CNS Infections

Question 1

What is leptomeningitis?

Answer 1

inflammation in the subarachnoid space (between the arachnoid and pia mater)

Question 2

What is pachymeningitis?

Answer 2

Inflammation of the dura mater.

Question 3

Petechial rash in meningitis could herald the onset of?

Answer 3

DIC - Disseminated Intravascular Coagulation which is often fatal.

Question 4

What is a well recognised complication of open skull fractures?

Answer 4

Pachymeningitis

Question 5

Cerebral abscess often develops from what type of encephalitis?

Answer 5

Acute suppurative encephalitis

Question 6

Is gram +/- bacteria more common in cerebral abscess infections?

Answer 6

Gram - bacteria

Question 7

In septic sinus thrombosis, spread of infection is via which sinus?

Answer 7

Sigmoid sinus

Question 8

What is the difference between encephalitis and meningitis?

Answer 8

Encephalitis is an acute inflammatory process affecting the brain. Meningitis is inflammation of the meninges only.
Encephalitis has personality changes but meningitis does not. Encephalitis also presents with fever and confusion

Question 9

What is the difference between acute bacterial meningitis and cerebral abscess?

Answer 9

Similar clinical presentations, except raised intracranial pressure (papilloedema, absent venous pulsation, decreased GCS), epilepsy and focal neurological deficits are more commonly seen in cerebral abscess.

Question 10

What are the 4 complications of cerebral abscess?

Answer 10

Meningitis, Epilepsy, focal neurological deficits, intracranial herniation.

Question 11

Neutrophil polymorphs are only seen in which 2 types of meningitis?

Answer 11

Neutrophil polymorphs are only seen in bacterial meningitis and TB meningitis

Question 12

What are the clinical presentations in syphilitic meningitis?

Answer 12

1. Clinically silent in the primary and secondary stages.
2. Meningeal thickening in the tertiary stage cause cranial nerve palsies.
3. Gummas (focal inflammatory lesions) causing cerebral or spinal compression
4. Tabes Dorsalis due to degeneration of dorsal spinal columns

Question 13

Fungal and viral causes of meningitis often have greater neutrophil polymorphs or lymphocytes?

Answer 13

Lymphocytes, although in early viral meningitis, neutrophil polymorphs are seen without lymphocytes.

Question 14

What type of meningitis is suggested if there is high proteins, high lymphocytes and low glucose?

Answer 14

TB meningitis

Question 15

Mollaret’s Meningitis is often caused by which virus?

Answer 15

HSV2

Question 16

What are the 6 complications of Meningitis?

Answer 16

1. Cerebral Odema
2. Venous sinus thrombosis
3. Brain Abscess
4. Septicaemia
5. DIC
6. Multi-organ failure

Question 17

What are prions?

Answer 17

Prions are abnormal proteins without nucleic acid, that replicates and cause diseases.

Question 18

What are the 8 clinical features of CJD/vCJD?

Answer 18

1. Personality changes
2. Psychiatric symptoms (Depression, etc)
3. Cognitive Impairment
4. Neurological deficits (Sensory, Motor, and Ataxic)
5. Myoclonic jerks (chorea or dystonia, less frequently)
6. Rapid or unpredictable step-wise deterioration
7. Increasing difficulty with communication, mobility, swallowing and continence.
8. Coma and death

Question 19

Is EEG and MRI scans useful for vCJD? What about CJD?

Answer 19

EEG and MRI scans are useless for vCJD, but useful for CJD.