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Neurology > CNS infections* > Flashcards

CNS infections* Flashcards

1
Q

What type of meningitis shows a thick layer of suppurative exudate that covers the leptomeninges over the surface of the brain

A

pyogenic (bacterial)

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2
Q

microscopically what does pyogenic meningitis show

A

neutrophils in the subarachnoid space

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3
Q

when does viral meningitis occur
causes
dx
rx

A

late summer/autumn
enteroviruses (ECHO), other microbes and non-infectious causes also
viral stool culture, throat swab and CSF PCR
supportive as self limiting

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4
Q

how to treat viral encephalitis caused by herpex simplex

A

high dose IV aciclovir

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5
Q

how to treat viral encephalitis caused by varicella zoster and who does it occur in

A

history of shingles

high dose acyclovir

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6
Q

what other viruses can cause viral encephalitis

A

CMB, HIV, measles

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7
Q

what are some travel related causes of viral encephalitis

A

west nile, japanese B encephalitis, tick borne encephalitis

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8
Q

what are some occupational related causes of encephalitis

A

rabies

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9
Q

clinical features of encephalitis (9)

A 
insidious onset, sometimes sudden
stupor
coma
meningismus
seizures
partial paralysis 
confusion 
psychosis 
speech &memory problems
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10
Q

investigations for encephalitis and what should be done if there is a delay

A

LP, EEG, MRI

start acicilovir pre emptive

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11
Q

how do cerebral abscesses arise

A

spread from intracranial infection such as mastoiditis but usually via blood stream

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12
Q

common causes of cerebral abscesses

A

congenital HD, pulmonary AV fistulas, bronchiectasis, lung abscess, bacterial endocarditis

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13
Q

common organisms in cerebral abscesses and which is the commonest

A

strep viridian’s (commonest)

SA, haemolytic strep, enterbacteriacie, bacteroids and other anaerobes

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14
Q

what are the organisms in immunosuppressed for cerebral abscesses

A

fungal or toxoplasmic gondii abscesses may occur

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15
Q

symptoms and signs of cerebral abscess (4 and one negative)

A

headache
focal neurological deficits
papilloedema
nausea and vom

fever, chills and other signs of infections do not occur

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16
Q

diagnosis of abscesses

A

contrast enhanced CT/MRI
if dx in doubt then do a stereotaxic brain biopsy which will confirm the lesion is an abscess
cultures
empiric treatment

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17
Q

organisms in bacterial meningitis

A 
neonates - listeria, group b strep, EColi
children - HI
10-21-meningococcal 
21 onwards - pneumococcal>meningococcal 
elderly - pneumococcal>listeria
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18
Q

risk factors for listers, staph GNR and pneumococcal acquired bacteria meningitis

A

decreased CMI
neurosurgery/open head trauma
fracture of the cribriform plate

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19
Q

organisms in BM in immunocomprimised state
basically skull fracture
head trauma or neurosurgery
CSF shunt

A

S pneumonia, N meningitis, listeria, aerobic GNR, mycobacterium tuberculosis, cryptococcus neofromans

S pneumonia, HI, beta haemolytic strep group A

SA, S epidermis, aerobic GNR

SE, SA, aerobic GNR, propionibacterium acnes

20
Q

3 types pf pathogenesis of BM

A

nasopharyngeal colonisation
direct extension of bacteria
from remote foci of infection (endocarditis, UTI, pneumonia)

21
Q 
Meningococcal meningitis 
found where in healthy people?
how does it get to meninges?
where is the bacteria found?
what are the symptoms due to?
who is the disease commonly in?
vaccination in who?
A 
throats 
bloodstream
leukocytes in CSF
endotoxin 
young children 
military recruits
22
Q

HI meningitis
part of what normally?
what does it require for growth?
how many different types?

