CNS infections

Question 1

What are the 4 causes of CNS infection?

Answer 1

Direct innoculation
Local spread from adjacent structures
Spread from a distant focus of infection
Trauma to the skull

Question 2

Just a statement really…
Time is neural tissue, untreated infection may cause brain herniation and death, cord compression and necrosis with subsequent permanent paralysis

Answer 2

PREACH IT BROTHA

Question 3

Encephalopathy

Answer 3

Irritation but not inflammation

Question 4

Encephalitis

Answer 4

Infection of the brain parenchyma

Question 5

Aseptic meningitis

Answer 5

Non-pyogenic bacterial meningitis (i.e. not found a bacterium but think there is an infection involved often virus but not always)

Question 6

Meningitis

Answer 6

Inflammation of layers covering brain parenchyma

If meninges inflamed it becomes like injecting pus into the CNS, all the cranial nerves as they exit can be effected

Question 7

What are the trio of symptoms that represent meningitis?

Answer 7

Headache, Photophobia and Neck stiffness

Question 8

What does pyogenic mean?

Answer 8

Pus forming organism

Question 9

Bacterial meningitis frequently causes severe oedema and ——- —–

Answer 9

Raised ICP

Question 10

What is the common causative organism for bacterial meningitis in those age 10-21

Answer 10

Meningococcus

Question 11

What is the common causative organism for bacterial meningitis in those 21+

Answer 11

Pneumococcus

Question 12

Most common causative organism for bacterial meningitis in elderly?

Answer 12

Listeria Monocytogenes

Question 13

Most common causative organism for bacterial meningitis in infants

Answer 13

H.Influenza

Question 14

Most common causative organism for bacterial meningitis in neonates

Answer 14

E.Coli

Question 15

What are the two common gram + bacteria that can cause meningitis?

Answer 15

Strep pneumonia ( diplococci in chains)
Listeria Monocytogenes (bacilli)

Question 16

What are the three gram - bacteria that can cause meningitis?

Answer 16

E.coli (bacilli)
H.Influenza (cocco bacilli)
Nisseria Meningitis (diplococci, intracellular)

Question 17

What is the likely causative bacterium in meningitis if there is a fractured cribriform plate, diabetic/alcoholic, hospitalised patient?

Answer 17

Strep Pneumonia

Question 18

Likely causative organism in meningitis if there is neurosurgery or head trauma?

Answer 18

Staph A or staph epidermis

Question 19

Likely causative organism if pregnant, over 55, neonates or immunosuppressed?

Answer 19

Listeria monocytogenes

Question 20

What is Waterhouse-Friderichsen syndrome?

Answer 20

A form of fulminant meningococcal disease in which severe septicaemia is complicated by the development of bilateral haemorrhage into the adrenal glands and disseminated intravascular coagulation (DIC)

Question 21

What does the LP look like for bacterial meningitis?

Answer 21

Cloudy turbid CSF
Polymorphs present
Low glucose
Raised protein

Question 22

Treatment of community acquired meningitis

Answer 22

IV Cefriaxone and Dexamethasone

Question 23

is listeria is suspected what should be added to the treatment regime?

Answer 23

Amoxicillin (for 21 days)

Question 24

If recent travel to a country with high rates of penicillin resistant pneumococcus add in…

Answer 24

Vancomycin

Question 25

What is the prophylactic therapy for those in close contact to those with meningitis

Answer 25

Ciprofloxacin (single dose)

Question 26

What are two specific tests that are positive in meningitis?

Answer 26

Kernig's sign | Brudzinksis sign

Question 27

What are the indications for hospital admission in those with acute adult bacterial meningitis

Answer 27

Meningeal irritation Impaired conscious level Petechial rash Those who are febrile or unwell and have had a recent fit Ill and had recent close contact with someone with meningococcal infection

Question 28

When does viral meningitis commonly occur?

Answer 28

After a viral illness (late summer/autum)

Question 29

What are the common viruses that cause viral meningitis?

Answer 29

Enteroviruses e.g. echovirus (or coxsackie)

Question 30

If the viral meningitis is severe what is the most likely causative organism

Answer 30

HSV

Question 31

What does LP look like for patients with viral meningitis?

Answer 31

Clear fluid Lymphocytes Low/Normal glucose Normal/ Slightly raised protein

Question 32

TRUE/FALSE | Viral meningitis is often self-limiting

Answer 32

TRUE | If severe then IV Acyclovir may be used

Question 33

Findings of TB meningitis on LP?

Answer 33

Low glucose High protein Presence of fibrin webs

Question 34

Which disease is cryptococcal meningitis common with?

Answer 34

HIV disease

Question 35

What is the treatment of TB meningitis?

Answer 35

RIPE

Question 36

When does neonatal meningitis present?

Answer 36

1st 4wks of life

Question 37

What are the 3 organisms that can cause neonatal meningitis?

Answer 37

Group B strep E Coli Listeria Monocytogenes

Question 38

What is the treatment of neonatal meningitis caused by group B strep?

Answer 38

Benzylpenicillin and gentamicin

Question 39

What drugs are used to treat E.Coli causing neonatal meningitis?

Answer 39

Cefotaxime and gentamicin

Question 40

What is used to treat neonatal meningitis caused by Listeria monocytogenes?

Answer 40

Amoxicillin and gentamicin

Question 41

What is encephalitis?

Answer 41

Inflammation of the brain parenchyma commonly due to viral infection

Question 42

What is the most common cause of encephalitis?

Answer 42

HSV

Question 43

What are the two ways that HSV can spread to the brain to cause encephalitis?

Answer 43

- Through CN1 | - Reactivation in trigeminal root ganglia

Question 44

How does encephalitis present?

Answer 44

Acute onset headache and fever Altered consciousness Focal neurological deficit

Question 45

Seizures with focal neurological deficits

Answer 45

Herpes simplex encephalitis

Question 46

Parotitis in an unvaccinated patient

Answer 46

Mumps encephalitis

Question 47

Skin lesions/vesicles in a dermatomal pattern

Answer 47

VZV encephalitis

Question 48

What is an uncommon serious sequel of measles virus

Answer 48

Subacute sclerosing panencephalitis

Question 49

How does subacute sclerosing pan encephalitis present?

Answer 49

Change in personality Cognitive decline Myoclonus

Question 50

Speech and memory problems is more common in encephalitis or meningitis?

Answer 50

Encephalitis`