CSF Shunt infections, Brain abscess, Subdural empyema

Question 1

CSF shunt infections

Complication of neurosurgical procedures used to treat __________

Answer 1

hydrocephalus

Question 2

CSF shunt infections

Shunt infection can be:
__________
____________

Answer 2

Internal

External

Question 3

CSF shunt infections

Shunt infection can be:
Internal (as with _____ abnormalities)

External (as with _______ abnormalities)

Answer 3

CSF

soft tissue

Question 4

Aetiology of CSF infections

__________ (most common isolate)

___________
__________,________
Corynebacteria e.g. ___________
Gram negative organisms
Mycobacteria fungi

Answer 4

S. epidermidis

S. aureus

Streptococci, enterococci

Propionobacterium acnes

Question 5

Clinical features of csf infections

Dependent on ______ of patient, _____ of infection, presence of _________________

Fever
Headache
Vomiting
Neck ________
Impaired ______________

Answer 5

age

site

raised intracranial pressure

stiffness

conscious level

Question 6

Lab diagnosis of csf infections

Specimen- __________

Gram stain – gram____ cocci (________ __________ )

Culture – ___________ agar
Biochemical identification

Answer 6

Cerebrospinal fluid

Staphylococcus epidermidis

sheep blood

Question 7

Lab diagnosis - Staphylococcus epidermidis

Gram ________
Catalase ________
Coagulase ________
H2S ________
Gelatin hydrolysis ________
(Motile or Non-motile?)
DNase ________

Answer 7

Gram positive

Catalase positive

Coagulase negative

H2S positive

Gelatin hydrolysis negative

Non-motile

DNase negative

Question 8

Treatment of csf infections

Empiric – _________

Specific antibiotic therapy – based on _________ and _______

Answer 8

vancomycin

culture results and AST

Question 9

Cerebral abscess

(Focal or Diffuse?) (Intra or extra?) cerebral infection

Develops into a collection of ______ surrounded by a (poorly or well?) -vascularized capsule

Answer 9

Focal intracerebral

pus

well

Question 10

Cerebral abscess

Caused by _____ spectrum of pathogens

Some are associated with certain predisposing conditions

Answer 10

broad

Question 11

Clinical features of Cerebral abscess

Presents with:
Headache
Altered _______
Fever, Seizures
Nausea & vomiting
Neck ______
____________

Answer 11

mental status

stiffness

Papilloedema

Question 12

Factors predisposing to cerebral abscess

Predisposing condition Microorganisms

Otitis media/mastoiditis _____,______,_____

Sinusitis. ______,_____,________, ____,_____

Dental sepsis ____,_____,______,______

Trauma or neurosurgery ____,___,___,____

Pulmonary/pleural sepsis
Fusobacterium, Actinomyces, Bacteroides, Prevotella spp, Streptococci, Nocardia spp

Answer 12

Streptococci, Bacteroides spp, Prevotella spp

Streptococci, Bacteroides spp, Enterobacteriaceae, S. aureus, Haemophilus spp

Fusobacterium, Prevotella, Bacteroides spp, Streptococci

S. aureus, Streptococci, Enterobacteriaceae, Clostridium spp

Question 13

Factors predisposing to cerebral abscess

Predisposing condition Microorganisms

_______/______ Streptococci, Bacteroides spp, Prevotella spp, Enterobacteriaceae

___________. Streptococci, Bacteroides spp, Enterobacteriaceae, S. aureus, Haemophilus spp

______________ Fusobacterium, Prevotella, Bacteroides spp, Streptococci

______________ S. aureus, Streptococci, Enterobacteriaceae, Clostridium spp

__________________ Fusobacterium, Actinomyces, Bacteroides, Prevotella spp, Streptococci, Nocardia spp

Answer 13

Otitis media/mastoiditis

Sinusitis

Dental sepsis

Trauma or neurosurgery

Pulmonary/pleural sepsis

Question 14

Factors predisposing to cerebral abscess

Endocarditis _________,_______

Transplantation _____,_____,______,______

Congenital heart disease _______,________

HIV _____,_____,______,______,_______

Answer 14

S. aureus, Streptococci

Candida spp, Aspergillus spp, Mucorales, Enterobacteriaceae

Streptococci, Haemophillus spp

T. gondii, Nocardia spp, Mycobacterium spp, L. monocytogenes, C. neoformans

Question 15

Treatment of Cerebral Abscess

___________

________ + __________

Culture & AST

Answer 15

Surgical drainage

Ceftriaxone + metronidazole

Question 16

Subdural empyema

Collection of ———- in the space between the ———- and the ———-

Associated with (acute or chronic?) onset of fever, headache, vomiting, altered mental state, focal neurological signs

Answer 16

pus

dura and the arachnoid

acute

Question 17

Aetiology Of Subdural empyema

__________,_________

Aerobic gram ______ bacilli Anaerobes

_____________ infections are common

Answer 17

Streptococci
Staphylococci

negative; Polymicrobial

Question 18

Lab diagnosis of subdural empyema

Specimen – _______
Gram stain
Culture
Identification

Answer 18

Aspirate

Question 19

Treatment of subdural empyema

_________ + ________

___________ added if staphylcoccal infection is suspected

Answer 19

Ceftriaxone + metronidazole

Vancomycin