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Nervous System > Infections of the Nervous System > Flashcards

Infections of the Nervous System Flashcards

1
Q

what is Meningitis?

A

inflammation / infection of 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 spinal cord

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4
Q

what are the symptoms of Meningitis

A 
fever
short history of progressive headache
blotchy rash that doesn't fade when a glass is rolled over it 
stiff neck
photophobia
nausea or vomiting 
drowsiness or unresponsiveness
seizures 
Cranial nerve palsy
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5
Q

what is the differential diagnosis of meningitis?

A

Infective: Bacterial, Viral, Fungal
Inflammatory: Sarcoidosis
Drug induced: NSAIDs, IVIG
Malignant: Metastatic Haematological e.g. Leukaemia

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6
Q

what are the bacterial causes of meningitis?

A

Neisseria meningitidis
Streptococcus pneumoniae: Gram positive cocci in chains
sensitive to penicillin

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7
Q

what are the viral causes of meningitis?

A

enteroviruses

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8
Q

what are the symptoms of Encephalitis?

A 
Flu-like prodrome (4-10days)
Progressive Headache associated with fever 
\+/- meningism
Progressive cerebral dysfunction
Confusion
Abnormal behaviour
Memory disturbance
Depressed conscious level
Seizures
Focal symptoms / signs
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9
Q

what is the difference between viral encephalitis and bacterial meningitis?

A

viral encephalitis-generally slower and cerebral dysfunction is a more prominent feature

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10
Q

what is the differential diagnosis of encephalitis?

A

Infective: Viral (most common is HSV)
Inflammatory: Limbic encephalitis (Anti VGKC, Anti NMDA receptor), ADEM
Metabolic: Hepatic, Uraemic, Hyperglycaemic
Malignant: Metastatic, Paraneoplastic

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11
Q

what are the two important antibodies of Auto-immune Encephalitis?

A

Anti-VGKC (Voltage Gated Potassium Channel)

Anti-NMDA receptor

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12
Q

what are the investigations of meningitis?

A 
Blood cultures (bacteraemia)
Lumbar puncture (CSF culture/microscopy)
No need for imaging if no contraindications to LP
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13
Q

what are the investigations of Encephalitis?

A

Blood cultures
Imaging (CT scan +/- MRI)
Lumbar puncture
EEG

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14
Q

what are the indications for CT before lumbar puncture?

A

Focal symptoms or signs suggest a focal brain mass

Reduced conscious level suggests raised intracranial pressure

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15
Q

what are the CSF findings in bacterial meningitis?

A

opening pressure: increased
cell count: high, mainly neutrophils
glucose: reduced
protein: high

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16
Q

what are the CSF findings in viral meningitis and encephalitis?

A

opening pressure: normal/increased
cell count: high, mainly lymphocytes
glucose: Normal (60% of blood glucose)
protein: slightly increased

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17
Q

describe Herpes simplex (HSV) encephalitis

A

commonest cause of encephalitis in Europe
Lab diagnosis by PCR of CSF for viral DNA
Treat with aciclovir on clinical suspicion
Over 70% mortality and high morbidity if untreated

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18
Q

what herpes simplex type cause Encephalitis?

A

other than neonates, nearly all caused by type 1

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19
Q

describe enteroviruses

A

Tendency to cause CNS infections (neurotropic)
Spread by the faecal-oral route
Many can cause non-paralytic meningitis
They do NOT cause gastroenteritis
Include polioviruses, coxsackieviruses and echoviruses

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20
Q

what is Arbovirus encephalitides?

A 
Transmitted to man by vector (mosquito or tick) from non-human host e.g. :
West Nile virus
St Louis Encephalitis
Western Equine Encephalitis 
Tick Borne Encephalitis
Japanese B Encephalitis
travel history important
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21
Q

what are the Clinical Features of brain abscess and empyema?

A

Fever, Headache
Focal symptoms / signs (Seizures, dysphasia, hemiparesis)
Signs of raised intracranial pressure (Papilloedema, false localizing signs, depressed conscious level)
Meningism may be present, particularly with empyema
Features of underlying source
e.g dental, sinus or ear infection

22
Q

what are the causes of brain abscess and empyema?

A

Penetrating head injury
Spread from adjacent infection: Dental, Sinusitis, Otitis media Blood borne infection e.g. Bacterial endocarditis
Neurosurgical procedure

23
Q

what are investigations of brain abscess and empyema?

A

Imaging: CT or MRI
investigate source
blood cultures
Biopsy (drainage of pus)

24
Q

what are the organisms present in brain abscess?

A

Streptococci in 70% of cases, especially the penicillin-sensitive “Strep milleri” group
Anaerobes in 40 - 100% of cases- Bacteroides, Prevotella

25
Q

what is the management of brain abscess?

A

Surgical drainage if possible
Penicillin or ceftriaxone to cover streps
Metronidazole for anaerobes
High doses required for penetration
Culture and sensitivity tests on aspirate provide useful guide

26
Q

what are HIV indicator illnesses of the brain?

A 
Cerebral toxoplasmosis 
Aseptic meningitis /encephalitis
Primary cerebral lymphoma 
Cerebral abscess
Cryptococcal meningitis 
Space occupying lesion of unknown cause
Dementia
Leucoencephalopathy
27
Q

what are the diagnostics of Brain infections in HIV patients

A 
india Ink, cryptococcal antigen
Toxoplasmosis serology (IgG)
JC virus PCR 
CMV PCR 
HIV PCR
28
Q

what are the Spirochaetes in the CNS?

