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ICC3 > CNS infections > Flashcards

CNS infections Flashcards

1
Q

what are the main causative organisms in viral encephalitis ?

A

HSV
chicken pox measles
Enterovirus

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2
Q

bacterial meningitis can be classified into?

A

acute pyogenic meningitis
chronic meningitis

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3
Q

localized bacterial infections can be classified into

A

abscess
empyema

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4
Q

what are the main causative organisms of acute pyogenic meningitis ?

A

E.coli or group B streptococci ( in infants)
Neisseria meningitides ( young adults)
streptococcus pneumonia ( older patients)

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5
Q

what is the main causative organism in chronic meningitis ?

A

mycobacterium tuberculosis

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6
Q

what are the CNS infections caused by viruses ?

A

acute aseptic meningitis
encephalitis
brain stem and spinal cord syndrome

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7
Q

what is meningitis ?

A

an acute inflammatory process involving the leptomeninges ( arachnoid and pia mater)

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8
Q

what is the degree of exudate extension in meningitis ?

A

it may extend into the perivascular virchow robin spaces
however direct extension into the brain is rare

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9
Q

what are the types of infectious meningitis ?

A

acute pyogenic
aseptic
chronic

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10
Q

how can you differentiate between the various subtypes of infectious meningitis ?

A

CSF examination

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11
Q

what are the bacteria most commonly causing bacterial meningitis?

A

Children under 10 years:
streptococcus pneumoniae
neisseria meningitides
Newborn period:
Group B streptococci
E.coli and listeria
Adults:
streptococcus pneumonia

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12
Q

what is the gross picture in acute pyogenic meningitis ?

A

evident purulent exudate within leptomeninges on the surface of the brain , sulci are obscured by the exudate

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13
Q

what are the typical CSF findings in in acute bacterial meningitis?

A

low glucose
high protein
high cell count with many PMN
Lactate dehydrogenase is also increased with bacterial meningitis

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14
Q

how do we obtain a CSF sample ?

A

through a lumbar puncture

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15
Q

what do we have to check before proceeding with a lumbar puncture ?

A

we have to check for papiloedema ( increased intraocular pressure) this means that intracranial pressure is too high to safely perform a lumbar puncture

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16
Q

what are the typical CSF findings in viral infections?

A

low white blood cell count
predominance of lymphocytes
normal to elevated protein levels
CSF to glucose ratio is usually normal

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17
Q

what are the CSF findings in fungal infections ?

A

predominance of lymphocytes
elevated protein levels
low glucose levels

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18
Q

what are the CSF findings in tubercular infections?

A

predominance in lymphocytes
elevated protein levels
low glucose levels

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19
Q

what are the classifications of CNS tuberculosis ?

A

Intracranial
spinal

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20
Q

chronic meningitis?

A

TB

21
Q

what is tuberculous encephalitis ?

A

a syndrome exclusively present in infants and children

22
Q

what is the presentation of tuberculous encephalitis ?

A

comes in the form of stupor, convulsions , coma but without meningeal irritation or focal neurological deficit

23
Q

gross picture of a tuberculoma?

A

well circumscribes greyish white lesion with some fibrous encapsulation

24
Q

what would you find microscopically in a tuberculoma ?

A

giant cells
caseous necrosis
epitheliod cells

25
Q

what stain is used to identify TB

A

Zeihl neilson acid fast stain

26
Q

what kind of necrosis occurs with brain abscess ?

A

liquefactive necrosis

27
Q

what is a tuberculous brain abscess ?

A

an encapsulated collection of pus containing viable tubercular bacilli without a definite tubercular granuloma

28
Q

what would the microbiology of the tuberculous brain abscess show ?

A

TB bacilli

29
Q

what is the gross presentation of cryptococcal meningitis ?

A

Cerebral cortex shows multiple small cyst-like structures throughout the gray and white matter (soap bubble lesions)

30
Q

what do the cyst like structures in cryptococcal meningitis correspond to ?

A

corresponding to dilated perivascular (Virchow-Robin) spaces

31
Q

what do the ‘soap bubble lesions’ contain ?

A

contain mucoid material characteristic of Cryptococcal meningitis

32
Q

inflammatory response in cryptococcal meningitis ?

A

barley

33
Q

what are the characteristic location involvement in HSV encephalitis ?

A

inferior and medial temporal lobes

34
Q

what damage does HSV produce in the cerebral cortex?

A

hemorrhagic meningoencephalitis , The virus directly infects cells in the cerebral cortex, causing necrosis and a glial reaction

35
Q

what are the layers surrounding BV in HSV encephalitis ?

A

BV surrounded by lymphocytic infiltration which surrounded by haemorrhage causing necrosis

36
Q

how do CNS infections reach intracranial structures?

A

through hematogenous spread
direct extension from nearby structures
direct source ; trauma injury

37
Q

if we want to give empirical ab what to give ?

A

3rd generation cephalosporins ( cetriaxone)

38
Q

what ab to give with a confirmed case of meningococci meningitis ?

A

Penicillin G

39
Q

what are the antimicrobial prophylaxis required for close contact patients

A

single dose ciprofloxacin
or
rifampicin

40
Q

what are the preventative measures of bacterial meningitis ?

A

vaccination against strep pneumonia and
N.meningitidis C and
H.influenza

41
Q

how do we treat the complications of bacterial meningitis ?

A

for the dehydration ( IV fluids)
give dexamethasone to decrease oedema
give anticonvulsants

42
Q

what antibiotic to use with anaerobic bacteria ?

A

metradinazole

43
Q

what is the surgical treatment for brain abscess ?

A

stereotactic aspiration of the brain abscess , excision

44
Q

what to give for raised intracranial pressure ?

A

mannitol IV

45
Q

how to treat and manage a case of viral encephalitis?

A

control fever
give antivirals - acyclovir for 2 weeks
proper anti epileptic drugs

46
Q

treatment for fungal meningitis ?

A

symptomatic treatment

47
Q

what would confirm a diagnosis of Rabies ?

A

saliva testing , ab in CSF

48
Q

what is the treatment for rabies ?

A

human rabies vaccine

49
Q

locked jaw and gave birth recently ?

A

ask about tetanus shot (clostridium tetani)

ICC3 (66 decks)

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