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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What may untreated infection cause?

A
  • Brain herniation and death

* Cord compression and necrosis, with subsequent permanent paralysis

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2
Q

What is meant by the term ‘aseptic’? What may it be?

A

The bacterial cultures are negative

May be virus

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3
Q

What is acute encephalitis an infection of?

A

Brain parenchymal

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4
Q

What does pyogenic meningitis show?

A

A thick layer of suppurative exudate, covering the leptomeninges over the surface of the brain

i.e this is bacterial meningitis

Basically, pus in the subarachnoid space

Leptomeninges - only the arachnoid and pia

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5
Q

Where is exudate found in pyogenic meningitis?

A

In the basal and convexity surface

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6
Q

Microscopically, what is seen in pyogenic meningitis?

A

Neutrophils in the subarachnoid space

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7
Q

Is viral meningitis common?

A

YES

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8
Q

At what time of year does viral meningitis become an issue?

A

Late summer - Autumn

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9
Q

Suggest causes of viral meningitis.

A

ENTEROVIRUSES like ECHO virus
(will have bit of a flu, photophobia)
But also other microbes and non-infectious causes

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10
Q

How is the diagnosis of viral meningitis made?

A
  • Viral stool culture
  • Throat swab
  • CSF PCR
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11
Q

What is the treatment of viral meningitis?

A

Supportive

usually self limiting

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12
Q

What investigation should be done in suspected encephalitis?

A

MRI

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13
Q

What questions particularly helps differentiate between meningitis and encephalitis? Explain

A

Is there any altered behaviour or cognition, personality change or altered consciousness?

** Encephalitis tends to present more with changes in behaviour, compared to meningitis.

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14
Q

What are the clinical features of encephalitis?

A
  • Insidious onset, although sometimes sudden.
  • Meningismus (a triad of headache, photophobia and nuchal rigidity)
  • Stupor, coma.
  • Seizures, partial paralysis.
  • Confusion, psychosis.
  • Speech, memory symptoms
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15
Q

What is meningismus?

A

A triad of headache, photophobia and nuchal rigidity (back of neck stiffness)

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16
Q

What investigations should always be carried out?

A
  • Lumbar puncture
  • EEG
  • MRI
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17
Q

What should be done if Ix’s are delayed?

A

Start pre-emptive acyclovir as prompt therapy improves outcomes (death)

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18
Q

List the most common signs + symptoms of meningitis.

A 
Fever + Cold
Vomiting
Drowsiness
Muscle pain
Headache
Photophobia
Confusion
Stiff neck
Rash
Convulsions/seizures
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19
Q

What organism usually causes CAM in neonates?

A

Listeria
Group B strep
E. coli

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20
Q

What organism usually causes CAM in children?

A

H. influenza

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21
Q

What organism usually causes CAM in ages 10-21?

A

Neisseria meningitidis (freshers)

think ‘N’ for notty lol

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22
Q

What organism usually causes CAM aged over 21?

A

Streptococcus pneumoniae > Neisseria meningitidis

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23
Q

What organism usually causes CAM in those over 65?

A

Streptococcus pneumoniae > Listeria

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24
Q

What bacteria is decreased cell mediated immunity most often associated with

A

Listeria monocytogenes

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25
Q

What bacteria is neurosurgery/head trauma most often associated with?

A

Staphylococcus, Gram negative bacilli

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26
Q

What bacteria is fracture of the cribriform plate associated with?

A

Streptococcus pneumoniae

think in nose  travels to brain through # in cribriform plate

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27
Q

What is the ‘alcohol triad’?

A

Strep pneumoniae endocarditis, bacterial pneumonia, meningitis
(think pneumonia if lying on ground drunk)

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28
Q

Where are clusters found?

A

At the base of the brain

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29
Q

What nerves are especially vulnerable when there is an infection?

A

CN’s III and VI

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30
Q

What prevents meningitis becoming an abscess?

A

Pia

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31
Q

What can brain abscesses cause?

A

Secondary ventriculitis, and hence meningitis

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32
Q

Name 3 sources/ways that bacterial meningitis can develop.

