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Neurology > CNS Infection > Flashcards

CNS Infection Flashcards

1
Q

Symptoms of meningitis

A

Headache
Neck stiffness
Photophobia
Reduced consciousness level

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2
Q

Causative organisms of bacterial meningitis by age

neonates, children, adolescents, adults and elderly

A

Neonates

  • listeria monocytogenes
  • group B strep
  • e coli

Children
- haemophilus influenzae

Adolescents
- nerisseria meningtidis

Adults
- strep pneumonia > neisseria meningtidis

Elderly
- strep pneumonia > listeria monocytogenes

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3
Q

Appearance of strep pneumoniae on gram stain.

A

Gram positive diplococcus

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4
Q

Who get strep pneumoniae meningitis?

A

Adults
Elderly
Skull fractures

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5
Q

How do bacteria get to the meninges to cause meninigitis?

What is the clinical relevance of this?

A

Haematogenous spread from nasopharynx

Previous sinusitis can break down mucosa allowing spread of bacteria

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6
Q

Appearance of neisseria meningtidis on gram stain.

A

Gram negative diplococcus

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7
Q

Who gets neisseria meningtidis meningitis?

A

Adolescents

second most common in adults/elderly

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8
Q

Appearance of listeria monocytgenes on gram stain.

A

Gram positive bacillus

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9
Q

Who gets listeria monocytogenes meningitis?

A

Neonates and elderly

Immunocompromised

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10
Q

Patient presents to GP with non-blanching rash, fever, neck stiffness, photophobia.

Immediate management?

A

IM benzylpenicillin and immediate transfer to hospital

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11
Q

What organism causes non-blanching rash in meningitis?

A

Neisseria meningtidis

meningococcal

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12
Q

What antibiotic regimen do you use for bacterial meningitis?

A

IV ceftriaxone

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13
Q

What antibiotic regimen do you use for bacterial meningitis if

  • penicillin allergic
  • > 60/immunocompromised
  • recent travel?
A

Penicillin allergy: chloramphenicol

> 60/immunocompromised: amoxicillin (co-trimoxazole if penicillin allergic)

Recent travel: add vancomycin

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14
Q

What should be given with antibiotics in bacterial meningitis and in what scenario?

Why?

A

IV dexamethasone until pneumococcus ruled out

Reduces inflammation and neurological complications

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15
Q

What antibiotics should you give those in close contact with someone in meningitis?

A

Rifampacin 4 doses

Ciprofloxacin/ceftriaxone single dose

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16
Q

What is the commonest causative organism of viral meningitis?

A

Coxsackie/echovirus

17
Q

What organism causes severe viral meningitis?

A

Herpes simplex virus

Varicella zoster

18
Q

How do you manage viral meningitis?

A

Supportive

Unless HSV/varicella zoster where IV acyclovir

19
Q

Presentation of tuberculous meningitis.

A

Starts as non-specific illness in elderly/immunocompromised/travel history which progresses to a classical meningitis

20
Q

LP findings in bacterial meningitis.

A

Cloudy appearance

High neutrophils

Low glucose

21
Q

LP findings in viral meningitis.

A

Clear appearance

High lymphocytes

Normal glucose

22
Q

LP findings in tuberculous meningitis.

A

Clear appearance (forms fibrin web)

High lymphocytes

Low glucose

23
Q

How do you differentiate viral meningitis from bacterial on LP

A

Appearance: bacterial would be cloudy and viral would be clear

Cell type: bacterial has neutrophils and viral and lymphocytes

Glucose: bacterial has low glucose and viral has normal glucose

24
Q

How do you differentiate bacterial and tuberculous meningitis on LP?

A

Appearance: bacterial would be cloudy, tuberculous may form fibrin web

Cell type: bacterial as neutrophils and viral has lymphocytes

Glucose: both have low glucose

25
Q

How do you differentiate viral and tuberculous meningitis on LP?

A

Appearance: both clear but tuberculous may form fibrin web

Cells: both lymphocytes

Glucose: viral has normal glucose, tuberculous has low glucose

26
Q

Neutrophils on LP.

What type of meningitis?

A

Bacterial

27
Q

Cloudy LP

What type of meningitis?

A

Bacterial

28
Q

Fibrin web on LP.

What type of meningitis?

A

Tuberculous

29
Q

Normal glucose on LP.

What type of meningitis?

A

Viral

30
Q

What investigations should you order in meningitis?

A

Blood culture, LP

31
Q

Patient presents with fever, neck stiffness, photophobia and papilloedema.

What investigations should you request and why?

A

Blood culture (for septicaemia)

CT BEFORE LP (must rule out ICP to prevent coning)

LP

32
Q

Contraindications to LP.

A

Severe sepsis/rapidly evolving rash

Bleeding risk

Signs on ICP (LP may cause coning)

Neurology (11 decks)

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