Headache
Photophobia

Question 4

Which CNS infection presents as meningism, acute fever, +/- rash and no focal neurology?

Answer 4

MENINGITIS

Question 5

Which CNS infection presents as +/- meningism, acute fever, CHANGE IN MENTAL STATE, +/- focal neurology?

Answer 5

ENCEPHALITIS

Question 6

What type of fever do you get with a brain abscess?

other symptoms?

Answer 6

Gradual fever

Headache
+/- neck stiffness/ focal neurology

Question 7

Causes of brain abcesses?

Answer 7

Bacteria

parasites

Question 8

Which CNS infections have altered conciousness?

Answer 8

ENCEPHALITIS

BRAIN ABSCESS

Question 9

State the 4 causes of meningitis

Answer 9

Viral
Bacterial
TB
Cryptococcus

Question 10

What test would you do to analysis a patient’s CSF?

Answer 10

Lumbar puncture

Patient in foetal position - L3-L4

Question 11

What type of infection does the following CSF analysis suggest:
Cell count > 200
WBC present
Low glucose
Increase protein

Answer 11

Bacterial infection

Question 12

Bacterial meningitis can be caused by which 3 organisms?

Answer 12

N. Meningitidis
H. Influenzae
S. pneumoniae

Question 13

How would you treat Bacterial meningitis?

Answer 13

Ceftriaxone
Cefotaxime
Penicillin

Question 14

Would you give prophylaxis to the contacts of the bacterial meningitis patient?

Answer 14

YES

Rifampicin

Question 15

Neonatal meningitis is caused by E.Coli, Listeria monocytogenes, Group B strep.
How were they exposed?

Answer 15

Preg

Birth canal

Question 16

How would you treat neonatal meningitis?

Answer 16

Cefotaxime

Ampicillin + Gentamicin

Question 17

Which type of meningitis is a MEDICAL EMERGENCY + NOFTIABLE?

Answer 17

VIRAL MENINGITIS

Question 18

Viral meningitis is common in which age group?

Answer 18

Neonates

Children

Question 19

State 5 common causes of viral meningitis.

Answer 19

ENTEROVIRUS*
HSV - diff= Mollarets M..
VSV
Mumps 
HIV

“V” for Viral Meningitis

Question 20

Kernig’s and Brudzinski’s sign would be found on examination of a patient with bacterial meningitis.
T/F?

Answer 20

F

+ve in patient with VIRAL meningitis

Question 21

Describe Kernig’s sign.

Answer 21

When hip & knee flexed –> pain/stiff in hamstrings, when EXTEND knee

Question 22

Describe Brudzinski’s sign.

Answer 22

Flexing neck causes hip & knee to flex

patient lying down

Question 23

What investigations would you do in a case of suspected viral meningitis?

Answer 23

Blood tests - esp Clotting
LP
CT head
Throat/stool - enterovirus
Serology - Mumps, HSV, EBV, HIV

Question 24

Treatment for Viral meningitis?

Answer 24

Supportive

Question 25

What test do you need to do before performing a Lumbar puncture?

Answer 25

Clotting

Question 26

In order to compare the glucose CSF: blood, what should be taken simultaneously?

Answer 26

Blood glucose

Question 27

TB meningitis is gradual onset. (Bacteria slow to grow). What are the risk factors?

Answer 27

Same as TB Immunocompromised Alcoholics

Question 28

What cell type would you see in a LP confirming TB meningitis?

Answer 28

Lymphocytes

Question 29

Treatment of TB meningitis?

Answer 29

12 month standard TB treatment

Question 30

Cryptococcus meningitis is seen especially in whom?

Answer 30

HIV

Question 31

Cryptococcus meningitis has the same CSF findings as TB M. What is the treatment?

Answer 31

Fluconazole | Amphotericin

Question 32

List the complications of Meningitis

Answer 32

``` Sepsis Increased ICP Deafness Delayed development Seizures Stroke Hydrocephalus ```

Question 33

Which CNS infection should you treat on clinical suspicion?

Answer 33

ENCEPHALITIS

Question 34

With suspected Meningitis/Encephalitis, What should you alwyas ask the patient?

Answer 34

TRAVEL HISTORY

Question 35

90% of Encephalitis is caused by...?

Answer 35

HSV1

Question 36

Presentation of Encephalitis?

Answer 36

``` (Meningism) Acute fever CHANGE IN MENTAL STATE +/- focal neurology (weakeness, ataxia, dysphagia, CN palsy..) Seizures ALTERED CONCIOUSNESS ```

Question 37

Investigations of Encephalitis?

Answer 37

``` FULL NEUROLOGICAL EXAM Bloods CT MRI - typical changes LP EEG - abnormal tempora activity ```

Question 38

How do the LP results of Encephalitis compare to Viral Meningitis?

Answer 38

The same

Question 39

Treatment of Encephalitis?

Answer 39

IV Aciclovir (14-21 days) Repeat LP

Question 40

Which autoimmune CNS demyelination condition presents the same and has same CSF fidnings as encephalitis?

Answer 40

ADEM Acute disseminated Encephalomyopathy

Question 41

Are brain abscess monomicrobial or polymicrobial?

Answer 41

POLYMICROBIAL

Question 42

How do brain abscesses occur?

Answer 42

Direct spread (ear, sinus, teeth) Blood- Endocarditis, Bronchiectasis Trauma Idiopathic

Question 43

Clinical presentation of brain abcesses?

Answer 43

``` Headache Neck stiffness Gradual fever Seizures Nausea/Vomiting Focal neurology ```

Question 44

State 2 complications of brain abscesses.

Answer 44

Increased ICP --> mass effect Rupture --> Ventriculitis

Question 45

What is the main way of managing brain abscesses?

Answer 45

Drainage

Question 46

What is an example of a brain abscess

Answer 46

Subdural empyema

Question 47

Neurosurgical patients have a VP shunt/EVD shunt to treat hydrocephalus/monitor CSF respectively. How does infection occur?

Answer 47

Tubes become colonised

Question 48

How would you manage VP shunt/EVD infection to avoid ventriculitis?

Answer 48

Remove drain IV antibiotics