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Neuro week 3 > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

1
Q

What is brain parenchyma?

A

Functional tissue in the brain

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2
Q

The involvement of what structure is hallmark of encephalitis?

A

In encephalitis the brain parenchyma is inflamed

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3
Q

What are the classifications of meningitis?

A
  • Acute pyogenic (bacterial) meningitis
  • Acute aseptic (e.g. viral, non-infectious) meningitis
  • Acute focal suppurative infection (brain abscess, subdural/extradural empyema)
  • Chronic bacterial infection (TB)
  • Acute encephalitis (brain parenchyma)
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4
Q

How does pyogenic meningitis appear under a microscope?

A

Neutrophils in subarachnoid space

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5
Q

What antibiotics are given for pyogenic meningitis?

A

Ceftriaxone + Dexamethasone

If listeria add Amoxicillin 4 hourly

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6
Q

When do you give steroids in pyogenic meningitis?

A

10mg IV 15-20 mins before or with first dose of antibiotics and then every 6 hours for 4 days

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7
Q

What is a contra-indication for giving steroids to a patient with meningitis?

A
  • post-surgical meningitis
  • Meningococcal
  • Septic shock
  • Patients hypersensitive to steroids
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8
Q

What type of pyogenic meningitis benefits most from steroid treatment?

A

Pneumococcal meningitis

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9
Q

When is viral meningitis most often seen?

A

Late summer / autumn

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10
Q

What aspect of a patients history gives a big clue to viral meningitis?

A

Travel history

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11
Q

What organisms cause viral meningitis?

A

Enteroviruses e.g. ECHO virus

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12
Q

How is viral meningitis diagnosed?

A

Viral stool PCR + culture, throat swab & CSF PCR

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13
Q

What is the treatment for viral meningitis?

A

Supportive as the condition tends to be self limiting

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14
Q

What are some symptoms of encephalitis?

A
  • Mental status change
  • Confusion
  • Obtundation or coma
  • Seizure
  • Behavioral & speech disturbance
  • Focal or diffuse neurological signs
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15
Q

What are some symptoms of Meningo-encephalitis?

A
  • Headache
  • fever
  • Neck stiffness
    +
    encephalitis features
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16
Q

Is the cerebral cortex affected by encephalitis?

A

Yes

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17
Q

Does encephalitis tend to have a insidious or sudden onset?

A

Most likely insidious

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18
Q

What investigations are done for encephalitis?

A
  • Lumbar puncture (1st line)
  • EEG
  • MRI
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19
Q

If there’s a delay in encephalitis investigation what do you do?

A

Give aciclovir

20
Q

What are some general symptoms of CNS infections?

A
  • Headache
  • Vomiting
  • Pyrexia
  • Neck stiffness
  • Photophobia
  • Lethargy
  • Confusion
  • Rash
21
Q

What organisms are most likely to cause community acquired pyogenic meningitis in neonates?

A

Listeria
Group B strep
E.coli

22
Q

What organism is most likely to cause community acquired pyogenic meningitis in children?

A

H. Influenza

23
Q

What organisms are most likely to cause community acquired pyogenic meningitis in over 65s?

A
  • Strep pneumoniae
  • Listeria
24
Q

If a patient has decreased cell mediated immunity what organism is most likely to cause community acquired pyogenic meningitis?

25
If a patient has a fractured cribriform plate what organism is most likely to cause community acquired pyogenic meningitis?
Strep pneumoniae
26
If a patient has had neurosurgery or head trauma what organism is most likely to cause community acquired pyogenic meningitis?
- Staphylococcus - G-ve bacili
27
What patients with meningitis should undergo a CT before lumbar puncture?
- Immunocompromised - History of CNS disease - New onset seizure - Papillodema - Abnormal level of consciousness - Focal neurological deficit
28
CSF 99% predictive of bacterial meningitis if what readings are seen?
- WBC >200 - Neutrophils >1180 - Protein >220mg/dl - Glucose <34mg/dl - Glucose (CSF/serum) <0.23
29
What viruses commonly cause viral meningitis in immunosuppressed patients?
EBV CMV
30
What viruses commonly cause meningitis in regular patients?
- Enteroviruses - HSV 1&2 - M. tuberculosis - Pneumococci - Meningococci - H. influenzae
31
What organism causes meningococcal meningitis?
N. Meningitidus
32
What group of patients is meningococcal meningitis most common in?
young kids
33
What is the mortality rate of localized meningitis?
5%
34
What is the mortality rate of meningitis with septicemia?
15%
35
What is the mortality rate of fulminant (severe) septicaemia?
15-40%
36
Which of the 12 capsular groups of meningococcus are most common in the UK?
B, C, W & Y
37
What medication is first line for meningitis?
Ceftriaxone (not useful for listeria infections) + dexamethasone
38
What is the most common cause of meningitis in children under 6 years old?
H. Influenzae type b
39
Who's is most at risk of strep pneumoniae meningitis?
- Hospitalized patients - Patients with CSF skull fractures - Diabetics/alcoholics - Young children
40
What antibiotic is given for listeria infection meningitis?
IV ampicillin/amoxicillin
41
What medication is given for tuberculous meningitis?
Isonazid + rifampicin Add pyrazinamide + ethambutol
42
What medication is given for cryptococcal meningitis?
Fluconazole
43
If a patient has meningitis and is over 60 what medication do you add
Amoxicillin
44
If patient is pen allergic and has meningitis what do you give?
chloramphenicol + dexamethasone
45
If a meningitis patient is pen allergic and is over 6o what medication do you add?
co-trimoxazole
46
What drugs can be used for meningitis prophylaxis?
- Rifampicin - Ciprofloxacin - Ceftriaxone
47
What drug is given to close contacts of meningitis patients?
ciprofloxacin

Neuro week 3 (8 decks)

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