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CNS infections Flashcards

1
Q

How does N. meningitidis appear on gram stain?

A

Gram negative diplococcus

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2
Q

what is the common type of pathogen to cause encephalitis?

A

viral

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3
Q

what is encephalopathy?

A

reduced level of consciousness/ diffuse disease of brain substance, usually non-infective

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4
Q

What is a neutopathy?

A

damage to peripheral n erves cuasing wekaness or numbness

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5
Q

what is mononeuritis multiplex?

A

inflammation and damage to 2 or more individual nerves, usually causing pain and/or loss of function
can be caused by HIV, leprosy, Lyme’s disease and Hep A

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6
Q

what is polyradiculopathy?

A

damage to multiple nerve roots (e.g. cauda equina)

can be cuased by HIV, CMV, syphilis, HSV

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7
Q

what is myelitis?

A

inflammation of the spinal cord

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8
Q

what is Meningoencephalitis?

A

resembles both Meningitis and encephalitis (inflammation of the brain and the meninges)

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9
Q

what are the symptoms of meningitis?

A

fever
worsening headache
photophobia neck stiffness
rash commonly seen with N. meningitidis

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10
Q

what are the signs of menigism?

A

fever
worsening headache neck stiffness
papilloedeama Kernig’s sign
Brudzinski’s sign

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11
Q

what is Kernig’s sign?

A

lay pt supine
bend leg so thigh is 90˚ to waist
try to straighten the lower leg - unable to straighten leg greater than 135˚ without pain - this test stretches the meninges

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12
Q

what is Brudzinski’s sign?

A

flex the neck of the pt - the sign is that the pt’s hips and knees will flex to reduce the stretch on the meninges

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13
Q

how does papillodema look like on fundoscopy when it is due to menigitis?

A

bilateral
disc margin disappears
can occur over hours to weeks

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14
Q

How is meningitis managed?

A

Blood cultures before lumbar puncture
start antibiotics
FBC - to check the WCC and platelet count before lumbar puncture
U&E - baseline kidney function be fore starting antibiotics
CRP
serum Glucose - to compare to the CSF glucose
lactate
Lumbar puncture
CT Head - for signs of raised ICP
Throat swabs (bacterial and viral)
Pneumococcal and Meningococcal serum PCR

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15
Q

If a pt has raised ICP, when is their headache worse?

A

on sitting forward or bending

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16
Q

How is an LP done?

A

ask the pt to lie on their left side
flex knees to widen the gap between the lumbar vertebrae
use the superior ileac spine as a marker for L4
choose the L3/4 or L4/5 disc space
need goes THROUGH the dura (epidural does not go through the dura mater)

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17
Q

what layers would you go through when taking an LP?

A 
skin
fascia
spupraspinous ligament 
interspinous ligament 
ligamentum flavum
eipdural space 
dura mater 
arachnoid mater 
so smaple from the sub-arachnoid space where CSF is
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18
Q

what is the name to the equipment used to measure the opening pressure in LP?

A

manometer

normal opening pressure is 8-15 mm Hg

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19
Q

what are the adverse effects of an LP?

A 
Headache
Paresthesia - tingling/numbness around the legs 
CSF leak
Damage to spinal cord
Cerebral herniation and death
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20
Q

what type of consent is needed for an LP?

A

written consent

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21
Q

what advise is given for a post-LP headache?

A

lay down flat for several hours

drink plenty of fluids

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22
Q

when should a CT be done before LP?

A

Age more than 60 - due to increased risk of space-occupying lesions Immunocompromised History of CNS disease New onset/recent seizures
Decreased/-­‐ing conscious level
- GCS <14
Focal neurological signs Papilloedema
Atypical history - that is not entirely indicative of meningitis

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23
Q

how much CSF is needed from an LP?

A

5ml

10-15 drops per bottle

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24
Q

what is done with the CSF obtained from LP?

A 
CSF protein
CSF glucose 
microscopy, culture and sensitivity 
viral PCR - for enterovirus, HSV and VZV
bacterial PCR
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25
Q

when is more than 5ml CSF needed?

A

to test for TB - so 10 ml is needed

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26
Q

should antibitoics be given before or after a CT head or LP?

A

do not delay antibiotics whilst waiting for the CT head

if you can’t do an LP within 30 mins of arrival then give empirical antibiotics

27
Q

does a raised opening pressure mean a raised ICP?

A

not necessarily

28
Q

what are the CSF results for a bacterial cause?

A 
raised opening pressure
cloudy CSF
high cells - neutrophils 
low CSF:plasma glucose 
high protein
29
Q

what are the CSF results for a viral infection?

A 
normal/raised opening pressure 
clear CSF 
high cells - lymphocytes 
normal CSF:plasma glucose 
normal/high protein
30
Q

what are the CSF results for TB meningitis?

A 
raised opening pressure 
cloudy/yellow CSF 
slight increase in cells - lymphocytes 
low CSF:plasma glucose 
high protein
31
Q

what are the CSF results for fungal meningitis?