A
  1. Nasopharyngeal colonization
  2. Direct extension of bacteria -parameningeal foci (sinusitis, mastoiditis, brain abscess) OR across skull defects/fracture
  3. From remote foci of infection (ie. endocarditis, pneumonia, UTI)
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33
Q

Listeria monocytogenase likes?

A

FRIDGES

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34
Q

TB meningitis is

A

‘slow and grumbling’

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35
Q

What does neisseria meningitis cause?

A

Meningococcal meningitis

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36
Q

Where is neisseria meningitis found?

A

In the throats of healthy carriers

think reason why vaccination is given just before uni

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37
Q

How does bacteria gain access to the meninges?

A

Via the blood

38
Q

Where may bacteria be found?

A

In leukocytes in the CSF

39
Q

What are the symptoms of meningitis due to?

A

ENDOTOXIN

40
Q

H. influenza is part of the normal what?

A

Throat microbiota

41
Q

What does H. influenza require for growth?

A

Blood

42
Q

What is the most common cause of meningitis in children under 4?

A

H. influenza type B

43
Q

Where is S. pneumonia commonly found?

A

Nasopharynx

44
Q

Who is most susceptible to S. pneumonia meningitis?

A

Hospital pts.
Pts with CSF skull fractures.
Diabetics/alcoholics.
Young children

45
Q

Describe listeria monocytogenes?

A

gram +ve bacilli

46
Q

Who is most susceptible to listeria monocytogenes?

A

Neonates.
>55y/o’s.
Immunosuppressed patients, especially in the context of malignancy

47
Q

What is the best antibiotics for mistrial monocytogenes?

A

IV Ampicillin/Amoxicillin

48
Q

What does someone with TB meningitis have?

A

TB on CXR

49
Q

The CSF yield in TB meningitis is weak. What should therefore be done?

A

PCR and culture are important here due to the poor yield from CSF

50
Q

How is TB meningitis treated?

A

Isoniazid + Rifampicin (add pyrazinamide + ethambutol

51
Q

What type of infection is Cryptococcal Meningitis?

A

FUNGAL

52
Q

What people get cryptococcal meningitis?

A

People with HIV

53
Q

What kind of infection is cryptococcal meningitis?

A

Disseminated

54
Q

How does cryptococcal meningitis appear on CSF?

A

Aseptic

55
Q

How is cryptococcal meningitis treated?

A

With IV amphotericin B/flucytosine.

Fluconazole

56
Q

What bloods should be done in someone with suspected meningitis?

A
  • FBC
  • Urea, creatinine, electrolytes
  • LFT’s
  • Clotting screen
  • Procalcitonin
  • PCR
  • Serology
  • Glucose
57
Q

What are the clinical signs of bacterial meningitis?

A

Fever
Stiff neck
Altered level of consciousness

58
Q

List signs + symptoms of bacterial meningitis.

A
  • Headache
  • Vomiting
  • Pyrexia
  • Neck stiffness
  • Photophobia
  • Lethargy
  • Confusion
  • Rash
59
Q

When should you be cautious about doing a lumbar puncture?

A

If raised ICP

60
Q

What position should be utilised while doing a lumbar puncture?

A

Sitting

61
Q

If flow of CSF in a lumbar puncture is fast, what should you measure?

A

Opening pressure

62
Q

Describe H. influenza.

A

Gram -ve rods

63
Q

Describe S pneumonia.

A

Gram +ve diplococci

64
Q

Describe N. meningiditis.

A

Gram -ve diplococci

65
Q

In partially treated bacterial meningitis, what may predominate? What, however, allows this to be differentiated from viral meningitis?

A

Lymphocytes may predominate.

- but the protein is often high

66
Q

Neutrophilic Pleocytosis + Low CSF Glucose can sometimes mean?

A

Bacterial meningitis

67
Q

What is aseptic meningitis?

A

Non-pyogenic bacterial meningitis

68
Q

Describe the spinal fluid in aseptic meningitis?

A
  • A low number of WBC.
  • A minimally elevated protein.
  • A normal glucose
69
Q

What are the indications for hospital admission?

