CNS infection Flashcards
Encephalitis means what?
Inflammation of brain matter
Aseptic meningitis clinical picture?
WCC >5 in CSF
negative bact culture
Most common aseptic meningitis?
Viral, or partially treated bacterial
Individual virus particle?
Virion
Is herpes virus enveloped?
Yes
Peaks of viral meningitis age?
neonate and age 5
Most common viral cause?
Enteroviruses - coxsackie, echovirus
Herpes virus 1 or 2 causing meningitis more?
2 and this causes genital herpes
Unknown cause of viral meningitis %
35%
Viral symptoms usually due to what?
Bodies response
What is meningism?
Nick stiffness, headache, photophobia
Presentation of meningitis in kids?
absent often, rigid neck, and bulging ant fontanelle
What is kernigs sign?
hip and knee flexed at 90degree knee cant be extended due to neck pain/stiffness
Flexing of neck causes the hips and knees to flex is what sign?
Brudzinskis
When to do a ct in suspected meningitis?
Not very often on if sub arach or raised icp suspected or focal signs
When to do lumbar punctures?
should always measure what when you do a lumbar puncture?
Blood glucose too!
Viral csf profile?
Lymphocytic usually
Opening pressure in viral vs bacterial meningitis?
Viral low bac high
Bacterial meningitis protein?
High
Glucose ratio in bacterial meningitis?
Low
ABX of choice with suspected meningitis?
Cefotaxime
Classic time for enteroviral meningitis?
summer/aurumn
Any evidence to suggest use of aciclovir?
Not really
Viral encephalitis cause in >90%?
HSV1
Important difference with encephalitis is what?
Altered mental state and seizures
What may EEG show in 75% of patients with encephalitis ?
Abnormal temporall lobe activity
Treatment of viral enceph?
High dose aciclovir 10mg/kg tds for 2-3 weeks do not wait
Mortality of untreated enceph?
70%
ADEM stands for what in neuro?
Acute disseminated encephalomyelopathy
PCR is clear on csf could be?
ADEM
Neisseria meningitidis
bacteria type?
Gram +ve diplococci
what does Neisseria meningitidis need to grow?
Choclate agar (blood)
Antibiotics for close contacts of meninigitis victim?
ciprofloxacin/rifampicin
Other causative bacteria for meningitis other than meningitidis?
Strep pneumoniae and haemophillus
optochin test for which bacteria?
Strep pneumoniae
What adjunct is indicated for adult bacterial meningitis? Which strain?
Dexamethasone with first dose of abx strep pneumo only not meningococcal
Neonatal meningitis suspect organisms?
Group b strep, listeria and e-coli
Early neonatal infection likely to be what (neuro)?
Septicaemia
Late infection of neonate >5 days neuro signs =?
meningitis
Cryptococcal meningitis in who?
Late HIV
Cryptococcal (yeast)meningitis treatment?
amphotericin, fluconazole and flucytosine
Bacteria forming a drumstick appearance?
C.tetani
Where is c.tetani found naturally?
Soil
Most common entry site for tetanus infection?
foot
C.tetani treatment?
Antitoxin (horse or human) penicillin metronidazole)
Most common bacterium in brain abscess?
Strep milleri 60-70%
Atypical bacteria causing brain abscess?
TB, toxplasma, nocardia, actinomyces
Persistent infection can lead to brain abscess, which infection?
Endocarditis
Most common presentation of brain abscess?
Headache and focal neurological defect
Which symptom often missing in brain abscesses?
Fever can be severe infection too
Principle of abscess drainage?
Drainage unless very small, confirm bacteria and avoid spread to ventricles!
ABX that penetrate well into pus?
ampicillin, penicillin g, cefotax, ceftaz(anti pseudo) and metro
Subdural empyema is what?
Infection between dura and arachnoid
Subdural empyema often spreads from where?
Sinus and middle ear
Focal defects likely in which infection brain?
Subdural empyema
Most common cause of vp shunt infection?
Coagulase negative staph
