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Neuro > Infections of the Nervous System > Flashcards

Infections of the Nervous System Flashcards

1
Q

What is meningitis?

A

Inflammation/ infection of the meninges

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2
Q

What is encephalitis?

A

Inflammation/ infection of brain substance

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3
Q

What is myelitis?

A

Inflammation/ infection of the spinal cord

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4
Q

What is the clinical features of meningitis?

A

Fever, neck stiffness and altered mental state
Short history of progressive headache and meningism
Can also have cerebral dysfunction (confusion or delirium), CN palsy, seizers, petechial skin rash

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5
Q

What symptoms are included in meningism?

A

Neck stiffness, photophobia, nausea and vomiting

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6
Q

What are some differential diagnosis for meningitis?

A

Bacterial, viral, fugal
Inflammatory - sarcoidosis
Drug induced - NSAIDs and IVIG
Malignant - metastatic and haematological

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7
Q

What are the bacterial and viral causes of meningitis?

A

Bacterial - Neisseria meningitidis (meningococcus) + Streptococcus pneumoniae (pneumococcus)
Viral - Enteroviruses

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8
Q

What are the clinical features of encephalitis?

A

Flu like prodrome (4-10days)
Progressive headache with fever, meningism, progressive cerebral dysfunction (confusion, memory disturbance, abnormal behaviour), seizers

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9
Q

What is the difference between viral encephalitis and bacterial meningitis?

A

Viral encephalitis has slower onset and more prominent cerebral dysfunction features

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10
Q

What are the differential diagnosis for encephalitis?

A

Viral (HSV)
Inflammatory - limbic encephalitis, ADEM
Metabolic - hepatic, uremic, hyperglycaemic
Malignant - metastatic, paraneoplastic
Migraine, post ictal (seizer)

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11
Q

What are the 2 important antibodies for auto-immune encephalitis?

A

Anti-VGKC (voltage gated potassium channel)
Anti-NMDA receptor

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12
Q

What are the symptoms of anti-VGKC auto-immune encephalitis?

A

Frequent seizers, amnesia and altered mental state

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13
Q

What are the symptoms of anti-NMDA receptor auto-immune encephalitis?

A

Flu like prodrome, prominent psychiatric features, altered mental state and seizers, progressing to movement disorder and coma

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14
Q

What investigations are used for meningitis?

A

Blood cultures, lumbar puncture and no need for imaging if no contraindications to LP

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15
Q

What investigations are used for encephalitis?

A

Blood cultures, imaging (CT and maybe MRI), lumbar puncture and EEG

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16
Q

What are some contraindications for a lumbar puncture?

A

Focal symptoms and signs suggest focal brain mass
Reduced consciousness suggests raised ICP
New onset seizers
Papilledema

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17
Q

What are the CSF findings for bacterial meningitis?

A

Increased opening pressure
High WCC - mainly neutrophils
Reduced glucose compared to blood
High protein

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18
Q

What are the CSF findings for viral meningitis and encephalitis?

A

Normal or increased opening pressure
High WCC - mainly lymphocytes
Normal glucose
Slightly increased protein

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19
Q

What is culture streptococcus pneumoniae sensitive to?

A

Penicillin

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20
Q

Describe HSV encephalitis

A

Commonest cause in Europe
Lab diagnosis by PCR of CSF for viral DNA
Treat with aciclovir on clinical suspicion

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21
Q

Describe herpes simplex

A

Types 1 and 2 cause cold sores and genital herpes
Virus remain latent in trigeminal or sacral ganglion after primary infection
Encephalitis is rare complication of HSV

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22
Q

Describe enteroviruses

A

Spread by faecal oral route
Tendency to cause CNS infections, human infection and not animal
Do not cause gastroenteritis
Included poliovirus, coxsackieviruses and echoviruses

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23
Q

Describe Arbovirus encephalitis

A

Common in other parts of the world
Transmitted by vector from non-human host - arthropod borne
Relevant to travel

24
Q

What are brain abscesses and empyema?

A

Brain abscess - localised area of pus within brain
Empyema - thin layer of pus between dura and arachnoid membrane over surface of brain

25
Q

What are the clinical features of brain abscess and empyema?

A

Fever, headache, focal symptoms (seizers, dysphagia, hemiparesis)
Signs of raised ICP - depressed conscious state and papilledema
Meningism with empyema
Features of underlying source

26
Q

What are the cause for brain abscess and empyema?

A

Penetrating head injury, spread from adjacent infection, blood borne infection, or neurosurgical procedure

27
Q

How is brain abscess or empyema diagnosed?

A

CT or MRI, investigate source, blood cultures and biopsy (drainage of pus)

28
Q

What organisms can cause brain abscess?

A

Polymicrobial
Streptococci in most - esp. in penicillin sensitive strep milleri group
Anaerobes in most

29
Q

Describe the management for brain abscesses

A

Surgical drainage if possible
Penicillin or ceftriaxone to cover strep
Metronidazole for anaerobes
Culture and sensitivity tests
High mortality without treatment

30
Q

What are some HIV indicator illnesses of the brain?

