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NEUROLOGY > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Signs and symptoms of meningitis

A 
Fever 
Stiff neck 
Altered consciousness 
Headache 
Vomiting 
Photophobia 
Rash 
Shock
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2
Q

What would you expect to happen to glucose levels in CSF in a patient with meningitis?

A

Glucose levels in the CSF would be lower relative to blood glucose due to bacteria using up the glucose

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3
Q

What is the antibiotic of choice for meningitis?

What other medication should also be given?

A

IV ceftriaxone

steroids

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4
Q

Which antibiotic should be used if listeria meningitis is suspected?

A

IV amoxicillin

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5
Q

Which antibiotics are used for meningitis in patients with penicillin allergy?

A

Chloramphenicol IV and vancomycin IV

OR

Co-trimoxazole for listeria

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6
Q

Which inflammatory cell type can be seen in the subarachnoid space in patients with pyogenic (bacterial) meningitis?

A

Neutrophils

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7
Q

Which type of viruses most commonly cause viral meningitis (a subset of aseptic meningitis)?

A

Enteroviruses

*Because these live in the gut a stool culture is needed for detection

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8
Q

Describe the appearance of streptococcus pneumoniae

A

Gram positive diplococcus

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9
Q

Describe the appearance of neisseria meningitides

A

Gram negativ intracellular

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10
Q

Describe the appearance of listeria monocytogenes

A

Gram positive rods

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11
Q

Describe the appearance of haemophilia influenza

A

Gram negative bacillus

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12
Q

Which age group are most at risk of neisseria meningitis?

A

Young children

*nasopharyngeal colonisation

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13
Q

Who gets streptococcus pneumoniae meningitis?

A 
Hospital patients
Patients with skull fractures 
Alcoholics 
Diabetics 
Immunocompromised
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14
Q

Who gets listeria monocytogenes?

A

Neonates
Age 55+
Immunosuppressed

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15
Q

What side effects should you warn a patient about when treating them for tuberculous meningitis?

A

Reduced efficacy of the oral contraceptives
Red urine
Staining of contact lenses

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16
Q

Who gets cryptococcal meningitis?

A

HIV patients
(with a CD4 <100)

This is a FUNGAL infection so is aseptic

Treated with IV amphotericin B/ flucytosine/ fluconoazole

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17
Q

What are some consequences of untreated meningitis?

A

Brain herniation

Cord compression

18
Q

What is encephalitis and how is it managed?

A

Infection of the brain parenchyma

pre-emptive aciclovir

19
Q

What are the normal CSF values for white cells and red blood cells?

A

White cells <5mm3

There should be no RBCs in CSF

20
Q

What would RBCs in CSF indicate?

A

Subarachnoid haemorrhage

NB it is possible to contaminate CSF with RBCs when doing an LP

21
Q

What would you expect to happen to protein levels in the CSF in a patient with viral meningitis or encephalitis?

A

Protein would be normal or slightly increased

22
Q

What would you expect to happen to glucose levels in the CSF in a patient with viral meningitis or encephalitis

A

No change

23
Q

What would you expect to happen to glucose levels in the CSF in a patient with bacterial meningitis

A

Glucose would be decreased, this is because the bacteria use up the glucose

24
Q

Lymphocytes in the CSF would indicate a viral or bacterial infection?

A

VIRAL

25
Q

Polymorphs in the CSF would indicate a viral or bacterial infection?

A

BACTERIAL

26
Q

Which 3 structures make up the meninges?

A

Dura, arachnoid and pia

27
Q

Describe the location of the needle in LP

A

Needle enters the subarachnoid space at L4/5

28
Q

How would you describe the typical meningitis rash?

A

Non blanching purpuric rash

NB - petechiae if small

29
Q

When would you do a CT before an LP?

A

You should always really do this

But especially in patients with;

  • V.rapidly progressing rash (this may be suggestive of DIC)
  • GCS <12 / reduced consciousness
  • Seizures
  • Papilloedema
30
Q

What are some of the side-effects/ risks associated with dexamethasone IV?

A

Raised blood glucose

Confusion/ delirium

31
Q

What medication should be given to people who have been in close contact with someone who has meningitis?

A

Single dose of ciprofloxacin

32
Q

A “ring enhancing lesion” on a brain scan is the buzzword for what?

A

Brain abscess

33
Q

What is the most common cause of viral encephalitis?

A

Herpes simplex

34
Q

If confusion is the main presentation, which diagnosis should you think of?

If neck stiffness is the main presentation, which diagnosis should you think of?

A

Confusion = encephalitis

Neck stiffness = meningitis

Confusion+neck stiffness = meningoencephalitis

35
Q

Which antibiotics are used to treat neonatal meningitis?

A

Benzylbenicillin and gentamicin

36
Q

A brain abscess may arise from local spread of which infections?

A

Middle ear infections, sinusitis and dental infections

37
Q

What are the classic triad of clinical features that a patient with a brain abscess may present with?

A

Fever, headache and focal neurological signs

38
Q

Describe the typical LP results for viral meningitis

A

CSF clear

Normal opening pressure

Lymphocytes, increased protein and normal glucose

39
Q

Describe the typical LP results for bacterial meningitis

A

CSF cloudy

Increased opening pressure

Neutrophils, increased protein and decreased glucose

40
Q

Describe the typical LP results for TB meningitis

A

CSF opaque

Increased opening pressure

Lymphocytes, increased protein and decreased glucose

41
Q

Why is there raised protein in encephalitis and meningitis?

A

Because the BBB is leaky

42
Q

Which cell type is raised in encephalitis Vs bacterial meningitis?

A

Encephalitis is usually viral, so lymphocytes are raised

In bacterial meningitis, neutrophils are raised

NEUROLOGY (18 decks)

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