Encephalitis and infections of the nervous system Flashcards
What are the presenting symptoms of encephalitis?
- Bizarre encephalopathic behaviour or confusion
- headache
- Fever
- ↓ GCS
- focal neurological signs
- New onset seizures
- History of travel/animal bite → Rabies
What is the most common cause of encephalitis?
Herpes simplex virus (HSV)
What are 3 viral causes of encephalitis?
- herpes simplex virus ( 1 & 2 )
- Entero virus (ECHO)
- Cox-sachie
- Varicella zoster virus (chickenpox)
- HIV (seroconversion)
- Cytomegalovirus
- Epstein-barr virus (herpes virus 4)
- MMR
- Japanese encephaitis
- West nile virus
- Tick borne encephalitis
- Arbovirus
What are the tests for encephalitis?
- Bloods → Pretty useless but! Cultures, viral-PCR, toxoplasma IgM titre, malaria film
- Contrast enhanced CT/MRI (Dr hill says best form of imaging)
- Lumbar puncture → if no contraindication
- EEG
What is the treatment for Encephalitis?
• Aciclovir → 14-21 days treatment
What is the contraindication for a lumbar puncture?
raised intracranial pressure
What is the complication of Lumbar puncture in a case of raised intracranial pressure?
coning of the brain
What would cause you to suspect the presence of a brain abscess?
- ↑ Intracranial pressure
* Fever / ↑↑ WBC
What might precede a brain abscess?
- Ear/Sinus/dental/peridontal infection
- Skull fracture
- Congenital heart disease
- endocarditis
- Bronchiectasis
What are the signs of a brain abscess?
- New onset seizures
- Fever
- signs of ↑ intracranial pressure
- Coma
What is the best thing to do with a confirmed brain abscess?
Refer to neurosurgeons
What types of orgamisms cause infections of the CNS?
- Bacteria
- Viruses
- Fungi
- Parasites
- Prions
What gives the brain its blood brain barrier?
Capillaries in the brain have tight junctions between endothelial cells.
What is the commonest cause of meningitis in all ages?
Viruses → Viral menigitis
What is the normal treatment for viral meningitis?`
- symptomatic releif → Analgesia
* normally self limiting
What would lead you to suspect tuberculous meningitis?
A gradual onset of symptoms
When would you suspect fungal meningitis?
In the immuno-suppressed
What is the target rash associated with Lymes disease called?
Erythema migrans
What is a common intracellular protazoan parasite that is supected to infect 1/3 of the UK public?
Toxoplasma Gondii
How is toxoplasma Gondii contracted?
- Uncooked meats (hams/salami)
* cats
What is Kuru?
Prion disease associated with canabalism in Papua New Guinae.
What is the problem with prions in a helthcare setting?
They are very very difficult to destroy
Name 2 congenital infections of the CNS?
TORCH
- Toxoplasma
- Other → Syphalis
- Rubella
- Cytomegalo virus
- Herpes virus
What causes shingles?
Varicella zoster virus
What is the treatment for shingles?
- symptomatic relief → Analgesia
* Oral aciclovir
What is the spirochete that causes syphallis
Treponema pallidum
