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Neurology (Calum) > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What is acute encephalitis?

A

infection and inflammation of the brain parenchyma

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2
Q

what conditions are covered by the term focal suppurative infection?

A

abscess
subdural empyema
extradural empyema

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3
Q

What viruses typically cause viral meningitis?

A

enterovirus - ECHO

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4
Q

How is viral meningitis diagnosed?

A

viral stool culture
throat swab
CSF PCR

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5
Q

How is viral meningitis treated?

A

supportive treatment - self-limiting

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6
Q

What virus typically cause viral encephalitis?

A 
HSV1
Varicella zoster 
CMV
HIV
Measles
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7
Q

What is important about HSV encephalitis treatment?

A

rapid treatment within 6 hours

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8
Q

What is used to treat HSV encephalitis?

A

aciclovir IV high dose

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9
Q

What are common travel related encephalitis’?

A

West nile
Japanese B
Tick borne

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10
Q

What are the clinical features of encephalitis?

A 
insidious onset 
meningismus 
stupor, coma 
seizures/paralysis 
confusion, psychosis 
speech and memory problems
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11
Q

What investigations are done in encephalitis?

A

LP
EEG
MRI

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12
Q

What findings are seen on MRI in encephalitis?

A

inflamed temporal lobe involving uncut and parahippocampal gyrus (WHITE ON MRI)

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13
Q

What are common causative organisms of bacterial meningitis in neonates?

A

listeria
group B strep
E coli

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14
Q

What are common causative organisms of bacterial meningitis in children?

A

Hib

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15
Q

What are common causative organisms of bacterial meningitis in 10-21yo?

A

meningococcal

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16
Q

What are common causative organisms of bacterial meningitis in 21 onwards?

A

pneumococcal > meningococcal

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17
Q

What are common causative organisms of bacterial meningitis in elderly patients?

A

pneumococcal > listeria

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18
Q

Which bacteria is likely to cause a meningitis with a history of cribriform plate fracture?

A

pneumococcal

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19
Q

Which bacteria is likely to cause a meningitis with a history of neurosurgery or open head trauma?

A

staph aureus/epidermidis

gram negative rods

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20
Q

Which bacteria is likely to cause a meningitis with a history of immunocompromisation?

A

s. pneumoniae
n. meningitidis
listeria
pseudomonas

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21
Q

Which bacteria is likely to cause a meningitis with a history of CSF shunt?

A

staph epidermidis
staph aureus
aerobic GNR
propionibacterium acnes

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22
Q

What are the pathogeneses behind bacterial meningitis?

A

nasopharyngeal colonisation leading to direct extension of bacteria from sinusitis, mastoiditis or abscess.

from remote foci - endocarditis, pneumonia, UTI

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23
Q

What percentage of pre-school children carry pneumococcus?

A

60%

24
Q

What causes symptoms in N. meningitidis meningitis?

A

endotoxin

25
Q

How are people vaccinated against N. meningitis?

A

purified capsular polysaccharide

26
Q

Where is H. influenza normally found?

A

normal throat microbiota

27
Q

Is there a vaccine available against HiB?

A

yes - conjugated vaccine against capsular polysaccharide is available

28
Q

Where is strep pneumoniae normally found?

A

nasopharynx

29
Q

What is significant about strep pneumoniae infection?

A

rare and has a high mortality rate

30
Q

What is listeria monocytogenes?

A

gram positive bacilli

31
Q

What antibiotic is used against listeria?

A

IV ampicillin/amoxicillin

32
Q

Why is ceftriaxone not used in listeria?

A

bacteria are intrinsically resistant

33
Q

What population is TB meningitis seen in?

A

elderly - reactivation

foreign travel

34
Q

how is TB meningitis treated?

A

isoniazid + rifampicin

35
Q

What kind of organism causes cryptococcal meningitis?

A

fungus

36
Q

What disease is cryptococcal meningitis seen in?

A

HIV - CD4<100

37
Q

What is the treatment for cryptococcal meningitis?

A

IV Amphotericin B/flucytosine

fluconazole

38
Q

Where can the cryptococcal antigen be found in patients suffering cryptococcal meningitis?

A

serum and CSF

39
Q

What are the differential diagnoses of meningitis?

A 
meningitis 
encephalitis 
cerebral abscess 
severe sepsis from other source 
SAH 
cerebral tumour
40
Q

What can happen if ABX are given before LP?

A

gram stains of CSF may be negative

41
Q

What type of white cells are high in viral meningitis?

A

lymphocytes

42
Q

What type of white cells are high in bacterial meningitis?

A

neutrophils

43
Q

What type of white cells are seen in TB meningitis?

A

lymphocytes

44
Q

Which type of meningitis typically exhibits a very high protein count?

A

TB meningitis

45
Q

Which types of meningitis cause a reduction in CSF glucose?

A

bacterial

TB

46
Q

What is aseptic meningitis?

A

non-pyogenic bacterial meningitis

47
Q

What CSF make up is typically seen in aseptic meningitis?

A

low WBC
minimally elevated protein
normal glucose

48
Q

You should always wait until culture results come back before beginning any antibiotic treatment - T/F?

A

False - never delay Abx

49
Q

What are the indications for a CT scan in meningitis patients?

A

focal neurology

papilloedema

50
Q

What are the main serious warning signs in a patient with meningitis?

A 
decreased consciousness level 
focal neurology 
seizure at or before presentation 
shock 
bradycardia 
hypertension 
papilloedema
51
Q

What is the correct empirical antibiotic therapy for a patient with meningitis?

A

IV Ceftriaxone 2g BD

add ampicillin/amoxicilin 2mg qds if listeria suspected

52
Q

What treatment should be given in patients allergic to penicillin?

A

chloramphenicol 25mg/kg 6 hourly + vancomycin 500mg 6 hourly

53
Q

What medication should be given to all patients suspected of bacterial meningitis before or with the first dose of antibiotics and then 6 hourly for 4 days?

A

steroids - dex

54
Q

When should steroids not be given?

A

post-op meningitis
septic shock
steroid hypersensitivity

55
Q

What antibiotic is used in contact prophylaxis of meningitis in adults and children over 12 years old?

A

rifampicin 600mg orally every 12 hours

56
Q

what are common side-effects of rifampicin?

A

red colouration of bodily fluids

reduced OCP efficacy

Neurology (Calum) (21 decks)

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