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Neuro AM > Infections of nervous system > Flashcards

Infections of nervous system Flashcards

1
Q

What is meningitis?

A

Inflammation/infection of meninges

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2
Q

What is the classical triad of meningitis?

A

Fever
Neck stiffness
Altered mental state

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3
Q

What is the presentation of meningitis?

A 
Progressive headache
Fever
MEningism
Cerebral dysfunction
Cranial nerve palsy
Seizures
Focal neurological deficits
Petechial skin rash
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4
Q

What is the differential diagnosis of meningitis?

A 
Infective
Sarcoidosis
NSAIDs, IVIG
Metastatic
haematological
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5
Q

What are the causes of infective meningitis?

A

Bacterial
Viral
Fungal

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6
Q

What investigations should be done for meningitis?

A

Blood cultures
LP
Imaging only if LP contraindicated

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7
Q

What would be find on CSF in bacterial meningitis?

A

Increased opening pressure
High WBC, mainly neutrophils
Reduced glucose
High protein

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8
Q

What would be found on CSF in viral meningitis?

A

normal/increased opening pressure
High white cell count, esp lymphocytes
Normal glucose
Slightly increased protein

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9
Q

what is normal CSF glucose?

A

60% blood glucose

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10
Q

When should blood and CSF stains be carried out for meningitis?

A

If pyrexial

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11
Q

What is encephalitis?

A

Inflammation/infection of the brain substance

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12
Q

What are the clinical features of encephalitis?

A 
Slower onset
Flu like
Headache and fever
With or without meningism
Progressive cerebral dysfunction
Seizures
Focal signs and symptoms
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13
Q

How can encephalitis be differentiated from meningitis?

A

Slower onset

Cerebral dysfunction more common

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14
Q

What is the differential diagnosis for encephalitis

A 
Infective
Limbic encephalitis
Hepatic, uraemia or hyperglycaemic causes
Metastases or paraneoplasm
Migraine
Post octal
Autoimmune encephalitis
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15
Q

What are the most common causes of encephalitis?

A

Viral- herpes simplex

Autoimmune

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16
Q

What are the causes of infective encephalitis?

A

Herpes simplex
Abovirus encephalitides
Enterovirus

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17
Q

How is HSV encephalitis diagnosed?

A

PCR of CSF for viral DNA

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18
Q

How is HSV encephalitis treated?

A

Aciclovir on clinical suspicion

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19
Q

What investigations are done for encephalitis?

A

Blood cultures
CT/MRI
LP
EEG

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20
Q

What is myelitis?

A

Inflammation/infection of the spinal cord

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21
Q

What are the contraindications for LP?

A 
Focal neurological deficit
New onset seizures
papilloedema
GCS <10
Severely immunocompromised state
Raised ICP
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22
Q

Why is raised ICP a contraindication for LP?

A

Can cause distortion and herniation of brain contents through foramen

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23
Q

What is a brain abscess?

A

Localised area of pus within the brain

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24
Q

What is a subdural empyema?

A

Thin layer pf pus between dura and arachnoid maters over surface of brain

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25
Q

What are the clinical features of brain abscess and subdural empyema?

A 
Fever, headache
Focal signs and symptoms
Signs of raised ICP
Meningism
Features of underlying source
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26
Q

What is the differential for brain abscess/empyema?

A

Any focal lesion

Subdural haematoma

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27
Q

What are the causes of brain abscess/empyema?

A

Penetrating head injury
Spread from adjacent infection
Blood borne infection
Neurosurgical procedure

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28
Q

How are brain abscesses and empyema diagnosed?

A

Imaging
Blood cultures
Biopsy of pus

29
Q

How is a brain abscess managed?

A

Surgical drainage

Antibiotics- penicillin for streps, metronidazole for anarobes

30
Q

What bacteria is responsible for Lyme disease?

A

Borrelia burgdorferi

31
Q

What is stage 1 of Lyme disease?

A

Early localised infection

32
Q

What are the signs of stage 1 Lyme disease?

A

Erythema migrans

Flu like symptoms

33
Q

What is stage 2 Lyme disease?

A

Early disseminated infection

One or more organ systems involved

34
Q

What are the most common systems involved in stage 2 Lyme disease?

A

Musculoskeletal and neurological

35
Q

What are the symptoms of neurological involvement in stage 2 Lyme disease?

