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Neurology Year 3 > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Why are infections in the cranial cavity so dangerous?

A

Infection leads to inflammation which in an enclosed space like the skull leads to compression herniation and necrosis.

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2
Q

If you have pyogenic meningitis in a non immunosuppressed patient caused by a gram +ve what is it likely to be?

A

Streptococci Pneumonia

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3
Q

If you have pyogenic meningitis in a non immunosuppressed patient caused by gram -ve rods what is it likely to be?

A

Neisseria Meningitidis

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4
Q

If you have pyogenic meningitis in an immunosuppressed patient caused by gram +ve rods what is it likely to be?

A

Listeria Monocytogene

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5
Q

If you have a pyogenic meningitis in an immunosuppressed patient caused by gram -ve what is it likely to be?

A

H.Influenzae

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6
Q

Someone presents with pyogenic meningitis what is the treatment?

A

IV Ceftriaxone 2g

IV Dexamethasone

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7
Q

What organisms would IV Ceftriaxone be effective for?

A

Pneumococcus
Meningococcal
H.Influenzae

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8
Q

If someone is Penicillin allergic what is the alternative to Ceftriaxone?

A

Chloramphenicol IV 25mg

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9
Q

When is Listeria considered a suspected cause of meningitis?

A

Over 60’s

Immunosuppressed diabetes Alcohol

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10
Q

If Listeria is the suspected cause of the meningitis what is the treatment?

A

IV Ceftriaxone
IV Dexamethasone
IV Amoxicillin 2g 4 hourly

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11
Q

If someone has recently travelled and presents with meningitis what is the treatment?

A

IV Ceftriaxone
IV Dexamethasone
IV Vancomycin - increased risk of Penicillin resistance

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12
Q

For all cases of Pyogenic Meningitis what is the baseline length of treatment ?

A

5 days

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13
Q

A Purpuric non blanching rash is only present in one form of meningitis. Which organism is responsible?

A

Meningocococcal Menigitis

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14
Q

What is the presentation of viral meningitis?

A

Headache Fever Neck Stiffness

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15
Q

When is a common time for people to contract Viral Meningitis ?

A

Late Summer Autumn

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16
Q

What are two common causes of viral meningitis ?

A

Enterovirus

HSV - Most severe infection

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17
Q

What is the treatment for viral meningitis?

A

Usually supportive due to its self limiting nature.

18
Q

What is used to diagnose viral meningitis ?

A

CSF

PCR

19
Q

What are the clinical signs of encephalitis ?

A

Confusion
Coma
Behavioural Changes - due to cerebral cortex involved

20
Q

What signs can show up on MRI that might indicate a encephalitis?

A

Temporal lobe and adjacent parahippocampal gyrus are bright white on MRI

21
Q

What gives the definitive diagnosis of encephalitis ?

A

Lumbar puncture

22
Q

What are the clinical signs of a CNS infection?

A 
Headache
Vomiting
Pyrexia
Neck Stiffness
Photophobia
Lethargy
Confusion
Rash
23
Q

What nerves are at risk in a very purulent meningitis?

A

III Oculomotor

VI Abducens

24
Q

What routes can an infection take to cause a meningitis ?

A

Direct route - Invasion through bone into the cranial cavity e.g. mastoiditis from middle ear
Remote focus - Endocarditis Myocarditis blood

25
Q

If there is a suspicion of a raised ICP what should be undertaken before a Lumbar Puncture ?

A

CT

26
Q

What region are you trying to hit in a lumbar puncture?

A

Sub Arachnoid Space

27
Q

How may vials should be taken and where should they be sent to?

A

1 Haematology Cell Count and differentiation
2 Microbiology - Gram stain and culture
3 Chemistry - Glucose Protein
4 Haematology - Cell count

28
Q

What is normal for a CSF sample?

A

Protein - 0.15 to 0.45
Glucose - 40 to 60% of blood
No RBC
WBC 5mm³

29
Q

Bacterial Meningitis

A

WBC >2000mm³
Neutrophils >1180
High Protein >220
Low Glucose

30
Q

Viral Meningitis

A

Less WBC
Lymphocytes > Neutrophils
Normal Glucose
Slightly High or normal protein

31
Q

If someone presents with Neisseria Meningitis what should you do?

A

Alert Public Health

Close relatives given vaccine or prophylaxis

32
Q

Where is Neisseria Meningitis found in healthy individuals?

A

Throat

33
Q

What is it that causes the most serious symptoms in a Neisseria Meningitis infection?

A

Endotoxins

34
Q

What are some of the more severe symptoms due to Neisseria Meningitis?

A

Non Blanching Rash
Necrosis of the extremities
High Morbidity

35
Q

What else is required in order diagnose H.Influenzae?

A

Blood factors are required for cultures

36
Q

When is a S.Pneumonia infection more likely?

A

CSF leaking
Skull fractures
Cochlear Implant

37
Q

What does someone with TB meningitis present like?

A

Non specific generally ill health

High Morbidity

38
Q

When is a meningitis considered Aseptic?

A

No bacteria are found in the lumbar puncture

39
Q

What does the CSF look like in Aseptic Meningitis?

A

Low WBC
Normal Glucose
Minimally Elevated protein

40
Q

Treatment for HSV I and II is what?

A

Acyclovir

41
Q

What is one way other than the severity to differentiate between HSV and Enterovirus?

A

Enterovirus has no confusion

42
Q

List some non infectious causes of Meningitis?

A

Sarcoidosis

Carcinoid

Neurology Year 3 (29 decks)

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