A

part of normal throat microbiota
required blood factors
6 types, HI b commonest in under 4s

23
Q

Pneumococcal meningitis
where is it commonly found?
who is more susceptible to this?
what implants is it linked to

A

nasopharynx
hospitalised patients, CSF skull fractures, diabetics/alcoholics and young children
cochlear implants - rare but high mortality

24
Q 
Listeria monocytogenes 
gram what?
who?
antibiotic? 
what antibiotic has no value
A

gram positive bacilli
neonatal, >55s, immunosuppressed
IV ampicillin/amox
ceftriaxone is intrinsically resistant

25
Q 
Tuberculous meningitis 
who?
symptoms?
CSF what?
rx?
A

elderly
non specific ill health
poor yield form CSF
I & R (add P and E)

26
Q 
cryptococcal meningitis 
what?
where mainly?
CD4?
presentation?
culture?
antigen?
rx?
A 
fungal
mainly in HIV disease
CD4 <100
subtle neurological presentation
aseptic picture on CSF
serum and CSF cryptococcal antigen 
IV amphotericin B/flucytosine. fluconazole
27
Q

clinical signs of BM (3)

A

fever
stiff neck
alteration in consciousness

28
Q

signs and symptoms of BM (8)

A 
headache
vomiting 
pyrexia 
neck stiffness 
photophobia 
lethargy 
confusion 
rash
29
Q

who are the signs of BM absent or atypical?

A

the very young
the very old
the immunocompromised

30
Q

Principles of LP

A

only if clinically feasible
measure opening pressure if flow fast
treat with antibiotics first

31
Q

what are CSF pleocytosis not

A

bm

32
Q 
tubes for CSF interpretation 
1
2
3
4
A

1 - haem: cell count, differential
2 - micro: gram stain, cultures
3-chemistry: glucose, protein
4- haem

33
Q

microbiology diagnosis of BM

A

blood cultures
throat swab (meningococcal)
blood ADTA for PCR (meningococcal)
CSF - micro, biochem, culture, antigen detection, PCR

34
Q

when is bm culture negative

A

pre LP use of AB lowers gram stain positivity by 20% and culture positivity
in children in 90-100% of px within 24-36 hours of AB treatment CSF becomes culture negative and there is no significant change in cell count/chemistry

35
Q

CSF in BM

A 
WBC >2000
neutrophils >1180
protein >220
Glucose <34
Glucose (CSF/serum) <0.23
36
Q

what is aseptic meningitis

CSF?

A

non-pyogenic BM

low number of WBC, minimally elevated protein, normal glucose

37
Q

indications for hospital admission

A

signs of meninges irritation
impaired conscious level
petechial rash
any illness esp headache and in contact with meningococcal infected px even if they have had prophylaxis

38
Q

On arrival into hospital

A

bloods and coag screen
initial treatment
throat swab
disrupt and swab any rash

39
Q

indication for CT scan

A

all patients with papilloedema or focal neurological signs, immunocompromised, history of CNs disease, new onset seizure, abnormal level of consciousness

40
Q

warning signs in BM

A 
marked depressive conscious level GCS <12 or fluctuating 
focal neurology
seizure before or at presentation 
shock
bradycardia and hypertension 
papilloedema
41
Q

LP indications

what should be given first

A

suspected meningitis or clinical dx or meningococcal infection with typical meningococcal rash

ABs

42
Q

rx for BM

A

IV ceftriaxone (IV ampicillin/amox for listeria)

PA - chloramphenicol IV 25mg/kg 6hourly and vanc IV 500mg 6 hourly or 1g 12 hourly. If listeria - co-tramoxazole

Dexomethason before or with the first dose of AB 10mg IV

43
Q

when should steroids not be given

A

post surgical meningits
severe immunocomprimised
meningococcal or septic shock

44
Q

meningococcal disease on admission assessing prognosis

A 
haemorrhagic diatheses
deteriorating conscioussness
multi organ failure
rapidly developing rash
>60
45
Q

meningitis all types on admission

A 
tachycardia 
GCS<12 on admission 
Low GCS, cranial nerve palsy 
seizures within 24 hours 
hypotension 
>60
46
Q

management of low GCS or fluctuating consciousness level

A

secure airway and start high flow oxygen
IV 3g ceftriaxone (add amox if over 55 to cover listeria)
IV corticosteroids

47
Q

prophylaxis for BM

A

600mg rifampicin PO 12 hourly 4 doses in adults and over 12s, 10mg/kg IV 12 hourly 4 doses for 3-11 months
OR
500mg cipro PO for adults and >12s
OR
250mg ceftriaxone IM single dose in adults and 125mg IV as a single dose in under 12s

Neurology (15 decks)

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