A 
Mononeuropathy
Mononeuritis multiplex
Painful radiculoneuropathy
Cranial neuropathy
Myelitis
Meningo-encephalitis
36
Q

What is stage 3 Lyme disease?

A

Chronic infection

37
Q

What are the symptoms of neurological involvement of stage 3 Lyme disease?

A 
Mononeuropathy
Mononeuritis multiplex
Painful radiculoneuropathy
Cranial neuropathy
Myelitis
Meningo-encepgalitis
Subacute encephalopathy
Encephalomyelitis
38
Q

What investigations are carried out for Lyme disease?

A 
Serological tests
CSF lymphocytosis
PCR of CSF
MRI brain/spine for CNS involvement
Nerve conduction studies/EMG for PNS involvement
39
Q

What is the treatment of Lyme disease?

A

Prolonged antibiotic treatment

40
Q

What systems can be involved in Lyme disease?

A 
Skin
Rhematological
Neurological/neuropsychiatric
Cardiac
Opthamological
41
Q

What is the 3 stage presentation of syphilis?

A

Primary
Secondary
Latent

42
Q

What investigations are done for neurosyphilis?

A

Antibody tests
Increased CSF lymphocytes
Intrathecal antibody production
PCR of CSF

43
Q

What is the treatment of neurosyphilis?

A

High dose penicillin

44
Q

What causes poliomyelitis?

A

Poliovirus types 1, 2 and 3

45
Q

What does paralytic poliomyelitis infect?

A

Anterior horn cells of LMNs

46
Q

What does paralytic poliomyelitis cause?

A

Asymmetric flaccid paralysis, esp of legs

No sensory features

47
Q

What is included in the poliovirus?

A

All 3 poliovirus

48
Q

What is rabies?

A

Acute infectious disease of CNS

49
Q

How is ladies transmitted to humans?

A

Bite

Salivary contamination of open lesion

50
Q

How does the rabies virus progress/

A

Enters PNS and travels to CNS

51
Q

What are the signs f rabies?

A

Ascending paralysis and encephalitis

52
Q

How is rabies diagnosed?

A

Culture
Detection
Serology

53
Q

Who is the rabies immunisation given to?

A

Bat handlers
Handlers of imported animals
Selected travellers to exotic areas

54
Q

What is the post exposure treatment for possibles rabies?

A

Wah wound
Give active rabies immunisation
Give human rabies immunoglobulin if high risk

55
Q

What happens in tetanus?

A

Toxins act at neuromuscular junction and block inhibition of motor neurones, causing rigidity and spasm

56
Q

How is tetanus prevented?

A

immunisation

Penicillin and immunoglobulin for high risk wounds

57
Q

What causes botulism?

A

Clostridium botulinum

58
Q

What happens in botulism?

A

Neurotoxin binds irreversibly to presynaptic membranes pf peripheral neuromuscular and autonomic nerve junctions
The toxin binding blocks Ach release

59
Q

How do you recover from botulism?

A

Sprouting new axons

60
Q

What arebthe 3 modes of infection in botulism?

A

Intestinal colonisation
Food borne
Wound

61
Q

What is the presentation of botulism?

A

Descending symmetrical flaccid paralysis
respiratory failure
Autonomic dysfunction
Pupillary dilation

62
Q

What is the investigation for botulism?

A

Nerve conduction studies
Bioassay for toxin in blood
Culture from wound

63
Q

What is the treatment of botulism?

A

Anti-toxin
Penicillin/metronidazole
Radical wound debridement

64
Q

What are the types of Creutzfeldt Jakob disease?

A

Sporadic
New variant
Familial
Acquired

65
Q

What are the clinical features of sporadic CJD?

A 
Insidious onset
Early behavioural abnormalities
Rapidly progressive dementia
Myoclonus
Motor abnormalities
Cortical blindness
Seizures
66
Q

What motor abnormalities occur in sporadic CJD?

A

Cerebellar ataxia
Tremor, rigidity, bradykinesia, dystonia
Weakness, spasticity, hyper-reflexia

67
Q

What is the differential diagnosis for sporadic CJD?

A

Alzheimer’s with myoclonus
Subacute sclerosis panencephalitis
CNS vasculitis
Inflammatory encephalopathies

68
Q

What are the features of new variant CJD?

A

Younger onset
Prominent early behavioural changes
Longer course

69
Q

What are the investigations for CJD?

A

MRI
EEG
Protein in CSF

Neuro AM (38 decks)

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