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Year 2 Neuro > Infections of nervous system > Flashcards

Infections of nervous system Flashcards

1
Q

Meningitis definition

A

Inflammation/infection of meninges

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2
Q

Encephalitis definition

A

Inflammation/infection of brain structure

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3
Q

Myelitis definition

A

Inlfamation/infection of spinal cord

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4
Q

What are the clinical features of Meningitis

A

Classic Triad: Fever, stiff neck, altered mental status
Short history of progressive headache
associated with: fever >38, Meningism (neck stiffness, photophobia, nausea and vomiting)

Cerebral dysfunction: common, GCS <14
Cranial nerve palsy, seizures, focal neurological deficits
Petechial skin rash (Tumbler test)

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5
Q

How would you test for neck stiffness

A

Passively bending the neck forward

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6
Q

What are the symptoms of cerebelar dysfunction?

A

Confusion, delirium, declining conscious level

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7
Q

What is the Tumbler test

A

Placing a glass over a rash
If menigitis: rash will be able to be seen through the glass
Not meningitis: rash will not be visible through the glass

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8
Q

What causes petechial skin rash?

A

Usually caused by meningococcal meningitis
can occur in viral meningitis.

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9
Q

What are the causes of bacterial meningitis?

A

Neisseria menigitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)

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10
Q

What are the viral causes of meningitis

A

Main cause enteroviruses

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11
Q

What is the clinical features of encephalitis

A

Flu-like prodrome (4-10 days)
progressive headache associated with fever
+/-meningism
progressive cerebral dysfunction
seizures
Focal symptoms/signs

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12
Q

What is meningism?

A

set of Symptoms similar to those of meningitis but is not caused by meningitis

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13
Q

bacterial vs viral encephalitis onset times

A

Viral encephalitis: slower onset, cerebral dysfunction more prominent.
Bacterial encephalitis: faster onset

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14
Q

What are the antibodies that can cause Auto-immune encephalitis

A

Anti-VGKC (voltage gated Potassium channel)
Anti-NMDA receptor

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15
Q

What are charaterstic symptoms of Anti-VGKC autoimmune encephalitis?

A

Frequent seizures
amnesia
Altered mental state

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16
Q

What are characteristic symptoms of anti-NMDA receptor auto-immune encephalitis?

A

Flu like prodrome
Prominent psychiatric features
Altered mental state and seizures
Progressing to a movement disorder and coma

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17
Q

what is the Investigation for meningitis

A

Menigitis
Blood culture: bacteraemia
Lumbar puncture (CSF culture/microscopy)
No need for imaging if no contraindications to LP

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18
Q

What is the investigations for encephalitis

A

Blood cultures
Imaging (CT +/- MRI)
Lumbar puncture (CT before)
EEG

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19
Q

What would be indications to do a CT before a Lumbar puncture?

A

Focal neurological deficit (suggest focal brain mass)
New-onset seizure
papilloedema
abnormal level of consciousness
severe immunocomprised state

20
Q

What would a reduced conscious level suggest?

A

Raised intercranial pressure

21
Q

What could a raised intercranial pressure cause

A

reduced conscious level.

22
Q

What would the CSF findings be in bacterial meningitis

A

Opening pressure: increased
Cell count: High, mainly neutrophils
Glucose: reduced
Protein: high

23
Q

What would the CSF findings in Viral meningitis and encephalitis

A

Opening pressure: normal/increased
Cell count: High, mainly lymphocytes
Glucose: Normal (60% of blood glucose)
Protein: slightly increased

24
Q

How is Herpes simplex encephalitis diagnosed?

A

PCR of CSF for viral DNA

25
Q

How would you treat HSV encephalitis

A

Aciclovir on clinical suspicion.

26
Q

What is the mortality and morbidity of HSV encephalitis

A

> 70% mortality
High morbidity rate if left untreated.

27
Q

How would you treat viral encephalitis

A

Treat with IV aciclovir + ceftriaxone for 2 weeks

28
Q

What is the treatment for bacterial meningitis + encephalitis

A

IV Ceftraizone with IV amoxicillin
(penicillen allergy: Chloramphenicol)

29
Q

What is Arbovirus Encephalitides

A

Transmitted to man by vector from non-human host
relevant to travel (travel history important)

30
Q

Brain abscess definition

A

localized area of pus within the brain

31
Q

What is the definition of Subdural empyema

A

Thin layer of pus between the dura and arachnoid membranes over the surface of the brain

32
Q

What are signs and symptoms of Brain abscess and empyema

A

Fever, Headache
Focal symptoms/signs: seizures, dysphasia, hemiparesis etc.

Signs of raised intercranial pressure: Papilloedema (oedema in eye). false localizing signs
depressed conscious level

Meningism may be present (usually in empyema)

33
Q

What can cause Brain abscess and empyemas

A

Penetrating head trauma
Spread from adjacent infection (dental, sinusitis, otitis media)
Blood borne infection
neurosurgical procedures

34
Q

Investigations for brain abscess and empyema

A

Imaging CT/MRI
Investigate source
Blood cultures
Biopsy (drainage of pus)

35
Q

Brain abscess constituents

A

Polymicrobial
Streptococci 70% of cases
Anaerobes in 40-100% of cases (bacteroides, prevotella)

36
Q

What is the management of Brain abscesses?

A

Surgical drainage
Penicillin or Ceftriaxone to cover strep
Mentronidazole for anaerobes
High dose required

Culture and sensitivity test

37
Q

What are Spirochaete that can affect the CNS

A

Lyme disease (Borrelia Burgdorferi)
Syphilis (Trepomena pallidum)
Leptospirosis (leptospira interrogans)

38
Q

What is Trepomena pallidum

A

Syphilis

39
Q

What is Borrelia burgodorferi

A

Lyme disease

40
Q

What is Leptospira interrogans

A

Leptospirosis

41
Q

Lyme disease stage 1 characteristics

A

Expanding rash from site of tick bite
50% flu like symptoms (day-1 week)
-fatigue, myalgia, arthralgia, headache, fever, chills, neck stiffness

42
Q

Stage 2 signs + symptoms of lyme disease

A

weeks - months
Musculoskeletal and neurologic involvement most common
(one or more organ: haematologic or lymphatic spread)

PNS>CNS involvment

43
Q

Stage 3 lyme disease

A

Months to years: chronic infection
same neurological involvement as stage 2 + subacute encephalopathy, encephalomyelitis

44
Q

Investigation and treatment for Lyme disease

A

Investigation: serology tests, CSF Lymphocytosis, MRI brain/spine (if CSF involvement), nerve conduction studies

treatment antibiotic treatment: Oral doxycyline (amoxicillin in pregnancy)
IV ceftriaxone: in serious cases

45
Q

Neurosyphilis features

A

3 stage presentation
tertiary disease years/decades after infection (uncommon)
Investigation: treponema and non-treponemal specific antibody tests
CSF: lymphocytes increased, evidence of intrathecal antibody production

Treatment: High dose penicillin

Year 2 Neuro (14 decks)

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