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Y3 - Neuro > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What are the different CNS infections?

A

Meningitis

Encephalitis

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2
Q

What is meningitis?

A

Inflammation of the brain meninges

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3
Q

What is the pathology of acute bacterial meningitis?

A

Pia-arachnoid congested with neutrophils
Layer of pus forms
May organise to form adhesions, causing cranial nerve palsies and hydrocephalus

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4
Q

What is the pathology of chronic meningitis?

A

Brain is covered in exudate with numerous meningeal tubercles (small abscesses)
Adhesions form
Cerebral oedema occurs

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5
Q

What is the pathology of viral meningitis?

A

Predominantly lymphocytic

No pus formation, neutrophils or adhesions, little to no cerebral oedema

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6
Q

What is an example of a cause of chronic meningitis?

A

TB

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7
Q

What is the most common cause of meningitis?

A

Viral

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8
Q

When in the year does viral meningitis occur more often?

A

Late summer, early autumn

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9
Q

What are the most common causative organisms of viral meningitis?

A

Enteroviruses - coxsackie or echo viruses

Herpes simplex

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10
Q

How does the onset of viral meningitis differ from bacterial?

A

Viral has more insidious onset

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11
Q

What are the three ways that bacteria can spread into the CNS?

A

Spread from nasopharynx
Direct extension due to skull fractures or para-meningeal foci in the mastoid or air sinuses
Spread from remote foci due to sepsis

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12
Q

What are the most common causative bacteria in meningitis?

A 
Strep pneumoniae
Neisseria meningitis
Haemophilus influenzae
Listeria monocytogenes
TB
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13
Q

Who are more likely to get strep pneumoniae meningitis?

A 
Hospitalised patients
CSF skull fractures
Diabetics
Alcoholics
Young children
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14
Q

Who are more likely to get neisseria meningitis?

A

Young children

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15
Q

How can neisseria meningitis be differentiated?

A

Rash doesn’t blanch

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16
Q

What is the name for meningitis caused by neisseria meningitis?

A

Meningococcal meningitis

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17
Q

Who are more likely to get haemophilia influenzae meningitis?

A

<40 year olds

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18
Q

What is the most common cause of meningitis in children under 4?

A

Haemophilus type B

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19
Q

Who are more likely to get listeria monocytogenes meningitis?

A

Over 55 year olds, or neonates
Soft cheese consumption
Immunocompromised

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20
Q

What is important about listeria monocytogenes meningitis?

A

Resistant to ceftriaxone - ampicillin/amoxicillin used instead (co-trimoxazole if pen allergic)

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21
Q

Who are more likely to get fungal meningitis?

A

Severely immunosuppressed (e.g. active HIV)

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22
Q

How can fungal meningitis be differentiated?

A

More subtle presentation

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23
Q

What are infective and non-infective causes of aseptic meningitis?

A

Infective: HIV, cryptococcal, TB

Non-infective: vasculitis, dural sinus thrombosis, drug-induced (NSAIDs, co-trimoxazole)

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24
Q

What are the more likely causative organisms in neonates?

A

Listeria
Group B strep
E coli

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25
Q

What are the more likely causative organisms in children <10?

A

Haemophilus influenza

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26
Q

What are the more likely causative organisms in people aged 10-21?

A

Meningococcal

Pneumococcal

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27
Q

What are the more likely causative organisms in people aged >21?

A

Pneumoccal

Neisseria meningitides

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28
Q

What are the more likely causative organisms in the elderly?

A

Pneumococcal

Listeria

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29
Q

What are the more likely causative organisms in immunocompromised patients?

A

All the conventional organisms
TB
Cryptococcal

30
Q

What are the more likely causative organisms in patients with skull fractures?

A

Pneumococcal

31
Q

What are the more likely causative organisms in patients who have had surgery or open head wound?

A

Staph aureus

32
Q

What are the more likely causative organisms in patients with a CSF shunt?

A

Staph epidermidis

33
Q

What is the main triad of symptoms in meningitis?

A

Fever
Headache
Neck stiffness

34
Q

What are the visual symptoms of meningitis?

A

Photophobia

35
Q

What are the dermatological symptoms of meningitis?

A

Non-blanching purpuric rash (meningococcal)

36
Q

What are the neurological symptoms of meningitis?

A

Confusion
Agitation
Altered level of consciousness
Seizures

37
Q

What is Kernig’s sign?

A

Pain and resistance on passive extension of the knee with a flexed hip

38
Q

What is the clinical presentation of meningitis?

A

Fever, headache, neck stiffness
Visual (photophobia)
Dermatological (Non-blanching purpuric rash - meningococcal septicaemia)
Neurological (Confusion, agitation, altered level of consciousness, seizures)
Kernig’s sign
Vomiting, riggers, malaise

39
Q

What are the patterns of onset in meningitis?

A

Develops within hours or minutes in acute bacterial meningitis
More insidious in viral or encephalitis

40
Q

What investigations should be done in meningitis?

