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Neurology HK > CNS infections > Flashcards

CNS infections Flashcards

1
Q

histological appearance of bacterial meningitis

A

neutrophils in subarachnoid space

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2
Q

common viruses which cause meningitis

A

enteroviruses (eg ECHO)
herpes simplex
varicella zoster
paramyxovirus

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3
Q

how to diagnose viral meningitis

A

viral stool culture
throat swab
CSF PCR

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4
Q

treatment of viral meningitis

A

Supportive therapy - it is self-limiting

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5
Q

if viral meningitis, what else should be tested for

A

HIV

if HSV, test for other sexually transmitted diseases

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6
Q

encephalitis is usually bacterial/viral

A

viral - HSV1+2 most common

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7
Q

clinical features of encephalitis

A 
meningism 
odd 
behaviour/confusion
low GCS/coma
fever 
headache 
focal neurological symptoms/seizures
PRECEDED BY SYMTPOMS OF INFECTION
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8
Q

investigations for encephalitis

A

blood cultures (including toxoplasma IgM titre and malaria film)
lumbar puncture (increased protein and lymphocytes, decreased glucose, send for PCR)
EEG
MRI - inflamed portion of temporal lobe

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9
Q

Start treatment immediately/after lab results in encephalitis

A

immediately

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10
Q

treatment for viral encephalitis

A

If herpes/varicella, IV acyclovir for 14 days then repeat lumbar puncture
continue until PCR is negative

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11
Q

common bacterial organisms in neonates

A

listeria
group B strep
Ecoli

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12
Q

common bacterial organism in children

A

H influenza

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13
Q

common bacterial organism age 10-21

A

Neisseria meningitidis

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14
Q

common bacterial organism >21

A

strep pneumonia

can be Neisseria meningitides

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15
Q

common bacterial in ?65

A

strep pneumonia

can be listeria

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16
Q

bacterial organism if cell mediated immunity (e.g. neonatal, immunosuppressed, malignancy)

A

listeria monocytogenes
S. pneumoniae
N. Meningitidis
aerobic GNR

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17
Q

bacterial organism if neurosurgery/head trauma/CSF shunt

A

S. Aureus
S. epidermidis
aerobic GNR

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18
Q

bacterial organism if fracture of cribiform plate

A

strep pneumonia
H influenza
beta-haemolytic strep group A

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19
Q

most common organisms causing meningitis

A

meningococcus (Neisseria meningitides)

pneumococcus (strep pneumoniae) - MOST COMMON

20
Q

where does Neisseria meningitides usually reside

A

throats of healthy carriers - gets to meninges through bloodstream

21
Q

what meningitis organisms have a prophylactic vaccination

A

Neisseria meningitides
H influenza
Strep pneumoniae

22
Q

clinical presentation of tuberculous meningitis

A

non-specific ill health with previous TB on CXR

23
Q

treatment for TB meningitis

A

isoniazid and rifampicin

add pyrazinamide and ethambutol later

24
Q

early clinical signs of bacterial meningitis

A

headache
leg pins
cold hands and feet
abnormal skin colour

25
Q

signs of meningism

A

neck stiffness
photophobia
Kernig’s sign (pain and resistance on passive knee extension with hip fully flexed)

26
Q

late clinical features of bacterial meningitis

A 
meningism 
decreased consciousness 
seizures/focal neurological signs 
petechial rash (non-blanching)
pyrexia
27
Q

treatment should be started immediately/after culture results in meningitis

A

immediately

28
Q

immediate action in suspected bacterial meningitis

A

ceftriaxone IV and Dexamethasone IV immediately AFTER blood cultures are taken

29
Q

when is lumbar puncture contraindicated

A

suspected ICP
uncorrected coagulopathy
acute spinal cord trauma
severe sepsis/rapidly evolving rash

30
Q

what antibiotic should be used if penicillin allergic

A

chloramphenicol IV + vancomycin IV

31
Q

what antibiotic should be added if listeria cover is required

A

amoxicillin/ampicillin IV

32
Q

if recent travel in last 6 months, what antibiotic should be added

A

vancomycin or rifampicin

33
Q

what organism should dexamethasone be continued for

A

pneumococcal

34
Q

what time of year is viral meningitis common

A

late summer/autumn

35
Q

later tests in meningitis

A

throat swab
culture rash
CT if papilloedema/focal neuro signs
lumbar puncture if feasible

36
Q

Results of CSF culture in meningitis

A

neutrophils and protein increased

low glucose

37
Q

what does N meningitidis look like histologically

A

gram negative coffee bean shaped diplococci

38
Q

what does S pneumoniae look like histologically

A

gram positive lanceolate diplococci appearing in short chains

39
Q

H influenzae on gram stain

A

pleomorphic gram negative rods

40
Q

why might meningitis be ‘culture negative

A

pre-lumbar puncture use of oral antibiotics for a different infection

41
Q

what empirical antibiotic if penicillin allergy and listeria cover required

A

co-trimoxazole

42
Q

when should steroids be avoided

A

post surgical meningitis
severely immunocompromised
meningoccal/septic shock
hypersensitive to steroids

43
Q

what are the contact prophylaxis regimens for bacterial meningitis

A

600 mg rifampicin orally 12-hourly for 4 doses
OR
500mg ciprofloxacin orally as a single dose

44
Q

consequences of untreated infection

A

brain herniation and death

cord compression and necrosis - permanent paralysis

45
Q

complications of meningitis

A

purulence - clusters at base of brain, exudate around nerves (3 and 6 particularly vulnerable)
invasion - abscesses
cerebral oedema
ventriculitis/hydrocephalus

Neurology HK (26 decks)

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