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1. Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What is meningitis?

A

infection of the meninges

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2
Q

What is encephalitis?

A

inflammation of the brain parenchyma - cerebral cortex is diffusly involved

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3
Q

What are the features of pyogenic meningitis?

A

PUS FORMING
lots of neutrophils in the subarachnoid space
over the leptomeninges on the surface of the brain

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4
Q

What are the features of viral meningitis?

A

often late summer/autumn

often due to enteroviruses (ECHO etc)

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5
Q

How is viral meningitis diagnosed?

A

stool PCR
throat swab PCR
CSF PCR

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6
Q

What is the most common pathogen for bacterial meningitis for neonates?

A

listeria
group B strep
E. coli

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7
Q

What is the most common pathogen for bacterial meningitis for children?

A

H. influenza

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8
Q

What is the most common pathogen for bacterial meningitis for ages 10-21?

A

nisseria meningitidis

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9
Q

What is the most common pathogen for bacterial meningitis for ages >21?

A

strep pneumoniae > n.meningitidis

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10
Q

What is the most common pathogen for bacterial meningitis for ages >65?

A

strep pneumoniae > listeria

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11
Q

What are the risk factors for bacterial meningitis?

A

decreased cell immunity
neurosurgery/head trauma
fracture of the cribiform plate
CSF shunt

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12
Q

What are the complications that come from bacterial meningitis?

A

purulence - clusters around nerves and the bottom of the brain
invasion - pia prevents meningitis becoming an abscess
cerebral oedema
ventriculitis/hydrocephalus

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13
Q

What is the pathophysiology of bacterial meningitis?

A

nasopharyngeal colonisation
direct extension of bacteria - from across skull defects/fractures or parameningeal foci
from remote foci of infection - endocarditis, pneumonia, UTIs

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14
Q

What are the characteristics of nisseria meningitis?

A 
found in the throats of healthy carriers
causes meningococcal meningitis (most deadly form)
usually in young children
travels through the blood stream 
can vaccinate against it
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15
Q

What are the characteristics of H.influenzae?

A

part of normal throat microbia
type b is most common - in children under 4
can vaccinate against it

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16
Q

What are the characteristics of strep pneumoniae?

A

found normally in the nasopharynx
can vaccinate against it
common to occur in hospitalised patients, patients with CSF skull fractures, diabetics and young children

17
Q

What are the characteristics of listeria monocytogenes?

A

mainly bacteraemic illness
gram positive bacilli
common in neonatal and >55 years, or immunosuppressed

18
Q

What additional antibiotic must you give for listeria monocytogenes bacterial meningitis?

A

amoxicillin IV

19
Q

What are the characteristics of tuberculous meningitis?

A

occurs due to reactivation or in the elderly

previous TB on CXR

20
Q

What is the treatment for tuberculous meningitis bacterial meningitis?

A

4 RIPE 2 RI

21
Q

What are the characteristics of cryptococcal meningitis?

A

aseptic picture on CSF as it is a fungal
mainly in HIV patients
CD4 <100

22
Q

What is the treatment for cryptococcal meningitis bacterial meningitis?

A

IV Amphotenicin

23
Q

What are the clinical signs of bacterial meningitis?

A 
neck stiffness
photophobia
fever
altered conciousness
non blanching rash
lethargy
24
Q

How is bacterial meningitis diagnosed?

A 
lumbar puncture - BUT MUST DO CT FIRST IF THEY HAVE SIGNS OF A FOCAL DEFICIT ETC
do 4 tubes:
1 tube haematology
1 tube microbiology
1 tube chemistry
1 tube haematology
25
Q

What CSF signs are indicative of bacterial meningitis?

A

WBC count > 2,000
neutrophils > 1180
protein > 220
glucose >34

26
Q

What is the treatment of bacterial meningitis?

A

IV ceftriaxone and dexamethasone

27
Q

When would you not give dexamethasone in bacterial meningitis?

A

if immunocomprimised, septic shock or meningococcal

28
Q

What is the treatment of bacterial meningitis in a penicilin allergic patient?

A

chloramphenicol and vacomycin IV

29
Q

What is a common cause of encephalitis?

A

HSV 1 and 2 - treat with acliclovir

30
Q

How does encephalitis present?

A 
stupor
coma
seizures
confusion
partial paralysis
psychosis
speech and memory problems
31
Q

What is the presentation of meningo-encephalitis?

A

headache
fever
neck stiffness
PLUS features of encephalitis

1. Neurology (32 decks)

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