CNS infections Flashcards
What trio of clinical features suggest pyogenic bacterial meningitis
headache, fever, stiff neck
What additional features are sometimes present in meningitis
include what effect does meningitis have on blood pressure and HR
non-blanching rash papilloedema photophobia confusion hypertension bradycardia lethargy loss of consciousness
Which bacteria is associated with meningitis in those over 65yo
s. pneumoniae
Which bacteria is associated with meningitis in those aged 10-21
neisseria meningitides
What age ranges are associated with listeria monocytogenes meningits
neonates and over 55yo
Which organisms in meningitis are particularly associated with immunosuppressed patients
listeria and crytococcus
Which bacteria is associated with meningitis in military people / university freshers
neisseria meningitides
Which bacteria is associated with meningitis in cribriform plate fractures
s. pneumoniae
Which bacteria is associated with meningitis in alcoholic, diabetics and those with cochlear implants
s. pneumoniae
Neisseria is a gram +ve intercellular bacteria. True of false
false, gram -ve intracellular
Listeria is a gram +ve cocci. T or F
false, gram +ve bacilli
What is aseptic meningitis
no bacteria found
Which organisms known to cause meningitis have vaccines available
neisseria, Hib, others?
Which viruses can cause aseptic meningitis
syphilis, HSV
TB is known to cause bacterial meningitis. T or F
F, causes aseptic meningitis
What blood tests should be done when investigating meningitis
FBC CRP clotting screen U+Es LFTs BG urea creatinine serology
What microbiology specific tests should be done for meningitis
blood culture
throat swab + culture (for meningococcus/ enterovirus)
PCR (for meningococcus/ pneumococcus)
What is seen in CSF after LP in bacterial meningitis
> WCC, >protein, lactate, >pressure, decreased glucose
What imaging should be done for suspected bacterial meningitis
CT brain
Empirical management of bacterial meningitis (incl allergy)
IV dexamethasone+ IV ceftriaxone
allergy: chloramphenicol
What drug should be added to empirical management of bacterial meningitis in patients over 60 yrs
amox or co-trimoxazole
What drug should be added to empirical management of bacterial meningitis in patients who have traveled to an amox resistant country in the last 6 months
vanco
When are CCS contraindicated in the management of bacterial meningitis
immunocompromised, post-surgery, shock
What are the contact prophylaxis options for bacterial meningitis in people over 12 years old
rifampicin OR 1X IV ciprofloxacin OR IM ceftriaxone
What complication of bacterial meningitis occurs when the pia is invaded
brain abscess
What virus is the commonest cause of viral meningitis
enterovirus eg. ECHO
Investigations for viral meningitis
viral stool culture, throat swab, LP
What abnormalities are seen in CSF in viral meningitis
none: protein/glucose normal
my other notes say raised proteins and lymphocytes?
Management of viral meningitis
supportive
What is stupor
decreased consciousness of cognitive function
Commonest organism in encephalitis
HSV
What structure is inflamed in encephalitis
brain parenchyma
How does encephalitis present
decreased consciousness
focal sign hemiplegia, speech
psychosis
seizure
recent fever!
Is encephalitis acute or insidious
sudden acute
1st line investigation for encephalitis
LP (EEG also indicated)
Investigation for encephalitis if LP contraindicated
CT (EEG also indicated)
CSF abnormalities in encephalitis
mild >protein
>WCC lymphocytosis
OTHER ?
Aetiology of brain abscesses
skull fracture
sinusitis
mastoiditis
bloodborne
Presentation of brain abscess
> ICP + fever + underlying cause
