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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 the brain tissue

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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 classical triad of symptoms in meningitis?

A

Fever
Neck stiffness
Altered mental status

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5
Q

What rash should be looked for in suspected meningitis?

A

Petechial skin rash (tumbler test)

Hallmark test for meningococcal meningitis but can also occur in viral form

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6
Q

How is neck stiffness in meningitis tested?

A

Passively bending the neck forward

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7
Q

What is an inflammatory Ddx for meningitis?

A

Sarcoidosis

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8
Q

What are some malignant DDx for meningitis?

A

Metastatic malignancy

Haematological malignancy

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9
Q

What are some drug caused DDx for meningitis?

A

NSAID use

IVIG use

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10
Q

What are the two main causative bacterial agents of meningitis?

A 
Neisseria meningitides (meningococcus)
Streptococcus pneumonia (pneumococcus)
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11
Q

What are a key group of viral agents that can cause viral meningitis?

A

Enteroviruses

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12
Q

What are the clinical features of encephalitis?

A 
Flu-like symptoms for 4-10 days
Progressive headache associated with fever
Meningism may or may not be present 
Cerebral dysfunction
Seizures
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13
Q

Is the onset of viral meningitis slower or faster than that of bacterial meningitis?

A

Generally slower

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14
Q

Give some inflammatory DDx for encephalitis

A

Limbic encephalitis - anti VGCK/ anti NMDA receptor

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15
Q

What is the most common cause of encephalitis?

A

Viral - HSV most common

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16
Q

What should be considered if a patient has several seizures with little or no recovery period afterwards?

A

Viral encephalitis

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17
Q

What are the two forms of auto-immune encephalitis?

A

Anti-VGKC (voltage gated potassium channel)

Anti-NMDA receptor - more common

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18
Q

What are the features of auto-immune encephalitis causes by anti-VGKC type?

A

Frequent seizures
Amnesia (unable to retain new memories)
Altered mental state

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19
Q

What are the features of auto-immune encephalitis caused by the anti-NMDA receptor type?

A

Flu-like prodrome
Prominent psychiatric features
Altered mental state and seizures
Progressing to movement disorder and coma

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20
Q

What are the priorities when investigating and treating suspected meningitis and encephalitis?

A

Priority is to exclude infection and treat

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21
Q

What are the Ix for meningitis?

A

Blood cultures
LP (CSF culture/microscopy
No need for imaging if no contraindications to LP

22
Q

What are the Ix for encephalitis?

A

Blood cultures
Imaging - CT +/- MRI
LP
EEG

23
Q

What are the contraindications to LP?

A

Focal neurological deficit, not including cranial nerve palsies
New-onset seizures
Papilloedema
Abnormal level of consciousness, interfering with proper neurological exam (GCS)
Sever immunocompromised state

24
Q

What does observing the contraindications to LP aim to prevent?

A

If there is raised ICP, one of the compensatory mechanisms is the shunt CSF from the brain into the spinal cord. This creates a high pressure in the cord of fluid that it essentially exerting an upwards force on the brain. In this situation if an LP is done, the pressure in the cord will decrease, allowing the brain to move towards the are a of lower pressure at which point herniation, coning and resultant death are likely to follow

25
Describe the opening CSF pressure in bacterial meningitis
Increased
26
Describe the opening CSF pressure in viral meningitis and encephalitis
Normal, may be increased
27
Describe the CSF white cell count in bacterial meningitis
High, mainly neutrophils
28
Describe the CSF white cell count in viral meningitis and encephalitis
High, mainly lymphocytes
29
Describe the CSF glucose content in bacterial meningitis
Reduced
30
Describe the CSF glucose content in viral meningitis and encephalitis
Normal (60% of blood glucose level)
31
Describe the CSF protein content in bacterial meningitis
High
32
Describe the CSF protein content in viral meningitis and encephalitis
Slightly increased
33
What is a cardinal sign of bacterial meningitis upon visualisation of the CSF
CSF is cloudy
34
What is the normal white cell count in CSF?
0-5
35
What are the two causative agents of bacterial meningitis and which is sensitive to penicillin?
Streptococcus pneumoniae - sensitive to penicillin | Nisseria meningitides
36
What is the commonest cause of encephalitis i Europe?
HSV
37
What is the test for HSV in encephalitis?
PCR of CSF for viral DNA
38
What is the treatment for HSV induced encephalitis UPON CLINICAL SUSPICION?
Treat with aclovir
39
What is the mortality for encephalitis caused by HSV if untreated?
70%
40
Where does the HSV remain after primary infection?
Trigeminal or sacral ganglion
41
What form of HSV causes encephalitis in all but neonates?
Type 1
42
Describe the enterovirus cause of encephalitis
Enteroviruses are a large family of RNA viruses They tend to cause CNS infections Spread by the faecal-oral route Many can cause non-paralytic meningitis They DO NOT cause gastroenteritis Include polioviruses, coxsackiviruses and echoviruses
43
What is a brain abscess?
Localised area of pus within the brain
44
What is a subdural empyema?
A thin layer of pus between the dura and arachnoid membranes over the surface of the brain
45
What are the clinical features of brain abscess and empyema?
``` Fever Headache Focal symptoms and signs Signs of raised ICP Meningism may be present Features of underlying source e.g. dental, sinus or ear infection ```
46
Give some causes of brain abscess and empyema
Penetrating head injury Spread form adjacent infection Blood borne infection e.g. bacterial endocarditis Neurosurgical procedure
47
What is required for a diagnosis of brain abscess and or empyema?
CT/MRI Investigate source Blood cultures Biopsy (drainage of pus)
48
What bacterial organism is present in 70% of brain abscess cases, and what what group own particular? What is clinically significant about this group?
Streptococci, 'strep millenni' group | They are sensitive to penicillin
49
Outline the management for brain abscess
Surgical drainage Penicillin or ceftriaxone to cover streps Metronidazole for anaerobes High doses required for penetration High mortality without appropriate treatment
50
Give eight brain illnesses that may indicate HIV
``` Cerebral toxoplasmosis Aseptic meningitis/encephalitis Primary cerebral lymphoma Cerebral abscess Cryptococcal meningitis Space occupying lesion of unknown cause Dementia Leucoencephalopathy ```

Neurology (42 decks)

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