infections of the nervous system

Question 1

What is the presentation of meningitis

Answer 1

• Classic triad - fever, neck stiffness and altered mental state
• short history of progressive headache
• fever
• meningism - neck stiffness, photophobia, nausea and vomiting
• cerebral dysfunction
• petechial ranch

Question 2

What is the presentation of encephalitis

Answer 2

• Flu like symptoms before the other symptoms
• Progressive headache and fever with or without meningism
• Progressive cerebral dysfunction
• seizures

Question 3

How to tell if lyme disease or neurosyphilis is in a later stage

Answer 3

Look for increased lymphocytes because in long lasting bacterial infections, the serology will appear like one for a virus instead of a bacterial infection

Question 4

What is the indication for CT before lumbar puncture in meningitis or encephalitis

Answer 4

• Focal neurological deficit
• New onset seizure
• papilloedema
• GCS<10
• Immunocompromised

Question 5

What is the difference in CSF findings between bacterial meningitis compared to viral meningitis and encephalitis

Answer 5

• Bacterial meningitis has mainly neutrophils while the others have lymphocytes in their cell count
• Bacterial meningitis is the only one with reduced glucose due to the bacterial digesting it
• bacterial meningitis has high protein compared to slight increase in viral meningitis or encephalitis

Question 6

What are the clinical features of a brain abscess or empyema

Answer 6

• Fever
• headache
• seizures
• dysphasia
• hemiparesis
• raised ICP causing papilloedema

Question 7

What is the management of a brain abcess

Answer 7

• Surgical drainage
• Ceftriaxone if bacterial targets not known

Question 8

Describe stage 1 of lymes disease

Answer 8

Erythema migrans - dart board lesion characteristic of lyme disease plus systemic symptoms such as fatigue, myalgia, fevers and chills

Question 9

What is the treatment for lyme disease

Answer 9

IV doxycycline for 3 weeks
IV ceftriaxone used if neurological involvement

Question 10

Describe presentation of rabies

Answer 10

Paraesthesiae at the original bite site with ascending paralysis and encephalitis

Question 11

What is the treatment for rabies post exposure

Answer 11

• Wash wound
• Give active rabies immunisation
• Give human rabies immunoglobulin if high risk

Question 12

Describe presentation of Sporadic CJD - creutzfeldt Jakob disease

Answer 12

• rapidly progressive dementia
• insidious onset >60 years old
• myoclonus
• cerebellar ataxia
• tremor
• rigidity
• bradykinesis
• dystonia
• cortical blindness

Question 13

What is the investigations done for CJD

Answer 13

MRI - pulvinar sign seen