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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
How would you treat HSV encephalitis
Aciclovir on clinical suspicion.
26
What is the mortality and morbidity of HSV encephalitis
>70% mortality High morbidity rate if left untreated.
27
How would you treat viral encephalitis
Treat with IV aciclovir + ceftriaxone for 2 weeks
28
What is the treatment for bacterial meningitis + encephalitis
IV Ceftraizone with IV amoxicillin (penicillen allergy: Chloramphenicol)
29
What is Arbovirus Encephalitides
Transmitted to man by vector from non-human host relevant to travel (travel history important)
30
Brain abscess definition
localized area of pus within the brain
31
What is the definition of Subdural empyema
Thin layer of pus between the dura and arachnoid membranes over the surface of the brain
32
What are signs and symptoms of Brain abscess and empyema
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
What can cause Brain abscess and empyemas
Penetrating head trauma Spread from adjacent infection (dental, sinusitis, otitis media) Blood borne infection neurosurgical procedures
34
Investigations for brain abscess and empyema
Imaging CT/MRI Investigate source Blood cultures Biopsy (drainage of pus)
35
Brain abscess constituents
Polymicrobial Streptococci 70% of cases Anaerobes in 40-100% of cases (bacteroides, prevotella)
36
What is the management of Brain abscesses?
Surgical drainage Penicillin or Ceftriaxone to cover strep Mentronidazole for anaerobes High dose required Culture and sensitivity test
37
What are Spirochaete that can affect the CNS
Lyme disease (Borrelia Burgdorferi) Syphilis (Trepomena pallidum) Leptospirosis (leptospira interrogans)
38
What is Trepomena pallidum
Syphilis
39
What is Borrelia burgodorferi
Lyme disease
40
What is Leptospira interrogans
Leptospirosis
41
Lyme disease stage 1 characteristics
Expanding rash from site of tick bite 50% flu like symptoms (day-1 week) -fatigue, myalgia, arthralgia, headache, fever, chills, neck stiffness
42
Stage 2 signs + symptoms of lyme disease
weeks - months Musculoskeletal and neurologic involvement most common (one or more organ: haematologic or lymphatic spread) PNS>CNS involvment
43
Stage 3 lyme disease
Months to years: chronic infection same neurological involvement as stage 2 + subacute encephalopathy, encephalomyelitis
44
Investigation and treatment for Lyme disease
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
Neurosyphilis features
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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