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Block 3: Pathophysiology and pharmacology > Infections of the CNS > Flashcards

Infections of the CNS Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges

Does not have to be infectious but usually is

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2
Q

What is encephalitis?

A

Inflammation of the brain

Does not have to be infectious but usually is

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3
Q

What is meningoencephalitis?

A

Inflammation of the brain and the meninges

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4
Q

What is myelitis?

A

Inflammation of the spinal cord

Can be infectious (but not always)

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5
Q

What is a cerebral abscess?

A

Collection of pus in the brain

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6
Q

What is an epidural/ subdural abscess?

A

Pus in the epidural or subdural space

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7
Q

Which bacteria commonly cause meningitis?

A 
Neisseria meningitidis (Meningococcus) 
Haemophilus influenzae type B (HiB)
Streptococcus pneumoniae (Pneumococcus) 
Group B Streptococci 
Listeria monocytogenes
Mycobacterium tuberculosis
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8
Q

What viruses can cause meningitis?

A 
Enterovirus
Varicella Zoster virus (VZV) 
HIV
Mumps
Measles
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9
Q

What fungi can cause meningitis?

A

Cryptococcus neoformans

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10
Q

What viruses can cause encephalitis?

A 
Herpes Simplex virus (HSV) 
Varicella Zoster virus (VZV)
HIV
Arboviruses
Rabies
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11
Q

What can cause cerebritis?

A

Bacteria associated with immunodeficiency or abscesses

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12
Q

What bacteria usually causes abscesses?

A

Streptococci

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13
Q

What parasite can cause cysts?

A

Toxoplasmosis

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14
Q

What viruses can cause myelitis?

A

Poliomyelitis

Rabies

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15
Q

What is the most common form on meningitis in the UK?

A

MenB

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16
Q

What are the common clinical features of all CNS infections?

A 
Fever
Headache
Neck stiffness
Photophobia 
Rash 
Reduced GCS
Confusion 
Seizures
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17
Q

What are the clinical features of meningococcal infections?

A 
Acute
Sepsis
Purpuric rash 
Peripheral gangrene 
Often seen in children and young adults with possible outbreaks
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18
Q

What are the clinical features of pneumococcal infections?

A

Less acute
No rash
High mortality/ morbidity

19
Q

What form of CNS infection is generally associated with respiratory tract infections, trauma and immunocompromised patients?

A

Pneumococcal

20
Q

What form of bacteria is more commonly picked up in neonates during birth?

A

Group B Strep

Low mortality but risk of CN damage

21
Q

Who is most at risk of Listeriosis?

A

Neonates
Elderly
Immunocompromised
Pregnant women

22
Q

What are the clinical features of bacterial meningitis caused by tuberculous?

A

Gradual onset of fever
Confusion
Coma
High CSF protein

23
Q

What type of infection are brain abscesses commonly associated with?

A

Chronic URTIs (e.g. sinusitis or otitis media)

24
Q

What investigations should be carried out to diagnosis a CNS infection?

A

Bloods (FBC + CRP, U+Es, coagulation tests - APTT/ PT)
Blood cultures
HIV test (possibly)
Lumbar puncture
Head CT (if risk of raised ICP/ brain lesions)

25
Q

What is tested for in CSF for patients with suspected meningitis?

A 
RCC/ WCC 
Organisms
PCR test
Protein 
Glucose (compare with blood glucose)
26
Q

What are the contraindications for LP?

A 
Raised ICP 
Infection at LP site
Coagulation abnormality 
Septic shock/ convulsions 
Obvious/ extensive purpura
27
Q

What features indicate a raised ICP?

A 
GCS <12 (or >2 falls) 
Focal neurology
Seizures
Bradycardia / Hypertension 
Papilloedema
28
Q

What can happen in a patient with raised ICP if a lumbar puncture is performed?

A

Coning (herniation of brain through the foramen magnum)

29
Q

What should normal CSF look like?

A

Clear and colourless

30
Q

Where is a lumbar puncture generally taken from?

A

Between L3 and L4 (although can be between L1 and L5)

[L5/S1 in children]

31
Q

Why can a purpuric rash be misleading?

A

Only occurs in meningococcal meningitis

32
Q

Why is it important to take 2 sets of blood cultures?

A

Risk of contamination

Not reliable once antibiotics started

33
Q

What are the indicators of a bacterial infection in CSF?

A 
High WCC (esp. neutrophils) 
High protein 
Low glucose (compared to serum glucose levels)
34
Q

What are the indicators of a viral infection in CSF?

A

Slightly high WCC (esp. lymphocytes)
Slightly high protein
Normal glucose (compared to serum glucose levels)

35
Q

What are the indicators of a tuberculous infection in CSF?

A 
High WCC (esp. lymphocytes) 
Very high proteins 
Low glucose (compared to serum glucose levels)
36
Q

What are the priorities for immediate intervention when treating meningitis?

A

Early recognition
ABC (then secure airway, high flow O2, IV access, fluid resuscitation)
Urine output
Mental state
Neurology (focal neurological signs; persistent seizures; papilloedema)

37
Q

What are the treatment guidelines for meningitis?

A

Assessment prior to LP
Critical care (and postpone LP) if signs of raised ICP, shock or respiratory failure
Monitor and stabilise circulation

38
Q

What medication should be administered for suspected bacterial meningitis?

A

IV 2g Cefotaxime/ Ceftriaxone

IV 0.15mg/kg Dexamethasone

39
Q

What medication should be administered for suspected listeriosis?

A

IV 2g amoxicillin

40
Q

What medication should be administered for suspected viral encephalitis?

A

IV 10mg/kg aciclovir

41
Q

What is used to prevent development of meningitis in those potentially exposed?

A

Chemoprophylaxis (500mg ciprofloxacin single dose or 600mg rifampicin for 2 days)

42
Q

What viruses commonly cause peripheral nerve infections?

A 
Herpes simplex (oral HSV1, genitals HSV2)
Varicella Zoster (chickenpox/ shingles)
43
Q

How does shingles track?

A

Along dermatome

Block 3: Pathophysiology and pharmacology (16 decks)

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