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pipi&pi3 > * CNS Infections > Flashcards

* CNS Infections Flashcards

1
Q

What are the 3 common CNS infections?

A

1) Meningitis (bacterial)
2) Encephalitis (viral)
3) Brain abscess

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2
Q

What is meningitis?

A
  • Inflammation of the meninges surrounding the brain and spinal cord
  • Can be caused by bacteria, viruses or fungi
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3
Q

What does the brain look like in early and late meningitis?

A

Early: Meninges are highly inflamed and red

Late: Fibrosis present (white areas) , brain stem may be affected

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4
Q

S/s of meningitis?

A
  • Fever
  • Headache
  • Irritability
  • LOC
  • Delirium
  • Vomiting
  • Light aversion
  • Purpura (skin rash)

Signs of nerve irritation
- Neck stiffness (chin cannot touch sternum)
- Kernig’s sign (cannot straighten leg when being lifted up)
- Brudzinski sign (bending of knees when neck is raised)

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5
Q

Types of meningitis?

A

1) Meningococcal meningitis
2) Bacterial meningitis
3) Tuberculous meningitis
4) Viral meningitis

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6
Q

What is the most prominent symptom of meningococcal meningitis?

A

Ecchymotic patches

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7
Q

What are the bacteria that commonly causes bacterial meningitis?

A
  • Streptococcus pneumoniae
  • Hemophilus influenzae
  • Meningococcus
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8
Q

What are the common signs of bacterial meningitis?

A
  • Purulent exudate + thrombosed veins on brain
  • Hemorrhagic infarction on vessels
  • Neutrophils in subarachnoid space
  • May progress to adrenal hemorrhagic necrosis (Waterhouse-Friderischen syndrome)
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9
Q

What are the s/s of tuberculosis meningitis?

A

-Small yellow nodules on brain surface
- Brain histology shows
~ Lymphocytes
~ Vasculitis
~ Langhan’s giant cells

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10
Q

How is tuberculosis meningitis acquired?

A

Primary site through lungs -> Hematogenous spread into CNS

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11
Q

What viruses mostly cause viral meningitis?

A
  • Mumps
  • Measles
  • Echoviruses
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12
Q

What findings are indicative of viral meningitis?

A
  • Dense lymphocytic infiltration on microscopy
  • CSF shows lymphocytes
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13
Q

How to diagnose meningitis?

A

1) CT scan
- To exclude mass lesions in unconscious px

2) Lumbar puncture
- ^ Protein
- Dec glucose
- Neutrophils >5000 cells/mm^3

3) Blood culture
- To rule out septicemia

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14
Q

Treatment for meningitis?

A

1) IV Abx
2) Vaccination
- Quadrivalent vaccine A,C,Y, W135
- HIB against H. influenza B

3) Supportive measures

4) Rifampicin prophylaxis for close contacts
- Of meningococcal meningitis

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15
Q

What are the complications of meningitis?

A

1) Cranial nerve palsies
- Due to fibrosis
- Damage on cranial nerves

2) Hydrocephalus
- Due to blockage of aqueduct in subarachnoid space

3) Cortical atrophy
- Due to vessel thrombosis + ^ ICP
- Leading to mental retardation, blindness, deafness and paralysis in children

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16
Q

What is encephalitis?

A

Inflammation of the parenchyma (tissue) of the brain by viruses

  • Herpes simplex
  • VZ
  • CMV

Causes focal dysfunction

17
Q

What are the types of encephalitis?

A

1) Herpes simplex encephalitis
2) Japanese encephalitis

18
Q

What is the pathology and symptoms of Herpes simplex encephalitis?

A

Pathology:
- Edema -> hemorrhage of brain tissue which causes necrosis of temporal lobes
- Usually occurs in the temporal lobes first

S/s:
- Fever, chills, signs of ^ICP
- Behaviour and personality changes
- Seizures
- Drowsiness, coma
- Aphasia, hemiplegia
- 3 signs of meningism

19
Q

What are the signs of meningism?

A

1) Neck stiffness
2) Photophobia
3) Headache

20
Q

Who are those at risk of Japanese encephalitis?

A
  • Regions with culex mosquito endemic
  • Rural areas
21
Q

How to diagnose encephalitis?

A

1) CT scan
- To exclude mass lesions
- To localise the site of lesion

2) Lumbar puncture
- ^ Protein
- Normal glucose
- ^ lymphocytes

3) EEG
- Will show slow waves in temporal lobes in herpes simplex encephalitis

22
Q

What is a brain abscess?

A
  • Localised collection of pus within the brain parenchyma
  • Usually caused by pus forming/pyogenic bacteria
  • Presents as a space-occupying lesion (SOL)
23
Q

How to treat encephalitis?

A

1) Anticonvulsants
- To prevent and treat epilepsy

2) DEXAMETHASONE + MANNITOL
- To treat ^ ICP

3) Antivirals
- IV ACYCLOVIR
- For herpes simplex encephalitis

24
Q

Treatment for brain abscess?

A

1) Drainage/excision of abscess
2) IV Abx

25
Q

What are the indications for lumbar puncture?

A

1) for Diagnosis
- Rule out CNS infections/meningitis
- Thunderclap headache to rule out SAH
~ When CT/MRI is normal but headache is >3days

2) Therapy
- To evaluate for normal pressure hydrocephalus with walk test

26
Q

What are the contra-indications for lumbar puncture?

A
  • Infx near puncture site
  • Presence of space-occupying lesions
  • Bleeding tendencies
    ~ Plt <80 or INR >1.4
27
Q

What is the procedure for lumbar puncture?

A

Drape -> Lignocaine (5-10mls) -> Tap -> Measure opening pressure -> Collect a few bottles of 15 drops/1ml -> Measure closing pressure

28
Q

What does an abnormal opening pressure mean in a lumbar puncture?

A

Opening (Normal 10-18cm H20):
- ^ pressure
~ Infection, hydrocephalus or benign intracranial hypertension
- Low pressure
~ Spinal block with ^ ICP, intracranial hypotension

29
Q

What are the investigations done on the CSF from a lumbar puncture?

A
  • Cell count
  • Gram stain
  • Culture
  • Glucose (compared with fingerprick BSL)
    ~ Low glucose indicates bacterial infx

Note: 1st bottle is never sent for cell count and microscopy due to high RBC

30
Q

What are the meanings of the colours of CSF?

A

Clear
- Normal

Yellow
- Hyperbilirubinemia, ^ protein, ^ blood breakdown products

Orange
- ^ Blood breakdown products,^ carotenoid digestion

Pink
- ^ Blood breakdown products

Green
- Hyperbilirubinemia
- Purulent CSF

Brown
- Meningeal melanomastosis

31
Q

Slide 38 typical CSF findings in different types of meningitis?

A

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