Infections of Nervous System Flashcards
2 bacteria in bacterial meningitis?
neisseria meningitidis (meningococcus) streptococcus pneumonias (pneumococcus)
triad in meningitis? gcs?
fever
stiff neck
altered mental status
<14
(photophobia, nausea and vomiting)
what does encephalitis begin with?
flu like illness lasting 4-10 days
symptoms in encephalitis?
progressive headache associated with fever
progressive cerebral dysfunction (worse than meningitis and slower onset)
what is the hallmark of meningococcal meningitis ?
petechial skin rash
what is post-ictal?
after seizure
two antibodies in auto-immune encephalitis?
anti-VGKC
anti-NMDA receptor
CSF findings in bacterial meningitis?
opening pressure - high
cell count - high, mainly neutrophils
glucose - reduced
protein - high
CSF findings in viral meningitis/encephalitis?
opening pressure - normal/increase
cell count - high, mainly lymphocytes
glucose - normal (60% blood)
protein - slightly increased
what is a brain abscess and what is empyema?
brain abscess is a localised area of puss within the brain
empyema is a thin layer of pus between dura and arachnoid
signs of brain abscess?
fever, headache
focal symptoms
raised intracranial pressure
features of underlying source (dental/sinus/ear)
what are signs of raised intracranial pressure?
papilloedema
nausea and vomiting
diplopia
confusion
brain abscess bacteria group?
strep milleri
management in brain abscess?
drain if possible
penicillin for streps
metronidazole for anaerobes
high doses for penetration
spirochaetes in the cns? (3)
Lyme disease (borrelia burgdorferi) Syphilis (trepomena pallidum) leptospirosis (leptospira interrogates)
what is important to note in spirochaete investigations?
bacteria but can not grow them on culture
stage 1 Lyme disease? treatment?
early localised infection (1-30d)
erythema migrans
50% flu like symptoms
doxycycline at time
stage 2 Lyme disease?
early disseminated infection (d-m)
one or more organs involved
muscoskeletal and neuro involvement most common
stage 3 Lyme disease?
chronic infection (m to y after latent infection) muscoskeletal and neuro involvement most common
investigations in Lyme disease?
serological tests
CSF lymphocytosis (PCR)
MRI brain and spin
nerve conduction studies
prolonged treatment in Lyme disease?
IV ceftriaxone
oral doxycycline
what does Lyme disease not cause?
chronic fatigue syndrome
tests in neurosyphilis?
treponema specific and non specific (VDRL) antibodies
what is increased in syphillis?
CSF lymphocytes increased with evidence of intrathecal antibody production