A 
Bloods
Throat swab
CXR (if TB suspected)
Lumbar puncture
CT brain before LP if needed
41
Q

What is the diagnostic investigation for meningitis?

A

Lumbar puncture

42
Q

What bloods should be done in meningitis?

A 
FBC
U&Es
Coagulation screen
Glucose
Cultures
43
Q

What are the contraindications to a lumbar puncture?

A 
Immunosuppressed
Papilloedema
Focal neurological signs
Altered level of consciousness
History of CNS disease
44
Q

Why does a CT brain need to be done if any contraindications to LP are present?

A

To rule out raised ICP

45
Q

What results from a LP would suggest viral meningitis?

A 
Cell - lymphocytes
Gram stain - negative
Bacterial antigen - negative
Protein - normal
Glucose - normal
46
Q

What results from a LP would suggest bacterial meningitis?

A 
Cell - neutrophils
Gram stain - positive
Bacterial antigen - positive
Protein - high
Glucose - low <70% plasma
47
Q

What results from a LP would suggest TB meningitis?

A 
Cell - lymphocytes
Gram stain - positive or negative 
Bacterial antigen - negative
Protein - high or very high
Glucose - low <60% plasma
48
Q

What results from a LP would suggest aseptic meningitis?

A 
Cell - low WCC
Gram stain - negative
Bacterial antigen - negative
Protein - minimally increased
Glucose - normal
49
Q

What is the management for bacterial meningitis?

A

1st line - ceftriaxone
Penicillin allergy - chloramphenicol + vancomycin
>60 or immunosuppressed (listeria) - add amoxicillin (co-trimoxazole if penicillin allergy)
Give dexamethasone with or just before first dose of antibiotics - if pneumococcal confirmed continue for 4 days, if ruled out stop dex

50
Q

When should you not give dexamethosone with antibiotics?

A

Post-surgical meningitis
Severe immunocompromise
Meningococcal or septic shock
Patient hypersensitive to steroids

51
Q

What is the management for viral meningitis?

A

Treat as bacterial until viral confirmed

Then stop antibiotics and care switched to supportive

52
Q

What contact tracing needs to be done in meningitis?

A

Notify public health

Contact prophylaxis - ciprofloxacin single dose

53
Q

How many who survive meningitis are affected by after-effects?

A

25%

54
Q

What are examples of after-effects that can occur in meningitis?

A 
Lim loss
Deafness
Blindness
Cerebral palsy
Quadriplegia
Severe mental impairment
55
Q

What are complications of meningitis?

A

Purulence - exudate compressing cranial nerves (III and IV most vulnerable)
Invasion causing abscesses
Cerebral oedema
Hydrocephalus

56
Q

What is encephalitis?

A

Inflammation of the brain parenchyma (substance of the brain)

57
Q

How is encephalitis different from encephalopathy?

A

Encephalopathy is not always an infection, but can be any condition that alters brain function or structure

58
Q

What are the microbiological causes of encephalitis?

A

herpes simplex
Varicella zoster
CMV/HIV

59
Q

What is the presentation of encephalitis?

A

Similar to meningitis

Seizures

60
Q

How is encephalitis differentiated from meningitis?

A 
Presence of:
Psychosis
Odd behaviours
Speech and memory problems
Confusion
61
Q

What investigations are done for encephalitis?

A

Lumbar puncture
EEG
MRI

62
Q

How can HSV encephalitis be determined?

A

Bilateral focal temporal lobe enhancement on MRI

63
Q

What is the treatment of encephalitis?

A

Acyclovir

64
Q

What is meningoencephalitis?

A

Headache, fever and neck stiffness PLUS features of encephalitis

65
Q

What are the causes of a brain abscess?

A

Skull fractures
Endocarditis
Ear, sinus or dental infection

66
Q

What is the presentation of a brain abscess?

A

Raised ICP (headache, drowsiness)
Focal neurological signs
Fever
Epilepsy

67
Q

What investigations are done for brain abscesses, and what do they show?

A

CT/MRI - shows ring-enhancing mass, usually with surrounding oedema
Don’t do LP - because of raised ICP

68
Q

What is the management of brain abscess?

A

Neurosurgical referral for urgent drainage
High dose antibiotics
Mortality is high

69
Q

What is progressive multifocal leukoencephalopathy?

A

Caused by infection with JC virus within multiple areas of infection
Causes demyelinaion

70
Q

What are the risk factors for progressive multifocal leukoencephalopathy?

A

Immunosuppression
Autoimmune disease
Use of MS drugs (tysabri)

71
Q

How is progressive multifocal leukoencephalopathy diagnosed?

A

Symptoms of demyelination (similar to MS)
LP - JC virus DNA
MRI - enhancing lesions

72
Q

What is the treatment for progressive multifocal leukoencephalopathy?

A

No effective treatment - treat underlying cause

Y3 - Neuro (14 decks)

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