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Neurology > CNS Infection > Flashcards

CNS Infection Flashcards

1
Q

What are the cardinal features of meningism?

A
  • headache
  • neck stiffness
  • photophobia
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2
Q

What is meningococcaemia?

A

presence of neisseria meningitidis in the blood

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3
Q

What is meningitis?

A

Inflammation of the meninges (arachnoid and pia mater)

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4
Q

What are the most common bacterial causes of meningitis in neonates (<1 month)?

A
  • Beta-haemolytic streptococci
  • Gram negative bacilli (e.g. E. coli, proteus)
  • Listeria (less common)
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5
Q

What are the most common bacterial causes of meningitis in children <5yrs

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
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6
Q

What are the most common bacterial causes of meningitis in 5-60 year-olds?

A
  • Neisseria meningitidis

- Streptococcus pneumoniae

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7
Q

What are the most common bacterial causes of meningitis in elderly (>60yrs)?

A
  • Streptococcus pneumoniae
  • Gram negative bacilli
  • Listeria (less common)
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8
Q

What is a common bacterial cause of meningitis in immunocompromised, diabetic or pregnant people?

A

Listeria

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9
Q

What are the most common viral causes of meningitis?

A

Enteroviruses (e.g. coxackie)
HSV-1
VZV
Mumps

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10
Q

What are the 4 possible origins of infection in meningitis?

A

1) direct inoculation through skull trauma
2) direct spread from adjacent structures (sinuses, middle ear)
3) haematological (bacteraemia)
4) malignant (e.g. septic emboli from infective endocarditis vegetation)

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11
Q

Describe the two special tests during examination that indicate meningism

A

Kernig’s sign:
- pain in neck when extending the knee with hip flexed

Brudzinski’s sign:
- involuntary flexion of knees/hips on flexion of neck

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12
Q

Describe the classical clinical features of bacterial meningitis

A
  • acute, severe, generalised headache
  • fever
  • neck stiffness
  • altered mental state (e.g. drowziness, irritability)
  • vomiting
  • photophobia
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13
Q

In what scenario do you find a non-blanching petechial rash?

A

Meningococcal meningitis (late sign)

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14
Q

What are the most common clinical features of viral meningitis?

A
  • acute headache
  • irritability
  • meningism
  • with/without fever
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15
Q

At what level do you carry out a lumbar puncture?

A

Between L3-L4 spinous processes

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16
Q

When is LP contra-indicated and why?

A

Raised ICP

Risk of uncal herniation

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17
Q

What are the 2 most important investigations to carry out early in suspected meningitis?

A

1) Lumbar puncture

2) Blood cultures

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18
Q

Describe the expected LP results in bacterial meningitis, including:

  • appearance
  • cells count and type
  • protein
  • glucose
A
  • turbid
  • very high cell count, mainly polymorphonuclear neutrophils
  • v high protein
  • v low glucose
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19
Q

Describe the expected LP results in viral meningitis, including:

  • appearance
  • cells count and type
  • protein
  • glucose
A
  • clear
  • increased cell count (not as high as bacterial), mainly monocytes
  • normal or slightly raised protein
  • normal or slightly decreased glucose
20
Q

Describe the expected LP results in encephalitis, including:

  • appearance
  • cells count and type
  • protein
  • glucose
A
  • clear
  • slightly increased cell count (not as high as bacterial/viral meningitis), mainly monocytes
  • normal or slightly raised protein
  • normal glucose
21
Q

Apart from biochemical analysis of CSF, what other tests should be done with CSF?

A

Gram stain and culture

PCR

22
Q

A patient has bacterial meningitis. CSF culture shows gram negative diplococci - what is the most likely diagnosis?

A

N. meningitidis

23
Q

A patient has bacterial meningitis. CSF culture shows gram positive diplococci - what is the most likely causative organism?

A

S. pneumoniae

24
Q

A patient has bacterial meningitis. CSF culture shows chains of gram positive cocci - what is the most likely causative organism?

A

Beta-haemolytic strep

25
Q

A patient has bacterial meningitis. CSF culture shows gram -ve coccobacilli - what is the most likely causative organism?

A

H. influenzae

26
Q

What blood tests demonstrate DIC?

A

PT

d-Dimer

27
Q

Give 4 complications of bacterial meningitis

A

1) Seizure
2) raised ICP
3) sensorineural hearing loss (esp with H. influenzae and Strep pneumoniae)
4) intellectual impairment

28
Q

What is the empirical treatment for 18-60yr olds with suspected bacterial meningitis?

A

Ceftriaxone + dexamethasone

29
Q

What is the empirical treatment for children (<18yrs) with suspected bacterial meningitis?

A

Ceftriaxone + vancomycin

30
Q

What is the definitive treatment of meningococcal meningitis?

A

Benzylpenicillin

31
Q

What is the definitive treatment of H. influenzae meningitis?

A

Ceftriaxone

32
Q

What is the definitive treatment of Strep pneumoniae meningitis?

A

Ceftriaxone

33
Q

How do you manage viral meningitis?

A

supportive treatment

34
Q

What is encephalitis?

A

Inflammation of the brain parenchyma

35
Q

What are the most common causes of encephalitis?

A

HSV-1
HZV
Measles
HIV

36
Q

Describe the key clinical features of encephalitis

A
  • acute onset
  • headache
  • fever
  • vomiting
  • altered consciousness
  • focal neurological deficit
37
Q

How should you investigate suspected encephalitis?

A
  • Bloods
  • Blood cultures
  • Viral throat swab
  • LP
  • CT or MRI
  • EEG
38
Q

What is the empirical management of encephalitis?

A

Aciclovir + ceftriaxone

39
Q

What is the definitive treatment of viral encephalitis?

A

Aciclovir

40
Q

Give 3 common sites from which bacteria may spread to the brain and cause an abscess

A

Sinuses
Dental abscess
Middle ear infection

41
Q

What are the likely causative organisms of temporal lobe abscess and what is the likely source?

A

Middle ear infection

Streptococci
Enterobacteriacae

42
Q

What are the likely causative organisms of frontal lobe abscess and what are the likely sources?

A

Paranasal sinus infection
Dental abscess

Streptotocci
Anaerobes

43
Q

What are the likely causative organisms of cerebellar abscess and what are the likely sources?

A

Sphenoid sinus infection
Middle ear infection

Pseudomonas
Anaerobes

44
Q

What is the most common organism in an abscess arising from direct penetrating injury to the skull

A

S. aureus

45
Q

What are the clinical features of a cerebral abscess?

A

Insidious onset headache
Fever
seizures
Focal neurological deficits

46
Q

What are the most appropriate investigations for brain abscess?

A

CT or T2-weighted MRI

47
Q

What is the empirical treatment of a cerebral abscess?

A

ceftriaxone + metronidazole

Neurology (4 decks)

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