A

Cerebral toxoplasmosis, aseptic meningitis/ encephalitis, primary cerebral lymphoma, cerebral abscess, cryptococcal meningitis, dementia and leukoencephalopathy

31
Q

What infections can be seen in HIV patients with low CD4 counts?

A

Cryptococcus neoformans, toxoplasma gondii, HIV-encephalopathy

32
Q

What diagnostics are used for HIV indicator illnesses?

A

Cryptococcal antigen, toxoplasmosis serology, CMV PCR and HIV PCR

33
Q

What spirochaetes could be in the CNS?

A

Lyme disease
Syphilis
Leptospirosis

34
Q

Describe Lyme disease

A

Vector borne - tick
Borrelia burgdorferi
Has 3 stages and is multisystem

35
Q

What is stage 1 of Lyme disease?

A

Early localised infection - characteristic expanding rash at site of bite (erythema migrans)
Mainly flu like symptoms

36
Q

What is stage 2 of Lyme disease?

A

Early disseminated infection weeks or months after
Musculoskeletal and neurological involvement most common
More PNS than CNS

37
Q

What is stage 3 of Lyme disease?

A

Chronic infection months to years after
Musculoskeletal and neurological involvement common
Subacute encephalopathy and encephalomyelitis

38
Q

What is the investigation and treatment of Lyme disease?

A

Range of serological tests, CSF lymphocytosis, MRI brain, nerve conduction studies
Prolonged antibiotic treatment - IV ceftriaxone or oral doxycycline

39
Q

Describe neurosyphilis

A

3 stage presentation - primary, secondary and latent
Tertiary disease is years or decades after primary
Treponema specific and non treponemal specific antibody tests
CSF lymphocytes increased
High dose penicillin

40
Q

Describe poliomyelitis

A

Caused by poliovirus type 1,2 or 3 - all enteroviruses
Paralytic disease in 1% - anterior horn cells of LMN affected
Asymptomatic, flaccid paralysis esp. legs

41
Q

Describe rabies

A

Acute infectious disease of CNS affecting almost all mammals
Transmitted to human by bite or salivary communication
Neurotropic
Paraesthesia at site
Ascending paralysis and encephalitis

42
Q

Describe rabies encephalitis

A

No clinical diagnostic test before disease apparent
Diagnosis by PCR and serology
Sedation, intensive care needed and possible death

43
Q

What is used for pre-exposure prevention?

A

Active immunisation with killed vaccine
In UK - bat handlers, imported animal handlers and selected travellers

44
Q

What is rabies post-exposure treatment?

A

Wash wound, give active rabies immunisation, and give rabies immunoglobin

45
Q

Describe tetanus

A

Infection with clostridium tetani
Anaerobic gram positive bacillus and spore forming
Toxin acts at NMJ
Blocks inhibition of motor neurons
Rigidity and spasm

46
Q

Describe the prevention of tetanus

A

Immunisation
Give combined with other antigens
Penicillin and immunoglobulin for high risk wounds/ patients

47
Q

Describe botulism

A

Clostridium botulinum - anaerobic spore producing gram positive bacillus
Neurotoxin
Naturally presents in soil, dust and aquatic environments
Modes of infection - infantile, food, wound

48
Q

What is the presentation of botulism?

A

Incubation period 4-14 days, descending symmetrical flaccid paralysis, pure motor, respiratory failure and autonomic dysfunction

49
Q

What is the diagnosis and treatment of botulism?

A

Nerve conduction studies, mouse neutralisation bioassay for toxin in blood and culture
Treatment is antitoxin, penicillin/ metronidazole and radical wound debridement

50
Q

What are some post infective inflammatory syndromes?

A

CNS - acute disseminated encephalomyelitis
PNS - Guillain Barre syndrome
Preceding infection or immunisation - molecular mimicry, latency and autoimmune

51
Q

Describe Creutzfeldt-Jacob disease

A

Transmissible proteinaceous particle - prion
Aetiology - sporadic CJD, new variant, familial and acquired

52
Q

What are the clinical features of sporadic CJD?

A

Rapidly progressive dementia
Insidious onset, early behavioural abnormalities, myoclonus, progressive neurological decline, motor abnormalities and seizers

53
Q

What are the differential diagnosis for sporadic CJD?

A

Alzheimer’s disease
Subacute sclerosing pan encephalitis
CNS vasculitis
Inflammatory encephalitis

54
Q

What is the prognosis of sporadic CJD?

A

Rapid progression and death often within 6 months

54
Q

Describe new onset variant CJD

A

Younger onset <40
linked to bovine spongiform encephalopathy in cattle
Early behavioural changes are common
Longer course

55
Q

What are the investigations for CJD?

A

MRI - pulvinar sign in variant but usually no specific changes in sporadic
EEG - generalised periodic complexes typical
CSF - normal or raised protein, immunoassay 14-3-3 brain protein

Neuro (40 decks)

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