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Week 13 - neurology > CNS infection > Flashcards

CNS infection Flashcards

1
Q

What are the anatomical categories of CNS infection?

A
  • Meningitis
  • Encephalitis
  • Mass lesion
  • Myelitis
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2
Q

What CNS infections can be caused by bacteria?

A
  • Meningitis
  • Meningo-encephalitis
  • Abscess
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3
Q

What CNS infections can be caused by viruses?

A
  • Encephalitis

* Meningitis

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4
Q

What CNS infections can be caused by fungi?

A
  • Meningo-encephalitis

* Mass lesions

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5
Q

What CNS infections can be caused by protozoa?

A
  • Mass lesion

* Eosinophilic-meningitis

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6
Q

What are the common bacterial causes of meningitis?

A
  • Meningococcus
  • Pneumococcus
  • Haemophilus influenza
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7
Q

What are the common bacterial causes of meningoencephalitis?

A
  • Listeria
  • Lyme
  • Syphilis
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8
Q

What are the common bacterial causes of abscess

A
  • Strep species
  • Anaerobes
  • Nocardia
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9
Q

What are the common viral causes of encephalitis?

A
  • Herpes simplex virus
  • Varicella zoster virus
  • Enterovirus
  • HIV
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10
Q

What are the common viral causes of meningitis?

A
  • Mumps
  • cytomegalovirus
  • West nile
  • JBE
  • JCV
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11
Q

What are the common fungal causes of meningoencephalitis?

A

Cryptococcosis

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12
Q

What is meningitis?

A
  • Inflammation of the meninges +/- cerebrum (meningoencephalitis)
  • Inflammatory CSF
  • Can be acute (bacterial or viral) or sub-acute (bacterial)
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13
Q

What are the signs and symptoms of meningitis?

A

•95% have two of:
- headache
- neck stiffness/rigidity
- reduced GCS
- fever
•Confusion indicative of cerebritis/encephalitis
•Rash - purpuric or petechial but macular early on

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14
Q

Describe the appearance of streptococcus pneumoniae

A

Gram positive diplococcus

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15
Q

Describe the appearance of neisseria meningitidis

A

Gram negative diplococcus (pink stained)

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16
Q

What is the appearance of listeria monocytogenes?

A

Gram positive rods

17
Q

What are the risk factors of meningitis?

A
  • Travel abroad -non endemic disease
  • IVDU - Staph aureus and streptococci
  • South east Asia - strep suis spread by pigs
  • cochlear implant
18
Q

Describe the risk factors of pneumococcal meningitis

A 
70% have an underlying disorder: 
•Middle ear disease 
•Head injury 
•Neurosurgery 
•Alcohol 
•Immunosuppression
19
Q

What are the risk factors of listeria meningitis

A
  • Immunosuppression
  • Pregnancy
  • Age >60
20
Q

What are the signs of pneumococcal meningitis?

A

•Much more likely to have neurological effects:
- focal signs
- seizures
- VIII palsy
•Community acquired infection, ENT infection, endocarditis

21
Q

What are the poor prognostic indicators?

A
  • Pneumococcus
  • Reduced GCS
  • CNS signs
  • Older age
  • CN palsy
  • Bleeding
22
Q

Describe the investigations for suspected meningitis

A 
•History and exam: examine throat and examine for cervial lymph nodes
•Blood cultures (PCR) 
•Throat culture, viral gargle 
•FBC, UEs, LFTs, CRP 
•Lumbar puncture: 
 - cell count, gram stain, culture, PCR 
 - protein and glucose 
 - viral PCR
23
Q

When should you do a CT in a suspected meningitis case?

A

•To exclude mass lesion/mass effect or gross cerebral oedema
•Doesn’t exclude raised intracranial pressure
•You should CT before a lumbar puncture if:
- GCS<12
- CNS signs
- papilloedema
- immunocompromised
- seizure

24
Q

What should you give before CT scan in suspected meningitis?

A

Antibiotics

25
Q

When is a lumbar puncture contraindicated?

A
  • Brain shift
  • Rapid GCS reduction
  • Respiratory or cardiac compromise
  • Severe sepsis
  • Rapidly evolving rash
  • Infection at LP site
  • Coagulopathy (INR>/1.5, platelets<40, DOAC, therapeutic LMWH)
26
Q

Describe bacterial meningitis CSF

A
  • Neutrophils (and lymphocytes with listeria)
  • Raised protein
  • Glucose reduced <50%
27
Q

Describe viral meningitis CSF

A
  • Lymphocytes (neutrophils early on)
  • Raised protein
  • Normal glucose
28
Q

Describe TB meningitis CSF

A
  • Lymphocytes
  • Raised protein
  • Reduced glucose <50%
29
Q

Describe fungal meningitis CSF

A
  • Lymphocytes
  • Raised protein
  • Reduced glucose <50%

Week 13 - neurology (12 decks)

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