CNS infections

Question 1

meningitis

Answer 1

Sx: headache, nausea, neck stiffness, aching, photophobia
Signs: objective neck stiffness/photophobia, kernig’s and brudzinski’s

rash does not indicate meningitis, but meningococcal septicaemia

Question 2

encephalitis

Answer 2

Sx: as with meningitis + drowsy, behavioral change, focal neurology and seizures
Signs: focal neurology, reduced GCS

NB an abscess will present in the same way

Question 3

in meningococcal CT before LP if

Answer 3

reduced GCS
focal neurology
seizures
papilloedema
immunocompromised (e.g. HIV)

Question 4

CSF findings

Answer 4

bacterial: increased cells, increased protein, decreased glucose
viral: increased lymphocytes, normal protein, normal/slightly low glucose

Question 5

pneumococcal meningitis

Answer 5

steroids can reduce the mortality. useIV dexamethasone, 0.15mg’kg with or around the first dose of ABx

Question 6

meningococcal meningitis/septicaemia prophylaxis

Answer 6

contact tracing of close (kissing) contacts or sharing a room
prophylaxis is ciprofloxacin or rifampicin and vaccination

Question 7

encephalitis

Answer 7

most common cause is HSV
spreads from the cranial nerve ganglia to the frontal and temporal lobes
treat quickly with aciclovir