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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?

24
Q

What causes symptoms in N. meningitidis meningitis?

25
How are people vaccinated against N. meningitis?
purified capsular polysaccharide
26
Where is H. influenza normally found?
normal throat microbiota
27
Is there a vaccine available against HiB?
yes - conjugated vaccine against capsular polysaccharide is available
28
Where is strep pneumoniae normally found?
nasopharynx
29
What is significant about strep pneumoniae infection?
rare and has a high mortality rate
30
What is listeria monocytogenes?
gram positive bacilli
31
What antibiotic is used against listeria?
IV ampicillin/amoxicillin
32
Why is ceftriaxone not used in listeria?
bacteria are intrinsically resistant
33
What population is TB meningitis seen in?
elderly - reactivation | foreign travel
34
how is TB meningitis treated?
isoniazid + rifampicin
35
What kind of organism causes cryptococcal meningitis?
fungus
36
What disease is cryptococcal meningitis seen in?
HIV - CD4<100
37
What is the treatment for cryptococcal meningitis?
IV Amphotericin B/flucytosine fluconazole
38
Where can the cryptococcal antigen be found in patients suffering cryptococcal meningitis?
serum and CSF
39
What are the differential diagnoses of meningitis?
``` meningitis encephalitis cerebral abscess severe sepsis from other source SAH cerebral tumour ```
40
What can happen if ABX are given before LP?
gram stains of CSF may be negative
41
What type of white cells are high in viral meningitis?
lymphocytes
42
What type of white cells are high in bacterial meningitis?
neutrophils
43
What type of white cells are seen in TB meningitis?
lymphocytes
44
Which type of meningitis typically exhibits a very high protein count?
TB meningitis
45
Which types of meningitis cause a reduction in CSF glucose?
bacterial | TB
46
What is aseptic meningitis?
non-pyogenic bacterial meningitis
47
What CSF make up is typically seen in aseptic meningitis?
low WBC minimally elevated protein normal glucose
48
You should always wait until culture results come back before beginning any antibiotic treatment - T/F?
False - never delay Abx
49
What are the indications for a CT scan in meningitis patients?
focal neurology | papilloedema
50
What are the main serious warning signs in a patient with meningitis?
``` decreased consciousness level focal neurology seizure at or before presentation shock bradycardia hypertension papilloedema ```
51
What is the correct empirical antibiotic therapy for a patient with meningitis?
IV Ceftriaxone 2g BD add ampicillin/amoxicilin 2mg qds if listeria suspected
52
What treatment should be given in patients allergic to penicillin?
chloramphenicol 25mg/kg 6 hourly + vancomycin 500mg 6 hourly
53
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?
steroids - dex
54
When should steroids not be given?
post-op meningitis septic shock steroid hypersensitivity
55
What antibiotic is used in contact prophylaxis of meningitis in adults and children over 12 years old?
rifampicin 600mg orally every 12 hours
56
what are common side-effects of rifampicin?
red colouration of bodily fluids | reduced OCP efficacy

Neurology (Calum) (21 decks)

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