CNS Infections

Question 1

what is encephalitis an infection of

Answer 1

brain parenchyma

Question 2

what is the most common cause of encephalitis

Answer 2

herpes simplex

Question 3

how does encephalitis present

Answer 3

insidious onset of:

• confusion
• seizures
• speech/memory problems
• partial paralysis

Question 4

investigations of encephalitis

Answer 4

MRI, LP, EEG

Question 5

treatment of encephalitis

Answer 5

IV Aciclovir

Question 6

what is meningitis

Answer 6

inflammation of the meninges

Question 7

what is meningococcal septicaemia? what is the presenting feature?

Answer 7

when the meningococcal bacteria has entered the bloodstream

• NON BLANCHING RASH
• indicates there has been disseminated intravascular coagulopathy (DIC) and subcutaneous haemorrhages

Question 8

what causes viral meningitis

Answer 8

ECHO virus
coxasackie virus
herpes simplex

Question 9

investigations of viral meningitis

Answer 9

viral stool culture + throat swab

CSF PCR

Question 10

CSF results in viral meningitis

Answer 10

clear appearance
CSF protein + glucose normal
high numbers of lymphocytes

Question 11

treatment of viral meningitis

Answer 11

supportive

Question 12

most common cause of bacterial meningitis in neonates

Answer 12

Group B step

can also be caused by listeria / e.coli

Question 13

what age group gets meningococcal meningitis

Answer 13

10-21 year olds

Question 14

what causes bacterial meningitis in under 10s

Answer 14

H.influenzae

Question 15

what causes bacterial meningitis in adults (>21)

Answer 15

Strep. Pneumoniae

Question 16

what can cause bacterial meningitis in elderly (>65)

Answer 16

Listeria

Question 17

what bacteria is suspected in patients who have had neurosurgery / open head trauma

Answer 17

staph aureus

staph epidermis

Question 18

what bacteria is suspected in immunocompromised

Answer 18

strep pneumonia
listera
meningococcal

Question 19

symptoms of bacterial meningitis

Answer 19

fever
neck stiffness
altered consciousness
vomiting 
photophobia

Question 20

CSF results bacterial meningitis

Answer 20

cloudy appearance
high protein
low glucose
high numbers of neutrophils

Question 21

what should be given in the community if meningococcal meningitis is suspected

Answer 21

IM Benzylpenicillin

Question 22

what is the empirical therapy for bacterial meningitis

Answer 22

IV ceftriaxone 2g BD

IV chloramphenicol + vancomycin if allergic

Question 23

what is added if listeria is suspected in bacterial meningitis treatment

Answer 23

IV amoxicillin

if allergic co-trimoxazole

Question 24

what else should be given in the management of bacterial meningitis

Answer 24

IV Dexamethasone

Question 25

why is dexamethasone given in management of bacterial meningitis

Answer 25

reduce risk of neurological complications

Question 26

neurological complications of meningitis

Answer 26

hearing loss
seizures + epilepsy
cognitive impairement
memory loss

Question 27

what is given for post exposure prophylaxis for bacterial meningitis to at risk individuals

Answer 27

ciprofloxacin

Question 28

what is aseptic meningitis

Answer 28

non-pyogenic bacterial meningitis

Question 29

CSF results aseptic meningitis

Answer 29

low WBC count
normal glucose
minimally elevated protein

Question 30

what can cause aseptic meningitis

Answer 30

TB

cryptococcal meningitis

Question 31

what is cryptococcal meningitis

Answer 31

fungal meningitis

- associated with HIV

Question 32

treatment of cryptococcal meningitis

Answer 32

IV amphotericin + fluconazole

Question 33

what virus causes progressive multifocal leucoencephalopathy

Answer 33

JC virus

Question 34

multiple ring enhancing lesions

Answer 34

intra-cerebral toxoplasmosis

Question 35

what patients require a CT before an LP

Answer 35

immunocompromised
hx of stroke 
new onset seizures
papilloedema
altered conscious 
focal neurological deficit

Question 36

what patients should never receive an LP

Answer 36

those with raised ICP