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Med school ICP > CNS infections > Flashcards

CNS infections Flashcards

1
Q

CT head

A 
Required prior to LP (to exclude ↑ ICP) if:
• GCS <8
• Focal neurological signs
• Previous CNS pathology
• Immunocompromise
May show abscess, meningeal enhancement
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2
Q

MRI head

A

Greater definition than CT

May show encephalitis, meningeal enhancement

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3
Q

Acute meningitis clinical presentation

A 
Headache
Fever
Nausea
Vomiting
Photophobia
Confusion
Coma
Rash - non-blanching
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4
Q

Acute meningitis causes

A

Bacterial
Viral
Protozoa: Naegleria fowleri, acanthamoeba
Non-infective: SLE, seizures, migraines, post vaccination

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5
Q

Bacterial meningitis

A

Infection usually begins in the nasopharynx with colonisation by a new pathogenic bacteria → systemic invasion
Splenectomy, complement deficiency and base of skull fracture all predispose

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6
Q

Bacterial causes and treatment 0-4 weeks

A 
Gp B strep
E coli
L monocytogenes
K pneumoniae
Salmonella
Antibiotic: amoxicillin and cefotaxime
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7
Q

Bacterial causes and treatment 4-12 weeks

A 
Gp B strep
E coli
L monocytogenes
K pneumoniae
Salmonella
N meningitides
S pneumoniae
H influenzae
Antibiotic: amoxicillin and cefotaxime/ceftriaxone
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8
Q

Bacterial causes and treatment 3 months - 18 years

A

N meningitis
S pneumoniae
H influenzae
Antibiotic: Cefotaxime/ceftriaxone

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9
Q

Bacterial causes and treatment 18 - 50 years

A

N meningitides
S pneumoniae
Antibiotic: cefotaxime/ceftriaxone

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10
Q

Bacterial causes and treatment >50 years

A

S pneumoniae
N meningitides
L monocytogenes
Antibiotic: amoxicillin and cefotaxime/ceftriaxone

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11
Q

Bacterial meningitis CSF

A

Cells ↑ >100 (usually neutrophils)
Protein ↑ >1g/ml
Glucose ↓ <40% of serum levels

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12
Q

Viral CSF

A

Cells ↑ 5 - 200 (often lymphocytic)
Protein ↑ 0.5-1g/ml
Glucose normal

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13
Q

TB/fungal CSF

A

Cells ↑ 5-200 (lymphocytes)
Protein ↑ >1g/ml
Glucose ↓

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14
Q

Antibiotics by organism

A

H. influenzae: ceftriaxone or cefotaxime 7 days
N meningitides: ceftriaxone or cefotaxime 7 days
S pneumonia: ceftriaxone or cefotaxime 10-14 days
L monocytogenes: amoxicillin 21 days
Gp B strep: amoxicillin 14-21 days

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15
Q

Viral meningitis causes

A 
Enteroviruses
Arboviruses
Mumps
Herpes
HIV
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16
Q

Viral meningitis clinical features

A

Enterovirus: fever, headache, neck stiffness, photophobia
Mumps: CNS symptoms 5 days after onset of parotitis
HSV2: may occur as primary infection without genital lesions
HIV: usually part of primary infection

17
Q

Viral meningitis diagnosis

A

Characterised by lymphocytes in CSF
Viral culture rarely used
Serology - IgM Ab of enteroviral infection
PCR on CSF for HSV, VZV, enterovirus and mumps

18
Q

Viral meningitis treatment

A

Mostly supportive
HSV - acyclovir IV 10mg/kg for 14-21 days
HIV - consider antiretrovirals

19
Q

Encephalitis causes

A 
HSV
CMV
EBV
HHV-6
HHV-7
Arboviruses (tick-borne encephalitis, west nile virus, St Louis encephalitis, Japanese B encephalitis, equine encephalitis)
Rabies
Mumps
Measles
HIV
20
Q

Encephalitis clinical features

A 
Irritability
Altered personality
Drowsiness
Ataxia
Excessively brisk tendon reflexes/upgoing plantars
Signs of cerebral or brainstem failures
Signs of brain swelling
Fever +/- signs of meningitis
21
Q

Encephalitis diagnosis

A

Viral culture rarely used
Serology - IgM Ab of enteroviral infection
PCR on CSF for HSV, VZV, enterovirus and mumps

22
Q

Cerebral abscess aetiology

A 
Otitis media/mastoiditis
Sinusitis
Dental sepsis
Trauma/neurosurgery
Pulmonary/pleural sepsis
Endocarditis
Congenital heart disease
nb. organisms often mixed
23
Q

Cerebral abscess clinical features

A 
Headache
Altered mental state
Fever (50%)
Seizures
Nausea and vomiting
Focal neurological deficits
Papilloedema
24
Q

Cerebral abscess diagnosis

A 
CT
MRI more sensitive
Aspiration of lesion via Burr hole or craniotomy:
• Culture
• Cytology - exclude malignancy
25
Q

Cerebral abscess treatment

A

Empirical: cefotaxime, amoxillin, metronidazole or meropenem
Ideally lesion drained in neurosurgery
MRSA +ve, add linezolid

Med school ICP (15 decks)

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