A 
Lyme Disease (Borrelia burgorferi)
Syphilis (Trepomena pallidum)
Leptospirosis (Leptospira interrogans)
29
Q

what is stage 1 of lyme disease?

A

Early localized infection (1-30d)
Characteristic expanding rash at the site of the tick bite: erythema migrans
50% flu like symptoms (days – 1 week)
Fatigue, myalgia, arthralgia, headache, fever, chills, neck stiffness

30
Q

what is stage 2 of lyme disease?

A

Early disseminated infection (weeks – months after initial infection)
Haematologic or lymphatic spread
Musculoskeletal and neurologic involvement
Neurologic involvement (10-15%) untreated patients
PNS > CNS
Mononeuropathy
Mononeuritis multiplex
Painful radiculoneuropathy
Cranial neuropathy

31
Q

what is stage 3 of lyme disease?

A

Chronic infection (months to years after period of latency)
Musculoskeletal and neurologic involvement most common
Neurologic involvement:
As described for stage 2
Subacute encephalopathy
Encephalomyelitis
Does NOT cause a chronic fatigue syndrome

32
Q

what are the investigations of lyme disease?

A 
Complex range of serological tests
CSF lymphocytosis
PCR of CSF
MRI brain / spine (if CNS involvement)
Nerve conduction studies / EMG (if PNS involvement)
33
Q

what is the treatment of lyme disease?

A

Prolonged antibiotic treatment
intravenous ceftriaxone
oral doxycycline

34
Q

describe the presentation of syphilis?

A 
has a similar 3 stage presentation
Tertiary disease (neurosyphilis) years/decades after primary disease - not common
35
Q

what are the investigations of neurosyphilis?

A

Treponema specific and non-treponemal specific (VDRL) antibody tests
CSF lymphocytes increased, evidence of intrathecal antibody production, PCR

36
Q

what is the treatment of neurosyphilis?

A

High dose penicillin

37
Q

describe Poliomyelitis

A

Caused by poliovirus types 1, 2 or 3 - all enteroviruses
asymptomatic
Paralytic disease in ~1%
infects anterior horn cells of lower motor neurones
Asymmetric, flaccid paralysis, esp legs
No sensory features
Polio Immunisation

38
Q

describe rabies

A

Acute infectious disease of CNS affecting almost all mammals
Transmitted to human by bite or salivary contamination of open lesion
Neurotropic - virus enters peripheral nerves and migrates to CNS
Paraesthesiae at site of original lesion
Ascending paralysis and encephalitis

39
Q

what can prevent/treat rabies?

A

pre-exposure: Active immunisation with killed vaccine
post-exposure: Give active rabies immunisation
Give human rabies immunoglobulin (passive immunisation) if high risk

40
Q

describe tetanus

A 
infection with Clostridium tetani
anaerobic Gram positive bacillus, spore forming
wound may not be apparent 
toxin acts at neuro-muscular junction
blocks inhibition of motor neurones
rigidity and spasm
41
Q

what can prevent tetanus?

A

immunisation (toxoid)
given combined with other antigens (DTaP}
penicillin and immunoglobulin for high risk wounds/patients

42
Q

describe botulism

A

Clostridium botulinum
Anaerobic spore producing gram positive bacillus
Neurotoxin: Toxin binding blocks acetylcholine release
Naturally present in soil, dust and aquatic environments

43
Q

what is the clinical presentation of botulism?

A 
Incubation period  4-14 days
Descending symmetrical flaccid paralysis
Pure motor
Respiratory failure
Autonomic dysfunction
Usually pupil dilation
44
Q

what are the investigations of botulism?

A

Nerve conduction studies
Mouse neutralisation bioassay for toxin in blood
Culture from debrided wound

45
Q

what is the treatment of botulism?

A

Anti-toxin (A,B,E)
Penicillin / Metronidazole (prolonged treatment)
Radical wound debridement

46
Q

what are post infective inflammatory syndromes?

A

Preceding infection (viral, bacterial) or immunization
“Molecular mimicry”
Latent interval between the precipitating infection and onset of neurological symptoms
Autoimmune

47
Q

describe Creutzfeldt-Jakob Disease (CJD)

A

Transmissible Proteinaceous particle – Prion

48
Q

what is the aetiology of CJD?

A 
Sporadic CJD
New variant CJD
Familial CJD (10-15%)
Acquired CJD (<5%)
( eg blood transfusion)
49
Q

what are the clinical features of Sporadic CJD?

A 
Consider in any rapidly progressive dementia
Insidious onset (usually older than 60)
Early behavioural abnormalities
Myoclonus
Progressing to global neurological decline
Motor abnormalities
Cortical blindness
Seizures may occur
Death often within 6 months
50
Q

what is the differential diagnosis of Sporadic CJD

A

Alzheimer’s disease with myoclonus - Usually more prolonged
Subacute sclerosing panencephalitis (SSPE) - Very rare, chronic infection with defective measles virus
CNS vasculitis
Inflammatory encephalopathies

51
Q

describe new variant CJD

A

Younger onset <40
Linked to Bovine Spongiform Encephalopathy in Cattle
Early behavioural changes more prominent
Longer course (average 13 months)

52
Q

what are the investigations of sporadic and variant CJD?

A 
MRI:
Pulvinar sign in variant CJD
Often no specific changes in sporadic CJD
EEG:
Generalised periodic complexes typical
Often normal in initial stages
CSF:
Normal or raised protein
Immunoassay 14-3-3 brain protein (non-specific, but very helpful in correct clinical context)

Nervous System (37 decks)

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