Infections of Nervous System

Question 1

2 bacteria in bacterial meningitis?

Answer 1

neisseria meningitidis (meningococcus)
streptococcus pneumonias (pneumococcus)

Question 2

triad in meningitis? gcs?

Answer 2

fever
stiff neck
altered mental status
<14

(photophobia, nausea and vomiting)

Question 3

what does encephalitis begin with?

Answer 3

flu like illness lasting 4-10 days

Question 4

symptoms in encephalitis?

Answer 4

progressive headache associated with fever

progressive cerebral dysfunction (worse than meningitis and slower onset)

Question 5

what is the hallmark of meningococcal meningitis ?

Answer 5

petechial skin rash

Question 6

what is post-ictal?

Answer 6

after seizure

Question 7

two antibodies in auto-immune encephalitis?

Answer 7

anti-VGKC

anti-NMDA receptor

Question 8

CSF findings in bacterial meningitis?

Answer 8

opening pressure - high
cell count - high, mainly neutrophils
glucose - reduced
protein - high

Question 9

CSF findings in viral meningitis/encephalitis?

Answer 9

opening pressure - normal/increase
cell count - high, mainly lymphocytes
glucose - normal (60% blood)
protein - slightly increased

Question 10

what is a brain abscess and what is empyema?

Answer 10

brain abscess is a localised area of puss within the brain

empyema is a thin layer of pus between dura and arachnoid

Question 11

signs of brain abscess?

Answer 11

fever, headache
focal symptoms
raised intracranial pressure
features of underlying source (dental/sinus/ear)

Question 12

what are signs of raised intracranial pressure?

Answer 12

papilloedema
nausea and vomiting
diplopia
confusion

Question 13

brain abscess bacteria group?

Answer 13

strep milleri

Question 14

management in brain abscess?

Answer 14

drain if possible
penicillin for streps
metronidazole for anaerobes
high doses for penetration

Question 15

spirochaetes in the cns? (3)

Answer 15

Lyme disease (borrelia burgdorferi)
Syphilis (trepomena pallidum)
leptospirosis (leptospira interrogates)

Question 16

what is important to note in spirochaete investigations?

Answer 16

bacteria but can not grow them on culture

Question 17

stage 1 Lyme disease? treatment?

Answer 17

early localised infection (1-30d)
erythema migrans
50% flu like symptoms

doxycycline at time

Question 18

stage 2 Lyme disease?

Answer 18

early disseminated infection (d-m)
one or more organs involved
muscoskeletal and neuro involvement most common

Question 19

stage 3 Lyme disease?

Answer 19

chronic infection (m to y after latent infection)
muscoskeletal and neuro involvement most common

Question 20

investigations in Lyme disease?

Answer 20

serological tests
CSF lymphocytosis (PCR)
MRI brain and spin
nerve conduction studies

Question 21

prolonged treatment in Lyme disease?

Answer 21

IV ceftriaxone

oral doxycycline

Question 22

what does Lyme disease not cause?

Answer 22

chronic fatigue syndrome

Question 23

tests in neurosyphilis?

Answer 23

treponema specific and non specific (VDRL) antibodies

Question 24

what is increased in syphillis?

Answer 24

CSF lymphocytes increased with evidence of intrathecal antibody production

Question 25

treatment in syphilis?

Answer 25

high dose penicillin