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Neurology > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges.

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2
Q

What are the symptoms and signs of meningitis?

A

Symptoms:

  • photophobia
  • N/V

Signs –> classical triad:

  • fever
  • neck stiffness
  • altered mental status

(Also petechial skin rash - hallmark of meningococcal meningitis)

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3
Q

What are the main organisms that cause meningitis?

A

Bacterial:

  • Neisseria meningitidis (meningococcus)
  • Strep pneumoniae (pneumococcus)

Viral:
- enterovirus

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4
Q

Which investigations would you do for suspected meningitis?

A
  • blood cultures looking for bacteraemia
  • lumbar puncture: culture CSF and do microscopy looking for bacteria

Don’t need to use imaging unless there are CI’s to LP.

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5
Q

What are CI’s to LP?

A
  • presence of focal signs/symptoms suggest a focal brain mass
  • reduced consciousness level suggests a raised ICP

–> in both cases, CT before LP

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6
Q

How can meningococcal meningitis be treated?

A

IV ceftriaxone.

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7
Q

What is encephalitis?

A

Inflammation of the brain.

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8
Q

What are the signs and symptoms of encephalitis?

A

Signs:

  • fever
  • meningism
  • progressive cerebral dysfunction
  • focal signs

Symptoms:

  • flu-like prodrome
  • progressive headache
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9
Q

What is the most common type of encephalitis in Europe?

A

HSV encephalitis - mostly type 1 HSV, but in neonates type 2.

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10
Q

How is HSV encephalitis diagnosed?

A

Lab diagnosis by PCR of CSF for viral DNA.

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11
Q

How is HSV encephalitis treated?

A

Aciclovir - over 70% mortality and high morbidity if untreated.

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12
Q

Where does HSV remain latent?

A

Trigeminal or sacral ganglion after primary infection.

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13
Q

Which family viruses can cause non-paralytic meningitis?

A

Enteroviruses: faecal-oral soread. Includes polioviruses.

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14
Q

Which organisms are the main cause of encephalitis in other parts of the world?

A

Arboviruses - mosquito or tick-borne. Importance of travel history.

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15
Q

What is a brain abscess?

A

Localised area of pus within the brain.

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16
Q

What is a subdural empyema?

A

A thin layer of pus between the dura and arachnoid membranes over the surface of the brain.

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17
Q

What are the symptoms and signs of brain abscess/empyema?

A

Symptoms:

  • headache that is worse in the morning
  • coughing
  • sleeping

Signs:

  • raised ICP (papilloedema, depressed conscious level)
  • fever
  • meningism
18
Q

What causes a brain abscess/empyema?

A
  • penetrating head injury
  • spread from adjacent infection (dental, otitis media)
  • blood-borne infection eg bacterial endocarditis
19
Q

How are brain abscess/empyema investigated?

A
  • Imaging: CT/MRI
  • Blood cultures
  • Drainage of pus
20
Q

Which organisms cause brain abscess?

A

Streptococci in 70% of cases, especially the Strep milleri group (Strep anginosis, Strep intermedius and Strep constellatus). Usually anaerobic organisms - bacteriodes, Prevotella etc.

21
Q

How are brain abscesses managed?

A
  • Surgical drainage if possible
  • Penicillin/ceftriaxone for Strep
  • Metronidazole for anaerobes

–> need high doses to penetrate the BBB

22
Q

Which illnesses indicate HIV?

A
  • cerebral toxoplasmosis
  • aseptic meningitis/encephalitis
  • primary cerebral lymphoma
  • cerebral abscess
  • Cryptococcal meningitis

HIV encephalopathy –> HIV-associated dementia

23
Q

How is HIV diagnosed?

A

HIV PCR. Can also do CMV PCR, JC virus PCR, toxo serology (IgG) etc.

24
Q

Describe Cryptococcal meningitis.

A

Mostly caused by C.neoformans. Most clinical cases present with meningoencephalitis - common in people with AIDS or on high doses of immunosuppression.

25
Q

Name 3 spirochaetes that can affect the CNS.

A

Borrelia burgorferm (Lyme), Treponema pallidum (Syphilis) and Leptospira interrogans (Leptospirosis).

26
Q

Name the rash that occurs in Lyme disease.

A

Erythema migrans - occurs at the site of the tick bite.

27
Q

Describe the 3 stages of Lyme disease.

A

1) Early localised infection (1-30 days): flu-like symptoms and erythema migrans rash.
2) Early disseminated infection (weeks-months): haematologic or lymphatic spread; 1 or more organs becomes involved; neurological involvement (PNS).
3) Chronic (months - years): MSK and neuro symptoms; subacute encephalopathy and encephalomyelitis.

28
Q

What are the investigations for Lyme?

A
  • serology
  • PCR of CSF
  • MRI (if brain/spine involvement)
29
Q

How is Lyme disease treated?

A

IV ceftriaxone and oral doxycycline.

30
Q

Describe neurosyphilis.

A
  • Uncommon tertiary form of syphilis
  • VDRL antibody test, PCR, look for CSF lymphocyte increase etc
  • Treat with high dose penicillin
31
Q

Which cells are affected by paralytic poliomyeitis?

A

Anterior horn cells of LMN. Causes asymmetric, flaccid paralysis mainly of the legs with no sensory features.

32
Q

Describe the polio vaccine.

A
  • contains serotypes 1, 2 and 3

- injected (as oral caused a higher incidence of polio than there is in the UK)

33
Q

What is rabies?

A
  • Neurotropic virus that causes ascending paralysis and encephalitis
  • Diagnosis is by culture, detection and serology
  • Dogs and bats are important reservoirs of human infection
  • Immunisation available (killed)
  • If exposed give rabies Ig
34
Q

What is tetanus?

A
  • caused by Clostridium tetani (spore-forming, anaerobic gram positive bacillus)
  • toxin acts at NMJ
  • causes rigidity and spasm
  • DTaP vaccine (toxoid)
  • penicillin and Ig for high risk patients
35
Q

What is botulism?

A
  • Clostridium botulinum (anaerobic, spore-forming, gram positive bacillus)
  • neurotoxic - blocks ACh release at the NMJ and autonomic junction
  • IDU, food-borne or infantile infection
  • purely motor; descending symmetrical flaccid paralysis
  • treat with anti-toxin (ABE), penicillin and metronidazole
36
Q

Name 2 post-infective inflammatory syndromes.

A
  • CNS: acute disseminated encephalomyelitis (ADEM)

- PNS: Guillain-Barre syndrome (GBS)

37
Q

What causes post-infective inflammatory syndromes?

A

A preceding infection or immunisation. Usually due to molecular mimicry - cause autoimmune destruction.

38
Q

What is CJD?

A

Prion disease - sporadic, new variant etc. Very rare.

39
Q

When should sporadic CJD be considered?

A
  • in any case of rapidly progressive dementia
  • over 60’s
  • motor decline: ataxia, extrapyramidal and pyramidal
  • seizures, cortical blindness
  • rapid progression and death within 6 months
40
Q

What are the differentials for sporadic CJD?

A
  • Alzheimer’s disease with myoclonus
  • Subacute sclerosing panencephalitis
  • CNS vasculitis
  • Inflammatory encephalopathies
41
Q

What is new variant CJD?

A
  • younger onset (<40)
  • linked to BSE in cattle: eating infected material
  • longer course of infection (13 months)
42
Q

How would you investigate suspected CJD?

A
  • MRI
  • EEG
  • CSF

Neurology (23 decks)

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