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Neurology SOH > CNS infections > Flashcards

CNS infections Flashcards

1
Q

What is the difference between meningitis and encephalitis?

A

meningitis - infection of the meninges

encephalitis - infection of the brain itself

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2
Q

Bacterial meningitis - what is it also known as

A

Pyogenic meningitis

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3
Q

Bacterial meningitis - where is the inflammation

A

Inflammation of the leptomeninges and CSF within the subarachnoid space

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4
Q

Bacterial meningitis. Thick layer of suppurative exudate covers the surface of the brain. True or false?

A

True

- think of injecting pus into the CSF and the pus gets everywhere and gets matted

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5
Q

Bacterial meningitis - patient with CNS devices (e.g. cochlear implants) - what is the likely causative organism?

A

Strep pneumoniae (pneumococcal meningitis)

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6
Q

Where is strep pneumoniae commonly found?

A

Nasopharynx

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7
Q

Bacterial meningitis - patient with CSF skull fracture - what is the likely causative organism?

A

Strep pneumoniae

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8
Q

Bacterial meningitis - what is the likely causative organism in adolescents?

A

Neisseria meningitidies (meningococcal meningitis)

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9
Q

Neisseria meningitides is intracellular/extracellular?

A

Intracellular

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10
Q

Neisseria meningitides likely gains access to the meninges through _______

A

The bloodstream

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11
Q

Bacterial meningitis - in the past what was the likely causative organism in childhood but incidence has decreased now due to introduction of vaccine?

A

Haemophilus influenzae

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12
Q

Bacterial meningitis - extremes of age (over 60 and neonates) - what is the likely causative organism?

A

Listeria monocytogenes

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13
Q

Bacterial meningitis - immunocompromised patients - what is the likely causative organism?

A

Listeria monocytogenes

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14
Q

Bacterial meningitis - E coli affects

A

Neonates

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15
Q

Bacterial meningitis - H influenzae affects

A

Infants and children

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16
Q

Bacterial meningitis - neisseria meningitides affects

A

Young adults

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17
Q

Bacterial meningitis - listeria monocytogenes affects

A

Elderly

and neonates

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18
Q

Bacterial meningitis - strep pneumoniae affects

A

Over 21 year olds (roughly)

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19
Q

Bacterial meningitis - from head trauma/neurosurgery - what is the likely causative organism (2)

A

Staph aureus

Staph epidermidis

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20
Q

Bacterial meningitis - microscopically, there will be an abundance of _____ in the subarachnoid space?

A

Polymorphs (neutrophils)

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21
Q

Bacterial meningitis - clinical features

A 
Crescendo headache 
Fever 
Change in mental state 
Neck stiffness 
N+V
Photophobia
Confusion
Slowness in responding to questions 
Non blanching ash
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22
Q

Bacterial meningitis - what are the 5 warning features

A 
Marked decline in conscious level 
Focal neurology 
Seizure before or at presentation
Bradycardia + hypertension
Papilloedema
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23
Q

Bacterial meningitis - investigations

A

Bloods
Throat swab
CSF lumbar puncture

24
Q

What is the best way to determine aetiology (viral vs bacterial) meningitis?

A

CSF lumbar puncture

25
Q

Bacterial meningitis - CSF lumbar puncture findings

A

Increased neutrophils (abundant polymorphs)

Low CSF glucose

26
Q

Bacterial meningitis - antibiotics should not be given until CSF lumbar puncture has been carried out. True or false?

A

False

- antibiotics should be given before lumbar puncture

27
Q

Bacterial meningitis - which patients should undergo CT prior to lumbar puncture?

A 
Immunocompromised patients 
Pts with Hx of CNS disease
Papilloedema 
Focal neurological deficit 
New onset seizure
28
Q

Management of suspected bacterial meningitis

A

High doses of antibiotics because you need to get into the CNS which is matted with pus

29
Q

Bacterial meningitis - which antibiotics are used?

A

Ceftriaxone IV 2g bd

Cefotaxime 2g qds

30
Q

Bacterial meningitis - which antibiotics are used if penicilin allergic ?

A

Chloraphenicol IV 25mg/kg qds

+ Vancomycin

31
Q

Bacterial meningitis - aside from antibiotics, what is also administered to the patient

A

Dexamethasone IV 10mg qds

32
Q

Bacterial meningitis - when is dexamethasone given in relation to antibiotics?

A

This is started with or just before first dose of antibiotics

33
Q

Bacterial meningitis - why is dexamethasone administered?

A

Required if the causative organism is strep pneumonia.

If the causative organism is strep pneumoniae, dexamethasone should be continues for 4 days

If the causative organism is not strep pneumoniae, dexamethasone should be stopped

34
Q

Bacterial meningitis management - if patient is over 60 which additional antibiotic should be administered

A

2mg amoxicillin

35
Q

Why is amoxicillin given in over 60 year olds?

A

As the likely organism may be listeria

36
Q

Bacterial meningitis - when organism is confirmed to be listeria, what is the management?

A

Ceftriaxone +
Dexamethasone +
Amoxicillin

37
Q

Bacterial meningitis - if the patient has recently travelled to a country with high rates of penicillin resistant pneumococci then what should be added to management?

A

Rifampicin

38
Q

If a patient has suspected meningitis, public health must be informed. True or false?

A

True

39
Q

What are the prophylactic regimes if you have been in contact with a patient with meningitis?

A

600mg rifampicin

40
Q

Bacterial meningitis - complications

A

Cerebral oedema

Hydrocephalus

41
Q

Bacterial meningitis - vaccinations

A

Haemophilus influenzae B
Neisseria meningitides
Pneumococcal vaccines

42
Q

Aseptic meningitis - definition

A

In patients where there is no bacteria found on investigation but you think there is some form of meningococcal infection

43
Q

Aseptic meningitis - CSF results

A

Low number of WBC
Normal glucose
No bacteria

44
Q

Aseptic meningitis - causes

A

Viruses (most common)
Fungi
Spirochetes

45
Q

Viral meningitis - cause

A

Enterovirus (ECHO virus)

Travel related viruses

46
Q

Viral meningitis - investigations

A

Viral stool culture
Throat swab
CSF PCR
Lumbar puncture

47
Q

Viral meningitis - lumbar puncture findings

A

Lots of lymphocytes

48
Q

Viral meningitis - management

A

Self limiting

49
Q

Encephalitis - causative organism

A

Herpes simplex virus (HSV)

50
Q

Encephalitis has a sudden onset. True or false?

A

False

- gradual onset

51
Q

Encephalitis - clinical features

A 
Mental state change
Seizures 
Partial paralysis 
Confusion
Speech problems 
Behavioural disturbances 
Meningismus - stiffness in the head
52
Q

Encephalitis - always do a lumbar puncture. True or false?

A

False

- try to do a lumbar puncture but if unsafe then do a CT scan

53
Q

Encephalitis - most useful investigation

A

MRI scan

54
Q

Encephalitis - management

A

IV aciclovir

55
Q 
Which antibiotic is first line for most cases of meningitis?
IV vancomycin 
IV amoxicillin
IV ceftriaxone 
IV chloramphenicol 
IV co-trimoxazole
A

IV ceftriaxone

Neurology SOH (31 decks)

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