Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > CNS infections > Flashcards

CNS infections Flashcards

1
Q

what is meningitis inflammation of

A

all the meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

why is time important in CNS infections

A

to save neural tissue
untreated infection may cause:
-brain herniation and death
-cord compression and necrosis (paralysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is encephalitis

A

global infection of the brain parenchyma often caused by viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is meningoencephalitis

A

inflammatory process (most often caused by viral infection), involving both the brain and meninges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is encephalomyelitis

A

inflammation of the brain and spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is neuritis

A

inflammation of one or more nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the types of menigitis

A

acute pyogenic (bacterial)
acute aseptic (viral)
acute focal suppurative infection (brain abscess, subdural and extradural empyema)
chronic bacterial infection (TB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is encephalopathy

A

any disease or disoder that affects the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the features of pyogenic meningitis

A

have a thich layer of suppurative exudate covering the leptomeninges over the surface of the brain
exudate in basal and convexity surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is seen microscopically in pyogenic meningitis

A

neutrophils in the subarachnoid space- lots of neutrophils in lumbar puncture= bacterial meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

do you get lots of neutrophils in CSF in a viral meningitis

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what bacteria commonly cause bacterial meningitis

A

pneumococcus (strep pneumoniae)
meningococcus
haemophilus influenzae

listeria if >60 or immunocompressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the treatment for bacterial meningitis

A

ceftriaxone IV
(if penicillin allergy chloramphenicol)
+
dexamethasone (IV) start with or just before abx

if listeria cover required add in amoxicillin IV (or co-trimoxazole if p allergic)

if recent travel ass in vancomycin IV for pneumococcal resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

why should you make sure someone is allergic to penicillin before giving chloramphenicol

A

as v nasty drug - grey baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what type of bacteria is strep pneumoniae

A

gram +ve cocci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what type of bacteria is listeria monocytogenes

A

gram +ve rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what type of bacteria is haemophilis influenza

A

gram -ve bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what causes viral meningitis

A 
enteroviruses (echo virus) 
herpes simplex (will have coldsores)
varicellar zoster virus

(in immunosuppressed EBV and CMV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is viral menigitis diagnosed

A

viral stool culture
throat swab
CSF PCR (will have only a few lymphocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the treatment for viral meningitis

A

initially same as bacterial

supportive- e.g. vomiting give anti emetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what should you not delay in suspected encephalitis

A

lumbar puncture (unless they have had seizures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what Tx for viral encephalitis

A

IV aciclovir

LP after 14 days, HSV PCR weekly until negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the clinical features of encephalitis

A

insidious onset
meningismus (features of meningitis without inflammation of the meninges)

cerebral cortex is diffusely involved:
mental changes
confusion
stupor 
coma 
seizures 
partial paralysis 
speech and memory symptoms 
pychosis 
focal or diffuse neurological changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the clinical features of meningoencephalitis

A

features of encephalitis but with alos:

  • headache
  • fever
  • neck stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what viruses commonly causes viral encephalitis

A

herpes simplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what investigations for encephalitis

A

LP, EEG, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the symptoms of meningitis

A 
headache 
vomiting 
pyrexia
neck stiffness
photophobia 
lethargy 
confusion 
rash (non blanching)
muscle pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what causes bacterial meningitis in neonates

A

listerior, group B strep, e coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what causes bacterial meningitis in children

A

h influenza (vaccinate against this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what causes bacterial meningitis in ages 10-21

A

neisseria meningitidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what causes bacterial meningitis in ages over 21

A

strep pneumoniae , neisseria meningitidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what causes bacterial meningitis in overs 65s

A

streptococcus pneumoniae, listeria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what causes bacterial meningitis in the immunocompromised

A

S. pneumoniae, N. meningitidis, listeria, aerobic GNR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what causes bacterial meningitis in basilar skull fractures

A

s. pneumoniae, h. influenzae, beta hemolytic strep group A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what causes bacterial meningitis in head trauma/ post op

A

s. aureus, s epidermis, aerobic GNR

36
Q

what causes bacterial meningitis in a CSF shunt

A

s. epidermis, S aureus, aerobic GNR, p. acnes

37
Q

what are the possible complications of meningitis

A

as limb loss, deafness, blindness, cerebral palsy, quadriplegia and severe mental impairment

Purulence
Exudate around nerves (III, VI cranial nerves particularly vulnerable)

invasion and abscesses

cerebral oedema

ventriculitis/ hydrocephalus

38
Q

what are the pathogeneses of bacterial meningitis

A
  • nasopharyngeal colonisation (most common)
  • direct (sinusitis, mastoiditis, brain abscess, skull defects/ fracture
  • from remote foci of infection (endocarditis, pneumonia, UTI)
39
Q

what do you analyse in CSF from a lumbar puncture

A

Tube 1. Hematology: cell count, differential
Tube 2. Microbiology: gram stain, cultures
Tube 3. Chemistry: glucose (will be low in meningitis as bacteria eating it), protein
Tube 4. Hematology: cell count, differential

opening pressure
lactate

40
Q

what precautions must be made in lumbar punctures

A

be careful of raised ICP (dont do)

treat with antibiotics first in suspected bacterial infection

41
Q

what CSF results are 99% predictive of bacterial meningitis

A 
high WBC count 
higher neutrophils 
high protien 
low glucose 
low glucose (CSF/serum)
42
Q

what are the typical CSF findings in viral meningitis

A

lymphocytes
protein normal/ slightly high
glucose usually normal
gram stain will be negative

43
Q

what will the gram stain be in TB CSF analysis

A

may be pos or negative

44
Q

what causes the symptoms in neisseria meningitis

A

endotoxin

45
Q

who usually gets neisseria meningitis

A

young children

46
Q

what does the rash look like in meningococcal infection

A

non blanching purpura that look like coalesced bruises

47
Q

what does H influenza require for growth

A

blood factors

48
Q

what is the most common cause of meningitis in children under 4

A

h influenzae

49
Q

where is strep pneumoniae usually found- why is this important

A

nasopharynx

Hospitalized patients, patients with CSF skull fractures, diabetics/ alcoholics and young children are most susceptible to S. pneumoniae meningitis.

