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Tim CP3 @ UoN - Medicine & Surgery > CNS Infection > Flashcards

CNS Infection Flashcards

1
Q

What is meningitis?

A

Inflammation of leptomeninges

-arachnoid/pia mater & underlying CSF

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2
Q

What are the most common (70%) causes of acute bacterial meningitis?

A

Neisseria meningitidis
-classic petechial rash, small epidemics
Streptococcus pneumonia
-more common if skull fractures/ear disease/congenital CNS lesions

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3
Q

What are the less common (30%) causes of acute bacterial meningitis?

A

Listeria monocytogenes (elderly/immunosuppressed)
Haemophilus influenzae
Staph aureus
TB

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4
Q

What are the common viral causes of meningitis?

A

Enteroviruses (coxsackie A/B, echoviruses)
HSV
VZV

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5
Q

What is the classic meningitic syndrome triad?

A

Headache
Neck stiffness
Fever

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6
Q

What sx are present in acute bacterial meningitis?

A 
Classic triad
High fever w/ rigors
Photophobia
Vomiting
Intense malaise
Confusion/seizures
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7
Q

What signs are present in acute bacterial meningitis?

A

Kernig’s –> knee flexed, knee extension causes pain
Brudzinski’s –> passive flexion of neck causes flexion of knees/hip
Signs of raised ICP/CN palsies

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8
Q

What are the common complications of acute bacterial meningitis?

A

Venous sinus thrombosis
Severe cerebral oedema
Hydrocephalus

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9
Q

What sx/signs indicate complications in acute bacterial meningitis?

A

Progressive drowsiness
Lateralising signs
CN lesions

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10
Q

What are the specific features of meningococcal meningitis?

A

Petechial rash (erythematous, non-blanching purpura)
Carried in nasopharynx
Caused by Men B/C
ACWY jab at 14yrs

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11
Q

What are the specific features of viral meningitis?

A

Benign/self-limiting
Lasts 4-10days
Headache for some months, no serious complications

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12
Q

What are the specific features of TB meningitis?

A

Insidious illness w/ fever, wt loss, progressive confusion/cerebral irritation –> coma
Treat w/ RIPE for 12mo w/ corticosterids
-decreases risk of cerebral oedema

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13
Q

What is the clinical presentation of an epidural spinal abscess?

A

Fever
Back pain
Spinal root lesiosn

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14
Q

What causes an epidural spinal abscess?

A

S. aureus from bloodsteam

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15
Q

What is the management of an epidural spinal abscess?

A

Rule out osteomyelitis
Emergency imaging
A/b
Surgical decompression

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16
Q

What is Encephalitis?

A

Inflammation of brain parenchyma, usually viral

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17
Q

What are the common clinical features of viral encephalitis?

A 
Headache
Drowsiness
Fever
Malaise
Confusion
18
Q

What are the clinical features of more severe viral encephalitis?

A 
High fever
Mood changes
Progressive drowsiness over hrs/days
Seizures/coma
Death (20%
19
Q

What are the causative organisms of severe viral encephalitis?

A

HSV-1
-necrotising encephalitis affecting temporal lobes
HSV-2
-meningitis (in adults)

20
Q

What investigations are appropriate in suspected viral encephalitis?

A

Head CT/MRI (diffuse oedema, temporal lobes)
LP (raised opening pressure, lympocytes, protein, normal glucose w/ +ve viral PCR)
Viral serology

21
Q

What is the management of viral encephalitis?

A

IV acyclovir >10/7

22
Q

What are the risk factors for TB meningitis?

A

Immunosuppression
Malnourishment
Multiple comorbidities
Recent contact w/ TB

23
Q

What is the most common cause of TB meningitis?

A

Blood-borne spread of M. tuberculosis

Following 1o infection/miliary TB

24
Q

What is the main risk factor for funal meningitis?

A

Immunosuppression

25
Q

What investigations are appropriate in suspected meningitis?

A

Bloods - FBC, LFTs, U&Es, clotting, glucose, lactate
Serum PCR (antigens)
Blood cultures
LP (MCS protein, glucose, meningo/pneumo/viral PCR)
CT (prior to LP if suspected raised ICP)
Throat swabs (1 for virology, 1 for bacteriology)

26
Q

What CSF stains demonstrate which causative organisms of meningitis?

A

Gram +ve intracellular diplococci (Pneumococcus)
Gram -ve cocci (Meningococcus)
Ziehl-Neelsen stain (TB)
Indian ink (Fungi)

27
Q

What are the features of normal CSF?

A

Crystal clear
<5 cells/mm3 (all lymphocytes/mononuclear cells)
Low protein (0.2-0.4g/L)
Low glucose (1/2 - 2/3 of blood levels)

28
Q

What are the features of CSF in bacterial meningitis?

A

Turbid fluid
High polymorphs
Low glucose
High protein

29
Q

What are the features of CSF in viral meningitis?

A

Clear fluid
High lymphocytes
Normal glucose
Normal protein

30
Q

What are the features of CSF in TB meningitis?

A

Yellowish/viscous fluid
High lymphocytes
Low glucose
High protein

31
Q

What is the appropriate empirical antibiotic regimen if a non-blanching rash is present?

A

Benzyl-penicillin 1.2g IM immediately

  • 2-4mg 4hrly in hospital
  • cefotaxime in penicillin allergic pts
32
Q

What is the appropriate empirical antibiotic regimen if <60yrs and NOT immunosuppressed?

A

IV ceftriaxone 2g BD
IV dexamethasone
-2 doses 6hrs apart, give w/ 1st a/b dose

33
Q

What is the appropriate empirical antibiotic regimen for penicillin allergic pts?

A

IV chloramphenicol 25mg/kg IV

34
Q

What is the appropriate empirical antibiotic regimen if >60yrs OR immunosuppressed?

A

IV ceftriaxone 2g BD
IV amoxicillin 2g 4hrly
IV dexamethasone

35
Q

What agent should be added in suspected herpes encephalitis?

A

IV acyclovir

36
Q

What agent should be given to close contacts as prophylaxis in meningococcal meningitis?

A

Ciprofloxacin, single dose

Eliminates pharyngeal cartilage

37
Q

What are the acute complications of bacterial meningitis?

A

Sepsis/DIC
Hydrocephalus
Adrenal haemorrhage (Waterhouse-Friderichsen syndrome)

38
Q

What are the long term complications of bacterial meningitis?

A

Brain abscess
Seizure disorders
CN palsies (sensorineural hearing loss or gaze palsies)
Ataxia/muscular hypotonia

39
Q

What are the risk factors for brain abscess formation?

A

Head trauma/neurosurgery
Otitis media/Paranasal sinus infections
2o to bacterial endocarditis

40
Q

What are the sx/signs of a brain abscess?

A

Features of expanding mass lesion
Fever
Systemic illness

41
Q

What is the management of a brain abscess?

A

Surgical drainage
Broad spectrum a/b
High dose corticosteroids

42
Q

What is the prognosis of a brain abscess?

A

Mortality 10%

Long-term sequalae greatest in pneumococcal disease

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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