A

raised opening pressure
cloudy/yellow CSF
normal/high cells - lympohocytes
normal/high protein

32
Q

what are the CSF results for subarachnoid haemorrhage?

A 
riased opening pressure 
blood stained CSF = XANTHOCHROMIA 
slight increase in cells 
normal CSF:plasma glucose 
high protein
33
Q

what are the risk factors for Listeria meningitis?

A 
immunocompromised 
pregnancy 
diabetes
chronic alcoholics 
age >60
34
Q

what bacteria cause meningitis in neonates and what is their appearance on gram film?

A

E.coli = Gram negative bacilli
Group B streptococci = Gram positive coccus
Listeria monocytogenes = Gram positive bacilli

35
Q

what are the bacterial causes of meningitis in children and adults and what is their appearance on a gram film?

A

Neisseria meningitidis = Gram negative diplococcus
Streptococcus pneumoniae = Gram positive diplococcus
Haemophilus influenzae = Gram negative coccobacilli

36
Q

how is suspected bacterial meningitis managed?

A

IV Cefotaxime
- ADD IV amoxicillin if Listeria
- ADD dexamethasone for Pneumococal menigitis
consider vancomycin in returning travellers

37
Q

Why is IV Cefotaxime particularly good (and better then IV amoxicillin for strep) in meningitis?

A

reliable BBB penetration

38
Q

how is meningococcal meningitis prevented?

A

Meningitis vaccine
Men B given at 8 weeks, 16 weeks and booster at 1 year
Men C at 1 year
Men ACWY given at age 14

39
Q

what prophylaxis is given to contacts of a pt with meningococcal meningitis?

A

ciprofloxacin - 500mg stat on tablet (can be given in pregnancy)
rifampicin - 600mg BD for 2 days (cannot be given in pregnancy)

40
Q

which infection is notifiable?

A

Meningococcal meningitis

41
Q

describe the meningococcal rash

A

petechial/non-blanching

42
Q

is LP needed in meningococcal sepsis/meningococcal meningitis if a rash is present?

A

no - not necessary

43
Q

what is the mechanism of death in those with meningocococal speticaemia?

A

cardiovascular disease

44
Q

what is the mechanism of death in those with meningocococal meningitis?

A

raised ICP

45
Q

is there a rash in viral meningitis?

A

no

46
Q

what treatment is given for viral meningitis?

A

supportive - no specific treatment

47
Q

What is the most common cause of viral meningitis?

A

enterovirus

48
Q

How dies enterovirus meningitis present?

A

child has flu-like illness, sore throat, diarrhoea and the parent presents with meningitis

49
Q

Is there risk of raised ICP with viral meningitis?

A

no

50
Q

how does encephalitis present?

A 
headache 
fever
lethargy
new onset confusion
decreased GCS 
no focal neurology
no meningism
progression to focal signs, seizure, coma
51
Q

which part of the brain is affected most in herpes simplex encephalitis?

A

fronto-temporal

52
Q

what investigations are done for encephalitis?

A

CT head
LP
can do an EEG

53
Q

what does the LP show in encephalitis?

A 
lymphocytes 
raised protein 
normal glucose
no organism seen on gram film  
viral CSF PCR shows virus
54
Q

How is HSV encephalitis treated?

A

10mg/kg IV aciclovir for 14 days

55
Q

what is CJD caused by?

A

prions

56
Q

what is rabies caused by?

A

RNA virus

57
Q

how is rabies transmitted?

A

saliva
spreads to CNS via peripheral nerves
replicates in the brain and then spreads to the salivary glands

58
Q

how is rabies prevented?

A

vaccine - given to travellers going to endemic areas eg India

59
Q

what are the symptoms of rabies?

A 
fever 
anxiety
confusion
hydrophobia 
hyperactivity/uncontrollable excitement 
hallucinations 
violent movement
60
Q

what are the neurological manifestations of HIV?

A 
HIV associated dementia 
viruses: HSV, CMV, progressive multifocal leukoencephalopathy due to the JC virus 
fungus: cryptococcal meningitis 
parasitic infection: toxoplasmosis 
lymphoma 
neurosyphilis
61
Q

What organism causes tetanus?

A

Clostridium tetani

62
Q

what would be seen on gram stain of Clostridium tetani?

A

Gram positive bacillus

has terminal spores

63
Q

How does Clostridium tetani cause disease?

A 
soil organism 
spore forming 
secretes a toxin - tetanospasmin 
infects dirty wounds 
toxin released in the wound translocates via peripheral nerve
64
Q

what are the symptoms of tetanus?

A

onset 7 days
Paraesthesia of wound
Trismus (lockjaw)
Sustained muscle contraction (opisthotonus)
Involvement of facial muscles (risus sardonicus- abnormal, sustained spasm of the facial muscles that appears to produce grinning.)
Paroxysmal generalised spasms
autonomic dysfunction - pain and temperature sensation

Neuro (9 decks)

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