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J Neuro > CNS infections > Flashcards

CNS infections Flashcards

1
Q

meningitis definition

A

inflammation of meninges

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2
Q

encephalitis definition

A

inflammation of the brain parenchyma

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3
Q

brain abscess definition

A

collection of pus

presents lie a stroke bc is focal

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4
Q

which of the following presents diffusely and which presents like a stroke (bc is focal);

meningitis
encephalitis
brain abscess

A

meningitis - diffuse
encephalitis - diffuse
brain abscess - focal (collection of pus)

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5
Q

what are the 4 main causes of bacterial meningitis

A

strep pneumoniae
Neisseria meningococcus
haem influenzae
listeria monocytogenes

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6
Q

who gets bacterial meningitis caused by strep pneumonia

A

most people! - its the most common cause

also cochlear implants, sinusitis - as its normally found in the nasopharynx

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7
Q

who gets bacterial meningitis caused by Neisseria meningococcus

A

10-20yos

students

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8
Q

who gets bacterial meningitis caused by haem influenzae

A

kids

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9
Q

who gets bacterial meningitis caused by listeria monocytogenes (2)

A

immunocompromised people ge HIV, >60yo, alcoholics, pregnant women, neonates

recently eaten soft cheese (or other deli products - grows at fridge temp) - lol our fridge juice is listeria

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10
Q

which bacteria is most the most common cause of bacterial meningitis

A

strep pneumoniae

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11
Q

which cause of bacterial meningitis is a Gm+ve (purple) diplococci on histology

A

strep pneumonia

2 purple circles

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12
Q

which cause of bacterial meningitis is a Gm-ve (pink)intracellular whisps on histology

A

Neisseria meningococcus

will probs be described not picture bc hard to see whisps

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13
Q

which cause of bacterial meningitis is a Gm-ve (pink) bacilus on histology

A

haem influenzae

pink rod

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14
Q

which cause of bacterial meningitis is a Gm+ve bacillus on histology

A

listeria monocytogenes

purple rod

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15
Q

causes of aseptic (non bacterial) meningitis

A

viruses!

enterovirus (ECHO)
EBV
CMV
HIV

travel history important!

also sarcoidosis, cancer, vasculitis…

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16
Q

do bacterial or aseptic meningitis more classically present with a rash

A

bacterial (though not always)

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17
Q

diagnostic investigation for aseptic meningitis

A

CSF PCR form lumbar puncture

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18
Q

treatment of aseptic (non bacterial) meningitis

A

supportive

IV Aciclovir if ?abscess

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19
Q

what type of rash does bacterial meningitis classically present with

A

non blanching purpuric rash

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20
Q

what does non blanching rash mean

A

when you put a clear glass over it the rash remains

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21
Q

presentation of meningitis

A 
non blanching purpuric rash - if bacterial 
fever 
seizure 
stiff neck 
headache 
photophobia
22
Q

what is kernigs sign

A

when you get patient to lie down and bend one knee with hip at 90 degrees, then try straighten knee = too painful

23
Q

what is kernigs sign positive of

A

meningitis

24
Q

is bacterial or viral meningitis more slow in onset

A

viral

25
Q

is bacterial or viral meningitis faster in onset

A

bacterial

26
Q

what other neuro condition does meningitis present similar as (but headache not as bad)

A

subarachnoid haemrrhage

27
Q

investigations for meningitis

A

CT and antibiotics first

lumbar puncture - look at CSF

28
Q

what is the purpose of doing a lumbar puncture if youre fairly sure diagnosis is meningitis

A

differentiates between bacterial and viral - diff treatments

29
Q

cloudy lumbar puncture in meningitis

viral/bacterial infection?

A

bacterial infection

30
Q

clear/translucent lumbar puncture in meningitis

viral/bacterial infection?

A

viral infection

31
Q

what investigations do you want to do after CSF sample obtained for meningitis (6)

A 
Gm stain and culture 
viral PCR 
cell count - lymphocytes and neutrophils 
glucose 
protein 
pressure
32
Q

high neutrophils in meningitis

viral/bacterial infection?

A

bacterial infection

33
Q

high lymphocytes in meningitis

viral/bacterial infection?

A

viral infection

think about EBV and its atypical lymphocytes!

34
Q

low glucose (<60% of blood glucose) in CSF in meningitis

viral/bacterial infection?

A

bacterial infection - bc bacteria eat up glucose for energy

35
Q

normal glucose (>60% of blood glucose) in CSF in meningitis

viral/bacterial infection?

A

viral infection - bacteria eats up the glucose = low

36
Q

acute treatment of meningitis

A

ABCDE

antibiotics and steroids - before you get results back

37
Q

which antibiotic do you give for meningitis

A

ceftriaxone

38
Q

what do you give alongside the ceftriaxone in ?bacterial meningitis

A

dexamethasone (steroid)

39
Q

which alternative antibiotic do you give (instead of ceftriaxone) to patient you suspect listeria in

who do you suspect listeria in

A

amoxicillin

immunocompromised

40
Q

what would you give instead of antibiotics when you confirm a viral cause of meningitis

A

acyclovir

41
Q

complication of untreated meningitis

A

brain abscess
sepsis

IS A MEDICAL EMERGENCY

42
Q

which CNs are at risk of being damaged if a brain abscess occurs after meningitis

A

CN III and VI

43
Q

what prophylaxis is given to people who have been in close contact and prolonged exposure with someone with bacterial meningitis

A

ciprofloxacin

44
Q

what public health intervention is used to try and reduce cases of meningitis

A

MenACWY vaccines given to adolescents

45
Q

what is the most common cause of encephalitis

A

herpes simplex virus

46
Q

which lobe is commonly affected in encephalitis

A

temporal lobe

47
Q

how does encephalitis present

A

sudden onset
fever/flu like illness
altered behavior (bc temporal lobe) new onset seizures
recent travel!

48
Q

investigations for encephalitis

A

lumbar puncture
CT
EEG - for seizures
MRI

49
Q

treatment of encephalitis

A

ABCDE

acyclovir

50
Q

what are the risk factors for developing a brain abscess

A

current infection eg ear infection, sinusitis

jaw trauma

someway for bugs to get into cranial cavity!

51
Q

how does a brain abscess look on CT

A

‘ring enhancing lesion’ - the contrast cant pass through the centre of the abscess bc so dense = looks like a ring

52
Q

treatment of brain abscess

A

ceftriaxone IV and metronidazole IV

J Neuro (32 decks)

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