50
Q

what tx for cryptococcus meningitis

A

will have very high ICP so give serial LPs and anti fungals (IV amphotericin A/ flucytosine, fluconazole)

51
Q

who gets cryptococcus

A

HIV patients

52
Q

what is the most common meningitis in immunocompromised

A

listeria

53
Q

what are the features of cryptococcal meningitis

A 
fungal 
mainly in HIV disease
low CD4
disseminated infection 
aseptic CSF
54
Q

who gets listeria meningitis infections

A

neonates
>55s
immunosuprpessed (esp malignancy)

55
Q

what antibiotic for listeria

A

IV amoxicillin (or ampicillin)

56
Q

what are the features of tuberculous meningitis

A

reactivation, elderly
often non specific illness
previous TB on CXR
hard to diagnose- poor yield on culture

57
Q

tx for TB meningitis

A

Isoniazid + rifampicin key (add pyrazinamide + ethambutol)

58
Q

why can bacterial meningitis be culture negative

A

10-15% are anyway

pre LB use of oral antibiotics can lower culture

59
Q

what other than bacterial meningitis can a neutrophilic & low glucose CSF mena

A

early viral
leakage of abscess into ventricle
TB

chemical meningitis
behcet syndrome
drug induced

60
Q

what is aspetic meningitis

A 
non pyogenic bacterial meningitis:
spinal fluid that contains
-low WBC
-minimally elevated protein 
-normal glucose

can be lots of things other than viral meningitis

61
Q

what are the (treatable) causes of aseptic meningitis/ encephalitis

A 
Infectious:
HSV 1 and 2
Syphilis
Listeria (occasionally)
Tuberculosis
Cryptococcus
Leptospirosis
Cerebral malaria
African tick typhus
Lyme disease
Non-Infectious:
Carcinomatous
Sarcoidosis
Vasculitis
Dural venous sinus thrombosis
Migraine
Drug
Co-trimoxazole
IVIG
NSAIDS
62
Q

what are the contact prophylaxis regimes for meningitis

A

500 mg ciprofloxacin orally as a single dose for adults and children aged more than 12 years

600 mg rifampicin orally 12-hourly for four doses (adults and children over 12 years)

63
Q

should you involve public health about meningitis

A

yes- all suspected cases

64
Q

what vaccines protect against meningitis

A

travel vaccinations (neisseria)
HiB vaccine
pneumococcal vaccines

65
Q

which space are samples obtained from in an LP

A

subarachnoid space

66
Q

what are normal CSF WBC and RBC counts

A

white 0-5

red 0

67
Q

what are the expected ratios for protein and glucose in CSF

A

glucose 0.6 (should be 2/3rds of blood glucose)

protein 150-450:1

68
Q

proportionally more neutrophils (aka polymorphs) in CSF= ?

A

bacterial infection

69
Q

proportionally more lymphocytes in CSF= ?

A

viral/ fungal infection

70
Q

what is petechea

A

non blanching rash, meningitis

71
Q

what are the rules for CTs and LPs

A

NEVER DO LP WITHOUT DOING CT AS MIGHT HAVE RAISED ICP- cause brain to herniate = coning (when cerebellum goes through foramen magnum)

unless
in suspected meningitis if patient has no focal deficit, is not immunocompromised, no skull #, has had no seizures,no Hx of CNS disease, no papilloedema, normal conscious level then do LP ASAP and start antibiotics

72
Q

gram -ve cocci meningitis= ?

A

meningococcus meningitis (caused by neisseria)

73
Q

what drug for chemoprophylaxis for bacterial meningitis

A

ciprofloxacin

74
Q

what is the abx treatment for a brain abscess

A

IV ceftriaxone
IV metronidazole

add flucloxacillin in staph suspected
IV vancomycin if pen allergic/ MRSA suspected

for 4 weeks minimum

75
Q

what other tests should be done in viral meningitisi

A

throat swap
stool sample
HIV test

76
Q

what CNS infection causes oedema in the temporal loves

A

herpes simplex encephalitis

77
Q

what test to confirm herpes simplex encephalitis

A

PCR from LP

78
Q

what 3 tests do you prioritise in meningitis

A

LP
CT
blood culture

79
Q

gram +ve diplococci meningitis= ?

A

pneumococcus

80
Q

where can an brain abscess originate from

A

mastoiditis
sinusitis
orbital cellulitis

81
Q

what organisms can cause brain abscesses

A

streptococci, bacteriodes, staphylococci, anaerobes, colliforms

82
Q

why do you give ceftriaxone and not penicillin for meninigitis

A

as lasts longer in CSF

83
Q

when do you delay an LP in meningitis

A 
signs of severe sepsis 
cardiac/ resp  compromise 
rapidly evolving rash 
significant bleeding risk 
signs suggesting shift of brain compartments (do CT)
- focal neuro signs 
- papilloedema 
- seizures that are continuous/ uncontrolled 
- GCS = 12
84
Q

buzzworrds: summer/ autumn time, GI symptoms

A

enterovirus viral meningitis

85
Q

what is the key symptom in encephalitis

A

confusion

Neurology (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions