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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What is the classification of meningitis?

A
  1. Acute pyogenic (bacterial) meningitis
  2. Acute aseptic (viral) meningitis
  3. Acute focal suppurative infection (brain abscess, subdural and extradural empyema)
  4. Chronic bacterial infection (tuberculosis)
  5. Acute encephalitis is an infection of the brain parenchyma
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2
Q

“a thick layer of suppurative exudate covers the leptomeninges over the surface of the brain.”

What does this describe?

Be more specific about areas the exudate is found

A

It’s a pyogenic meningitis

Exudate in basal and convexity surface

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3
Q

How does a pyogenic meningitis appear microscopically?

A

Neurophils in the subarachnoid space

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4
Q

What age group would you expect a pyogenic meningitis to be caused by Neisseria meningitidis?

A

10-21 y/o

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5
Q

Pt with pyogenic meningitis in 30s with no recent travel.

What’s the most likely bug?

A

Streptococcus pneumoniae

(in patients over 21 y/o)

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6
Q

What bug should you be worried about for

  • >60y/o
  • neonates
  • immunosuppressed?
A

Listeria monocytogenes

esp the >60s and immunocompromised groups

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7
Q

What bugs can are most likely to cause a pyogenic meningitis in a neonate?

A
  • E. coli
  • Group B streptococcus
  • Listeria monocytogenes
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8
Q

Bacterial meningitis in a child (neonate to 10 y/o)

What do you think is the causative organism?

A

H. influenzae

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9
Q

What are the clinical features of a bacterial meningitis?

A
  1. Fever
  2. Headache
  3. Photophobia
  4. Stiff neck
  5. Altered consciousness
  6. Petechial rash (non-blanching)
  7. Potential seizures
  8. Focal neurological deficits
  9. Coma
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10
Q

What investigation must be undertaken to diagnose meningitis?

A

Lumbar puncture

BUT a CT must be done first to exclude SOL

CSF assessment:

  • bacterial culture
  • fungal staining and culture
  • viral PCR
  • also look at the colour of it
  • and note the pressure as it comes out
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11
Q

Why is it important to always do a CT scan before a lumbar puncture?

A

Because a lumbar puncture could cause cerebral herniation in the event of a SOL

you’ll be struck off if you forget this!

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12
Q

What empirical treatment are you going to offer to someone between 21yrs and 60yrs with suspected bacterial meningitis?

A

Ceftriazone IV and dexamethasone IV

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13
Q

What empirical treatment are you going to give a patient >60y/o who has suspected bacterial meningitis?

A

Ceftriazone IV

Dexamethasone IV

Amoxicillin IV 4 hourly (for Listeria cover)

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14
Q

You are treating a >60y/o patient empirically for bacterial meningitis.

The cultures come back and confirm your suspicion of Listeria.

What do you need to do next?

and how long does the patient require amoxicillin?

A

Stop dexamethasone

Pt. will require at least 21 days of amoxicillin

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15
Q

You are treating someone between the ages 21 and 60 empirically for suspected bacterial meningitis.

The cultures come back and confirm pneumococcoal meningitis

How long will the patient remain on treatment?

A

Ceftriaxone IV for 10 days- can extend to 14 days if taking longer to respond

Dexamethasone IV for 4 days

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16
Q

What should be considered after 5 days of IV antibiotic treatment?

A

Consider outpatient IV therapy if patient has had 5 or more days treatment,

afebrile,

and clinically improving.

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17
Q

You’re treating a patient empirically for bacterial meningitis.

The cultures come back with no organism identified.

What do you?

A

Continue empirical treatment

Patient can be discharged after 10 days if they’ve clinically recovered

Request Infectious Diseases consult

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18
Q

What would be the best empirical treatment for a child between the ages of 1 and 10 suffering from bacterial meningitis?

What is the likely pathogen?

A

Ceftriazone IV and Dexamethasone IV

If confirmed on culture stop Dexamethasone and continue Ceftriazone IV for 10 days

H.influenzae

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19
Q

Which countries have high rates of penicillin resistant pneumococci?

(don’t need to learn these countries off but just want you to have read them)

A

Canada

China

Croatia

Pakistan

Poland

Spain

Mexico

Italy

USA

Greece

Turkey

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20
Q

A patient presents with suspected bacterial meningitis.

In the past 6 months they’ve travelled to a country with high rates of penicillin resistant pneuomococci.

What empirical treatment will you give them while you await the cultures?

A

Ceftriazone IV

Dexamethasone IV

Vancomycin IV

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21
Q

What are the likely causative organisms of a viral meningitis?

A
  1. Enteroviruses
    • Coxsackie viruses and echoviruses
  2. HSV 1/2
  3. Varicella zoster
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22
Q

What are the clinical features of a viral meningitis?

A
  • Headache
  • Photophobia
  • Stiff neck
  • Altered consciousness
  • Potential seizures
  • Focal neurological deficits
23
Q

What investigations do you need to undertake to diagnose a viral meningitis?

A

Lumbar puncture (CSF PCR)

BUT MUST undertake a CT scan first to rule out SOL

Viral stool culture

Throat swab

24
Q

What is the treatment for a patient with viral meningitis?

A

Supportive

25
Q

Where is N. meningitidis found naturally?

A

N. meningitidis occurs in the nasopharynx of many people

Usually bacterial meningitis is preceeded by a respiratory or ear infection

26
Q

What type of infection may precede a bacterial meningitis?

A

A respiratory or ear infection

27
Q

What would you prescribe for close contacts of someone with bacterial meningitis caused by N. meningitis?

A

Cirprofloxacin

28
Q

Why is Ceftriaxone used instead of penicillin for bacterial meningitis?

A

Ceftriaxone lasts longer than penicillin in the CSF

(Passtest and PassMed often say penicillin is the right answer)

29
Q

Why is dexamethasone given initially in bacterial meningitis?

A

Antibiotics can initially cause a damaging cytokine storm raising ICP which is why dexamethasone is given initially alongside antibiotics

30
Q

How does encephalitis often present?

A

an insidious onset

stupor

confusion

31
Q

What is encephalitis most commonly caused by?

A

HSV

32
Q

What do you do in suspected encephalitis?

A

a CT and LP

EEG and MRI

33
Q

How do you treat encephalitis?

A

IV aciclovir

34
Q

What’s the difference between encephalitis and meningitis?

A

Encephalitis= global infection, whole brain is inflamed

Meningitis= lining of brain

35
Q

What is aseptic meningitis?

A

Non-pyogenic meningitis

a big differential diagnosis

36
Q

What are the potential causes of an aseptic meningitis?

A

Infectious

  • HSV 1 & 2 (most common)
  • Syphilis
  • Listeria
  • others

Non-infectious

  • carcinomatous
  • sarcoidosis
  • vasculitis drugs
  • dural venous sinus thrombosis
37
Q
A
38
Q

What opening pressures would you expect to see in CSF of:

  1. Bacterial meningitis
  2. Viral meningitis
  3. Tuberculous meningitis
  4. Autoimmune meningitis
A
  1. Bacterial= very high
  2. Viral = slightly increased
  3. Tuberculous= very high
  4. Autoimmune = slightly increased
39
Q

What would you expect to see in the white cell count in the CSF of a bacterial meningitis?

A

Bacterial= increased neutrophil count

40
Q

What would you expect to see in the white cell count in the CSF of a viral meningitis?

A

Increased lymphocyte count

41
Q

What would you expect to see in the white cell count of a tuberculous meningitis?

A

Tuberculous= increased lymphocyte count

42
Q

What would you expect to see in the white cell count of an autoimmune meningitis?

A

Increased

43
Q

What would the protein levels be in a:

  1. bacterial
  2. viral
  3. tuberculous
  4. autoimmune

meningitis?

A

Protein levels:

  1. Bacterial= very high
  2. Viral = slightly increased
  3. Tuberculous= very high
  4. Autoimmune = slightly increased to very high
44
Q

What are the CSF:Serum Glucose ratios in a:

  1. Bacterial
  2. Viral
  3. Tuberculous
  4. Autoimmune

meningitis?

A

CSF: Serum Glucose ratio

  1. <50%
  2. >50%
  3. <50%
  4. >50%
45
Q

What lactate would you expect in the CSF of a:

  1. Bacterial
  2. Viral
  3. Tuberculous
  4. Autoimmune

meningitis?

A
  1. Bacterial= high
  2. Viral = normal
  3. Tuberculous= very high
  4. Autoimmune= normal
46
Q

What does CSF look like in a bacterial meningitis?

A

Bacterial= Turbid/purulent

47
Q

What does CSF look like in a viral meningitis?

A

Viral = clear/turbid

48
Q

What does CSF look like in a tuberculous meningitis?

A

Tuberculous= turbid/viscous

49
Q

What does turbid mean?

A

Not transparent because of stirred up sediment

50
Q

What is likely to be the causative organism of an immunocompromised patient presenting with bacterial meningitis?

A

S. pneumoniae

N. meningitidis

Listeria

aerobic GNR (incl. Ps. aeruginosa)

51
Q

What is likely to be the causative organism of a patient with a previous basilar skull fracture presenting with bacterial meningitis?

A

S. pneumoniae

H. influenzae

beta-haemolytic strep group A

52
Q

What is likely to be the causative organism of a patient with previous head trauma or neurosurgery presenting with bacterial meningitis?

A

S. aureus

S. epidermidis

aerobic GNR

53
Q

What is likely to be the causative organism in a patient with a CSF shunt presenting with bacterial meningitis?

A

S. epidermidis

S. aureus

aerobic GNR

Propionibacterium acnes

54
Q
A

Neurology (6 decks)

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