A
  • Signs of meningeal irritation.
  • An impaired conscious level.
  • A petechial rash.
  • Pt is febrile or unwell, and has had a recent fit.
  • Any illness, especially headache, and are close contacts of patients with meningococcal infection, even if they have received a prophylactic antibiotic
70
Q

What type of swab should be taken in someone with suspected meningitis?

A

Throat

71
Q

What should be done to petechial or purpuric skin rashes?

A

Disrupt and swab or aspirate

72
Q

Who should get a CT before doing a lumbar puncture?

A
  • Immunocompromised
  • History of CNS disease
  • New onset seizure
  • Papilloedema
  • Focal neurological deficit
  • Altered level of consciousness
73
Q

What are the key WARNING SIGNS to look for in someone with bacterial meningitis?

A
  • Marked depressive conscious level (GCS <12) or a fluctuating conscious level (fall in GCS >2).
  • Focal neurology.
  • Seizure before or at presentation.
  • Shock.
  • Bradycardia and hypertension.
  • Papilloedema
74
Q

What are the indications for lumbar puncture in early inpatient management? What should be done before LP?

A

All adult patients with suspected meningitis, except when a clear contraindication exists
(III) or of there is a confident clinical diagnosis of meningococcal infection with a typical meningococcal rash (III)

75
Q

Outline the standard management of a patient with bacterial meningitis. State what is done in penicillin allergy.

A

IV Ceftriaxone 2g bd.

  • ADD IV Ampicillin/Amoxicillin 2g qds IF LISTERIA IS SUSPECTED.
76
Q

What is given in penicillin allergy (rash or anaphylaxis)?

A

Chloramphenicol IV (25mg/kg 6-hourly) with Vancomycin IV (500mg 6-houtly or 1g 12-hourly)  if clear hx of anaphylaxis to beta-lactams.

Co-trimoxazole alone  if Listeria suspected and allergic to penicillin.

77
Q

Who should steroids be given to?

A

ALL patients with suspected bacterial meningitis

78
Q

When should steroids be given?

A

10mg iv 15-20 min before or with the first dose of antibiotic and then every 6 hours for 4d

79
Q

When should steroids NEVER be given?

A

Post-surgical meningitis.
Severe immunocompromise.
Meningococcal or septic shock.
Steroid hypersensitivity

80
Q

Outline option 1 of prophylaxis regimens.

A

Adults + Children >12yrs: Rifampicin (600mg, 12-hourly for 4 doses).
Ages 3-11: Rifampicin (10mg/kg orally, 12 hourly for 4 doses).

JUST REMEMBER RIFAMPICIN

81
Q

When Rifampicin is given, what should the patient be warned of?

A
  • Reduced efficacy of oral contraceptives.
  • Red colouration of urine.
  • Staining of contact lenses
82
Q

Outline option 2 of prophylaxis regimens.

A

Adults + Children >12yrs: Ciprofloxacin (500mg orally as single dose).

  • use of ciprofloxacin in younger children is NOT recommended
83
Q

Outline option 3 of prophylaxis regimens.

A

Adults: Ceftriaxone (250mg IM as single dose).
Children <12y/o: Ceftriaxone (125mg IV as single dose).

CEFTRIAXONE

84
Q

Outline option 4 of prophylaxis regimens.

A

Vaccines

85
Q

What should be noted when taking an LP from someone with meningitis?

A
  • Cell count
  • Glucose
  • Protein
  • RBC’s
86
Q

What cell type would be high in an LP from a patient with viral meningitis?

A

Neutrophils (polymorphs)

87
Q

What cell type would be high in an LP from a patient with bacterial meningitis?

A

Lymphocytes

88
Q

What are examples of what you should look for when trying to figure out the route by which someone has got viral meningitis?

A

Ear infection
Sinusitis
Laceration to face/head

89
Q

What symptoms should ALERT you that someone has meningitis

A
  • Crescendo headaches
  • Nausea
  • Fever
  • Slowness
90
Q

What is Kernig sign? What should you worry about?

A

Neck Stiffness

- Meningitis

91
Q

When is imaging mandate in meningitis?

A

If focal neurological signs or papilloedema

Neurology (42 decks)

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