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Neurology > CNS infections > Flashcards

CNS infections Flashcards

1
Q

What is acute encephalitis an infection of?

A

The brain parenchyma

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2
Q

What cells would you see in the CSF of a patient with acute bacterial meningitis?

A

Neutrophils

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3
Q

What is the most common cause of viral meningitis?

A

Enteroviruses such as ECHO

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4
Q

What is the treatment for viral meningitis?

A

Supportive treatment - generally a self limiting condition

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5
Q

How do you confirm a diagnosis of viral meningitis?

A

Viral stool culture Throat swab CSF PCR

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6
Q

List some causes of viral encephalitis?

A

Herpes Simples Varicella zoster CMV HIV Measles West Nile Virus Tick borne encephalitis Rabies

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7
Q

What is the treatment of herpes simplex encephalitis?

A

High dose IV aciclovir

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8
Q

What is the treatment for varicella zoster viral meningitis?

A

High dose aciclovir

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9
Q

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night.

A

Viral encephalitis due to varicella zoster virus

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10
Q

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night What investigations would you want?

A

Lumbar puncture MRI If she has had a seizure then EEG

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11
Q

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night. There is going to be a four hour wait to get any investigations. What do you do?

A

Start aciclovir

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12
Q

A 32 year old women presents to a & e with confusion. She also had a widespread blistering rash. This is the MRI of her brain; describe it and give the most likely diagnosis.

A

Viral encephalitis due to varicella zoster virus.

MRI shows an inflamed portion of the temporal lobe involving the uncus and parahippocampus (the birght white section)

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13
Q

A patients presents with syptoms suggestive of viral encephalitis. You are concerned that the patient has raised ICP. What investigation is best to perform.

A

CT scan. In a normal case a lumbar punture should be performed but if there is a concern about raised ICP a CT scan should be given first.

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14
Q

What is the first line investigation for a patient with suspected viral encephalitis (Normal ICP)

A

LP

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15
Q

What are the three most common causes of bacteria meningitis in neonates?

A

Listeria

Group B stre

E coli

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16
Q

What is the most common cause of bacterial meningitis in children?

A

H. Influenzae

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17
Q

What is the most common cause of bacterial meningitis in people aged 10 - 21?

A

Meningococcoal

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18
Q

What are the two most common causes of bacterial meningitis in people over 21?

A

Pneumococcal

Meningococcal

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19
Q

What are the two most common causes of meningitis in the elderly?

A

Pneumococcal

Listeria

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20
Q

What kind of bacterial meningitis is someone who has had a fracture of the cribriform plate at risk of?

A

Pneumococcal

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21
Q

What kind of bacterial meningitis is someone who has had open head trauma or open neurosurgery at risk of?

A

Staphylococcus

Gram Negative rods

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22
Q

List 4 things that can be predisposing factors for bacterial meningitis

A
  1. Immunocompromised state
  2. Basilar skull fracture
  3. Head trauma/Post neurosurgery
  4. CSF shunt
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23
Q

List three possible ways in which a bacterial meningitis can start. Explain briefly the pathogenesis of each one.

A
  1. Nasopharyngeal colonization (this can then spread)
  2. Direct extension of bacteria (from parameningeal foci such - sinusitis, mastoiditis or brain abscess)
  3. From a remote infection site (endocarditis, pneumonia, UTI)
24
Q

In meningococcal meningitis what actually causes the symptoms?

A

Endotoxins

25
Q

A gram positive bacilli then causes meningitis in neonates, elderly and immunocompressed patients

A

Listeria monocytogenes

26
Q

What antibiotic would you give in a patient with listeria meningitis?

A

IV ampicillin/amoxicillin

(NOT Ceftriaxone as listeria is intrinsically resistant to this!)

27
Q

What is the treatment for tuberculous meningitis?

A

Isoniazid

Rifampicin

Pyrazinamide

Ethambutol

28
Q
A
29
Q
A
30
Q
A
31
Q

How many tubes do you send for CSF interpretation? What are they?

A
  1. Haematology - cell count & differential
  2. Microbiology - gram staina & culture
  3. Biochemistry - glucose & proteins
32
Q

What antibiotics do you give for a suspected actute bacterial meningitis?

A

IV Ceftriaxone

33
Q

What investigations should someone with suspected meningitis get who also has papilloedema.

A

Urgent CT or MRI

34
Q

List 6 groups of people that should undergo a CT scan before an MRI in suspected bacterial meningitis?

A
  1. Immunocomprimised
  2. History of CNS disease eg stroke
  3. New onset seizure
  4. Papilloedema
  5. Abnormal level of consciousness
  6. Focal neurological deficit such a dilated non reactive pupil or abnormal eye movements
35
Q

A patients presents with a stiff neck fever and a non blanching rach into a & e. They are drowsy and confused. What do you do first?

A

Give antibiotics (Ceftriaxone)

36
Q

What two antibiotics should prescribes for people over the age of 55 presenting with symtpoms suggestive of meningitis? Why?

A

Ceftriaxone

Ampicillin (to cover listeria infections)

37
Q

What other drug could you give with the first dose of antibiotics in bacterial meningitis?

A

Dexamethasone

38
Q

What is the first line treatment for a patient with meningitis who has a severe penicillin allergy

A

Chloramphenicol IV & Vancomycin

39
Q

What is the treatment of penicillin resistant meningitis?

A

Vancomycin +/- Rifampicin

40
Q

What would you give to a penicillin allergic patient with meningitis caused by listeria?

A

Co - trimoxazole

41
Q

Is dexamethasone useful in pneumococcal or meningococcal meningitis?

A

Pneuomococcal

42
Q

Give a treatment plan for a patient with bacterial meningitis with low GCS of fluctuating conscious level.

A
  1. Admit to HDU
  2. Secure airway and start oxygen
  3. IV Cefriaxone (+ ampicillin if over 55)
  4. IV corticosteroids

DO NOT wait for CT scan or LP

43
Q

What prophylactic treatment should be given to close contacts of someone who has meningitis?

A
  1. Rifampicin

OR

  1. Ciprofloxacin

OR

  1. Ceftriaxone
44
Q

What prophylactic treatment is recommended for contacts of someone who has meningitis who is under 12?

A

Ceftriaxone

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Neurology (45 decks)

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