CNS infections

Question 1

What is the major causative virus for viral meningitis?

Answer 1

Enterovirus e.g. ECHO virus

Question 2

Management of viral meningitis

Answer 2

Supportive, as disease is usually self-limiting

Question 3

Diagnosis of viral meningitis

Answer 3

Viral stool culture
Throat swab
CSF PCR

Question 4

Presentation of viral encephalitis

Answer 4

Headache; fever; focal neurology e.g. speech, memory symptoms; stupor; coma

Question 5

Essential features of the history in suspected viral encephalitis

Answer 5

Recent travel (e.g. Japansese encephalitis)
Occupational exposure e.g. rabies virus

Question 6

Treatment of herpes simplex and varicella zoster encephalitis

Answer 6

High dose aciclovir

Question 7

Which area of the brain does viral encephalitis tend to affect?

Answer 7

Temporal lobe

Question 8

Main causative organisms of bacterial meningitis in teenagers/adults

Answer 8

Strep pneumonia (pneumococcus)
Neisseria meningitides (meningococcus)

Question 9

Risk factors for bacterial meningitis

Answer 9

Decreased cell-mediated immunity;
Skull trauma e.g. cribriform plate fracure;
Post-neurosurgery;
CSF shunt

Question 10

Symptoms of meningococcal meningitis are due to the effects of…

Answer 10

Endotoxin

Question 11

Listeria monocytogenes is more common in what groups of patients?

Answer 11

Neonatal; older patients; immunosuppressed

Question 12

Antibiotic for listeria

Answer 12

IV ampicillin/amoxicillin

Question 13

Main four clinical features of bacterial meningitis

Answer 13

Headache
Fever
Neck stiffness
Change in mental state

Question 14

Meningococcal meningitis may be associated with…

Answer 14

Purpuric (non-blanching) rash

Question 15

When should performing an LP be avoided?

Answer 15

If there is a possibility of increased ICP

Question 16

Key findings of LP in bacterial meningitis:

a) cells
b) gram stain
c) protein
d) glucose

Answer 16

a) 10^1 - 10^4. Polymorphs
b) Positive
c) elevated
d) lowered

Question 17

Indications for CT prior to lumbar puncture

Answer 17

Immunocompromised state
History of CNS disease
New onset seizue
Papilloedema
Abnormal level of consciousness
Focal neurology

Question 18

Initial “blind” antibiotic therapy

Answer 18

IV cefotaxime 2g bd. + amoxicllin if 50 years

Question 19

Role of steroids in bacterial meningitis

Answer 19

Give to all suspected of having bacterial meningitis with the first dose of antibiotic. Reduces unfavourable outcomes particularly in pneumococcal meningitis

Question 20

Antibiotic for meningococcal meningitis (after CSF/blood cultures)

Answer 20

Benzylpenicillin or ampicillin

Question 21

Management of tuberculosis meningitis

Answer 21

Isoniazid + rifampicin

Question 22

Most common cause of meningitis in neonates

Answer 22

Group B strep

Question 23

When is contact prophylaxis needed and what is given?

Answer 23

In meningococcal meningitis. Oral ciprofloxacin