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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

List 7 types of CNS infections

A 
Encephalitis, 
Meningitis, 
Meningoencephalitis, 
Encephalomyelitis, 
Epidural abscess, 
Neuritis, 
Sepsis syndrome due to infection elsewhere (indirect)
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2
Q

What is the difference between meningitis and encephalitis?

A

Encephalitis involves inflammation of brain parenchyma

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3
Q

How is meningitis classified? (5)

A 
Acute pyogenic (pus forming) meningitis, 
Acute aseptic meningitis, 
Acute focal suppurative infection, 
Chronic bacterial infection, 
Acute encephalitis
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4
Q

What is the most common microbial cause of acute pyogenic meningitis?

A

Bacterial

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5
Q

What is most common microbial cause of acute aseptic meningitis?

A

Viral

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6
Q

Give 3 examples of acute focal suppurative infections

A

Brain abscess,
Subdural empyema,
Extradural empyema

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7
Q

Give an example of a chronic bacterial infection of meningitis

A

TB

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8
Q

How does pyogenic meningitis present in pathology?

A

Thick layer of suppurative exudate covering the leptomeninges (arachnoid and pia mater) of surface of brain

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9
Q

How does pyogenic meningitis present microscopically in histology?

A

Neutrophils in the subarachnoid space

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10
Q

What are the 4 bugs found in bacterial meningitis? Which is very rare?

A

Strep pneumoniae,
Neisseria meningitidis,
Listeria monocytogenes,
Haemophilus influenzae - very rare

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11
Q

What type of bacteria is strep pneumoniae?

A

Gram +ve diplococci

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12
Q

What type of bacteria is neisseria meningitidis?

A

Gram -ve diplococci

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13
Q

What type of bacteria is listeria monocytogenes?

A

Gram +ve bacilli

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14
Q

What type of bacteria is haemophilus influenzae?

A

curvilinear gram -ve bacillis

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15
Q

Immunosuppressed patients of very young or people >60 tend to get which type of bacterial meningitis?

A

Listeria monocytogenes

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16
Q

Which bacterial meningitis used to mostly be in children but has been mostly eradicated by vaccines?

A

Haemophilus influenzae

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17
Q

Secondary attack

A

Neisseria meningitidis

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18
Q

What is treatment for patients with strep pneumoniae, neisseria, haemophilus influenzae?

A

Ceftriazone IV 2g bd and dexamethasone IV 10mg qds

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19
Q

What is treatment for patients with listeria bacterial meningitidis?

A

Ceftiaxone IV 2g bd + dexamethasone IV 10g qds + amoxicillin IV 2g 4ourly

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20
Q

If needing to add listeria cover and patient has penicillin allergy, what is treatment?

A

Co-trimoxazole IV

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21
Q

How long continue antibiotics for each bacteria: strep, neisseria, haem, listeria?

A

Strep: 5 days ceftriaxone
Neisseria: 10 days ceftriaxone
Haem: 10 days ceftriaxone
Listeria: 21 days amox

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22
Q

If patient has travelled to country with high rates of penicillin resistant pneumococci (e.g. Canada, China, Poland, Spain, USA, Mexico, Italy, Greece, Turkey, Croatia, Pakistan), what is treatment?

A

Ceftriaxone IV + dexamethasone IV + vancomycin IV or rifampicin IV/PO

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23
Q

Which patients should steroids be given to, how much?

A

ALL patients suspected of bacterial meningitis - 10mg IV 15-20mins before or with first dose of antibiotic

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24
Q

Giving what drug reduces unfavourable outcome from 25% to 15% and mortality from 15% to 7%?

A

Steroids

25
Q

When should you NOT give steroids meningitis? (4)

A

Post-surgical meningitis,
severe immunocompromise,
meningococcal septic/septic shock,
hypersensitivity to steroids

26
Q

Which bacteria has most striking benefit from steroids in menigitis?

A

Strep pneumonia (pneumococcal meningitis) so if not that can stop steroids

27
Q

Viral meningitis is common and usually occurs in late summer/autumn. What type of viruses tend to cause viral meningitis?

A

Enteroviruses

28
Q

What is important to ask about in history of someone with viral meningitis?

A

Travel history

29
Q

List 3 diagnostic tests for viral meningitis and which is best?

A

Viral stool culture,
Throat swab PCR,
CSF PCR - best one

30
Q

What is treatment for viral meningitis?

A

Supportive as self limiting e.g. fluids, paracetamol

31
Q

What is difference between encephalitis and meningo-encephalitis in terms of presenting symptoms?

