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Neurology > Infections of CNS > Flashcards

Infections of CNS Flashcards

1
Q

What is meningitis?

A

Inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid) space

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2
Q

Who can meningitis effect?

A
  1. Anyone but most common in babies, young children, teenagers and young adults
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3
Q

What is the most common type of meningitis?

A
  1. Viral meningitis

Least common and least serious type

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4
Q

What is the least common type of meningitis?

A
  1. Bacterial meningitis

Can be very serious if not treated

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5
Q

What are the 12 symptoms of meningitis?

A
  1. High temperature above 38C
  2. Vomiting
  3. Headache
  4. Rash that does not fade
  5. A stiff neck
  6. Dislike for bright lights
  7. Drowsiness or unresponsiveness
  8. Seizures
  9. Confusion
  10. Breathing quickly
  11. Muscle/joint pain
  12. Cold hands and feet
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6
Q

What are 6 additional symptoms of meningitis in babies?

A
  1. Refuse feeds
  2. Be irritable and unusual fussiness (particularly when held)
  3. High-pitched cry
  4. Stiff body/floppy/unresponsive
  5. Bulging soft spot on top of head (25%)
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7
Q

What is the prevalence of seizures in newborns and children in meningitis?

A
  1. 1/3 of newborns

2. 1/5 infants and children

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8
Q

What is the aetiology of bacterial meningitis in newborns? (2)

A
  1. Usually from an infection of the blood stream (sepsis)

2. Typically bacteria is acquired from birth canal

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9
Q

What are the most common types of bacteria causing meningitis in newborns?

A

Group B streptococci
Escherichia coli
Listeria monocytogenes

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10
Q

What is the aetiology of bacterial meningitis in older infants and children?

A
  1. Infection through contact with respiratory secretions containing bacteria
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11
Q

What are the most common type of bacteria causing meningitis in children? (3)

A
  1. Steptococcus pneumonia and neiserria meningitidis
  2. Haemophilus influeza type b was the most common type
  3. Current vaccines are making these rare causes of childhood meningitis
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12
Q

Give 3 types of bacteria causing meningitis

A
  1. Meningococcal bacteria (several types A, B, C, W, X, Y and Z)
  2. Pneumoccal bacteria
  3. Haemophilus infuenzae type b bacteria
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13
Q

Give 3 types of viruses causing meningitis

A
  1. Enteroviruses
  2. Mumps
  3. Herpes simplex
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14
Q

How can viral and bacterial meningitis be spread? (4)

A
  1. Sneezing
  2. Coughing
  3. Kissing
  4. Sharing utensils/toothbrushes
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15
Q

How is meningitis diagnosed? (4)

A
  1. Physical exam of symptoms
  2. Lumbar puncture
  3. Blood tests
  4. Sometimes imaging tests
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16
Q

Why are imaging tests sometimes used in diagnosis of meningitis? What imaging tests can be used?

A
  1. Ultrasonography and CT

2. Determine the degree of pressure on the brain and whether an abccess is present

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17
Q

What is the prognosis of bacterial meningitis?

A
  1. 1/10 cases is fatal

2. Even with timely treatment 5-25% of newborns die

18
Q

Give the mortality rates for older children according to bacterial time

  1. Haemophilus influenzae
  2. Neisseria meningitidis
  3. Streptococcus pneuomoniae
A
  1. Haemophilis 2-5%
  2. Neisseria 5-10%
  3. Streptococcus 10-20%
19
Q

In newborns who survive, what is the prognosis of meningitis? (2)

A
  1. 20-50% = serious brain and nerve problems (eg. hydrocephalus), hearing loss and intellectual disability
  2. 30% have mild residual problems eg. learning disorders, mild hearing loss or occassional seizures
20
Q

In children who survive, what is the prognosis of meningitis?

A

15-25% develop brain and nerve problems such as hearing loss, intellectual disability and seizures

21
Q

What are 6 other complications associated with meningitis?

A
  1. Memory/concentration difficulties
  2. Co-ordination/movement/balance
  3. Vision loss
  4. Amputation (prevent spread)
  5. Bone/joint problems eg. arthirits
  6. Kidney problems
22
Q

What is the treatment for meningitis? (5)

A
  1. Antibiotics intravenously
  2. Some corticosteroids (reduce risk of hearing loss)
  3. Fluid to prevent dehydration
  4. Oxygen if breathing difficulties
  5. Steroids to reduce swelling around brain
23
Q

What is encephalitis? (3)

A
  1. Inflammation of the brain when a virus directly infects the brain
  2. Or when a virus, vaccine or something else triggers inflammation
  3. The spinal cord may also be involved (encephalomyelitis)
24
Q

What is the classification of encephalitis? (2)

A
  1. Primary: virus directly infects brain and spinal cord

2. Secondary: infection starts elsewhere and spreads to the brain

25
Q

What are 5 early symptoms of encephalitis?