A

Meningo-encephalitis displays normal meningitis symptoms of headache, fever and neck stiffness PLUS features of encephalitis

32
Q

Outline symptoms of encephalitis (6)

A

Cerebral cortex is diffusely involved so INSIDIOUS onset of
mental status changes,
reduced consciousness/coma,
Confusion, psychosis,
Seizures,
behavioural and speech disturbances,
focal/diffuse neurologic signs e.g. partial paralysis

33
Q

List 3 investigations for encephalitis

A

Lumbar puncture,
EEG,
MRI

34
Q

What virus would you think about if patient presents with insidious onset of overall brain dysfunction symptoms i.e. everything dimmed?

A

Herpes simplex virus

35
Q

If delay in diagnosis but you are suspicious patient has viral encephalitis what treatment should be started pre-emptively?

A

Aciclovir

36
Q

How does HIV CNS infection normally present?

A

Meningitis

37
Q

What is ADEM and when can it occur? (2)

A

Acute disseminated encephalomyelitis - post flu/vaccine

38
Q

List 8 common symptoms of CNS infection

A 
Headache, 
Vomiting, 
Pyrexia, 
Neck stiffness, 
Photophobia, 
Lethargy,
Confusion, 
Rash
39
Q

Bacterial meningitis caused by which bacteria is very common with a cribiform plate fracture?

A

Strep pneumoniae

40
Q

Bacterial meningitis caused by which bacteria is can occur with neurosurgery/head trauma?

A

Staphyloccous,

Gram negative bacilli

41
Q

Strep pneumoniae and neisseria are common causes of bacterial meningitis in all age groups but strep is more common in young and neisseria more common in older. True/false?

A

False - is common in all age groups but neisseria more common in young and strep more common in older

42
Q

What percentage of people who survive an initial diagnosis of meningitis with sepsis will live with after-effects e.g. limb loss, deafness, blindness, cerebral palsy, quadriplegia and severe mental impairment?

A

25%

43
Q

What causes the complications of meningitis? (5)

A 
Purulence - pus clusters at base of brain and around nerves (especially CN III, VI), 
Invasion - abscesses,
Cerebral oedema, 
Ventriculitis, 
hydrocephalus
44
Q

List 3 types of pathogenesis of bacterial meningitis

A

Nasopharyngeal colonisation,
Direct extension of bacteria e.g. sinusitis, mastoidis and goes into brain,
From remote infection e.g. endocarditis (rare)

45
Q

Who should undergo CT prior to lumbar puncture? I.e. who should not get lumbar puncture straight away - warning signs (8)

A 
Immunosuppressed people, 
History of CNS disease, 
New onset seizure, (within 1 week) 
Papilloedema, 
Abnormal levels of consciousness, 
Shock,
Bradycardia/hypertension,
Focal neurologic deficit
46
Q

CSF results are 99% predictive of bacterial meningitis if:

A

CSF WBC count is very very high (>2000) and is mostly neutrophils (>1180), high protein and glucose in CSF a lot lower than serum because has been consumed

47
Q

Where is meningitis belt? (Meningococcus)

A

Across middle of west africa piece to east side

48
Q

Outline differences in CSF results between viral and bacterial in terms of cell type, cell number, gram stain, protein, glucose

A

Cell type: bacterial polymorphs and viral lymphocytes
Cell number: bacterial loads and viral less
Gram stain: bacterial positive and viral negative
Protein: bacterial high and viral normal/slightly high
Glucose: very low compared to BG, usually normal

49
Q

If no clear diagnosis from LP, stool and throat swabs, opening pressure, culture what additional tests can be done?

A

165 rRNA PCRs on CSF if bacterial seems likely,

CSF PCR for HSV1 and 2, zoster, enterovirus, stool and throat enterovirus PCR if viral seems likely

50
Q

How could you tell TB from viral/bacterial from CSF sample?

A

Cell count and type is same as viral (so lower)and is also lymphocytes but protein levels high and glucose levels low compared to blood glucose

51
Q

Symptoms of meningococcal meningitis are due to what from the bacteria?

A

Endotoxin

52
Q

What form of meningococcal infection presents with big deep purple purpuric rash that won’t blanch when pressed on?

A

Fulminant septicaemia.

53
Q

Meningococcal bacteria colonises the nasopharynx and around 10-25% of people carry it with no symptoms. True/false?

A

True

54
Q

Which are the more common capsular groups of meningococcus in UK?

A

B, C, W and Y

55
Q

TB meningitis is subacute illness. True/false?

A

True

56
Q

What is aseptic meningitis?

A

Meningitis where no bacteria found

57
Q

Contact prophylaxis treatment?

A

500mg single dose oral ciprofloxacin

58
Q

In management of bacterial meningitis with low GCS (<12) or fluctuating conscious level (fall >2) what is management?

A 
Admit, 
Airway and high flow O2, 
IV ceftriaxone +/- amoxicillin, 
IV steroids, 
Do not wait for CT scan/LP!!

Neurology (34 decks)

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