A

Similar to flu

  1. High temp above 38C
  2. Head ache
  3. Vomiting
  4. Aching muscles and joints
  5. Some - spotty/blistery rash
26
Q

What 5 additional symptoms may be seen in infants/young children?

A
  1. Vomiting
  2. Bulging fontanel (soft spot in scalp)
  3. Constant crying
  4. Body stiffness
  5. Poor appetite
27
Q

What are 13 serious symptoms of encephalitis?

A
  1. Confusion or disorientation
  2. Drowsiness
  3. Seizures
  4. Personality and behaviour changes eg. agitated
  5. Difficulty speaking
  6. Weakness or loss of movement
  7. Hallucinations
  8. Loss of sensation in body parts
  9. Involuntary eye movements eg. side to side
  10. Vision problems
  11. Loss of consciousness
  12. Coma
  13. Sensitivity to light
28
Q

What is the aetiology of encephalitis? (5)

A
  1. Cause is sometimes unclear, usually infection or problem with immune system
  2. Virus that directly infections brain
  3. Virus that caused a previous infection becomes reactivated and directly damages brain
  4. Virus or vaccine triggers an autoimmune reaction (attacks brain tissue)
  5. Mosquitos and ticks that carry viruses
29
Q

Give 4 viruses which can spread to the brain to cause encephalitis

A
  1. Herpes simple
  2. Varicella sozter (chickenpox and shingles)
  3. Measles, mumps and rubella
  4. Spread by animals
30
Q

Where in the brain does herpes simplex usually affect?

A
  1. Temporal lobe and frontal lobe

2. Can be dangerous and lead to severe brain damage and death

31
Q

Give 4 types of viruses spread by animals to cause encephalitis

A
  1. Tick-born encephalitis
  2. Japanese encephalitis
  3. Rabies
  4. Possibly Zika
32
Q

Give 4 triggers which can cause a problem with the immune system to cause encephalitis

A
  1. Previous infection in another part of the body (few weeks earlier) - post infectious encephalitis
  2. A tumour - autoimmune encephalitis
  3. A vaccination (very rare)
  4. Unknown cause - autoimmune encephalitis
33
Q

Give 5 investigations to diagnose encephalitis

A
  1. CT
  2. MRI (most common)
  3. Lumbar puncture
  4. EEG
  5. Blood/urine tests (test for antibodies to the virus)
34
Q

Why is a lumbar puncture used to diagnose encephalitis?

A
  1. Number of white blood cells is increased in CSF when brain and meninges are inflamed
35
Q

Summarise the prognosis of encephalitis

A
  1. Outlook depends on severity

2. Most people with severe encephalitis will experience complications

36
Q

Give 13 complications of encephalitis

A
  1. Loss of memory
  2. Behavioural/personality changes
  3. Epilepsy
  4. Fatigue
  5. Physical weakness
  6. Intellectual disability
  7. Lack of muscle co-ordination
  8. Vision problems
  9. Hearing problems
  10. Speech problems
  11. Coma
  12. Difficulty breathing
  13. Death
37
Q

What is the prognosis for mild and severe cases of encephalitis?

A

Mild: inflammation likely to resolve in a few days
Severe: may require weeks or months to recover and may cause permanent brain damage/death

38
Q

How is encephalitis treated? (3)

A
  1. Depends on cause: anti-viral drug, antibiotic, corticosteroids
  2. Measures to relieve symptoms and provide life support
  3. Plasma exchange
39
Q

Give 4 examples of drugs used to treat encephalitis

A
  1. Acyclovir (herpes simplex and herpes sozter)
  2. Ganciclovir (cytomegalovirus)
  3. Anticonvulsants (prevent/stop seizurs)
  4. Sedatives (restlessness, aggressiveness and irritability)
40
Q

Give 2 treatments of auto-immune encephalitis

A
  1. Corticosteroids to reduce brain inflammation

2. Plasma exchange (remove abnormal antibodies or immune globulin)

Neurology (17 decks)

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