Infections of the nervous system Flashcards
What is meningitis?
Inflammation/infection of the meninges
What is encephalitis?
Inflammation/infection of the brain substance
What is myelitis?
Inflammation/infection of the spinal cord
What is the name given to the artificial distinction with a mixture of CNS infection?
encephalomyelitis
Classic triad of clinical features of meningitis
fever, neck stiffness and altered mental status
3 symptoms of meningism
neck stiffness
photophobia
nausea and vomiting
How do you test neck stiffness?
passively bend neck forward and lift head up and should fall down but it does not in meningitis
What kind of rash Is present in meningitis?
petechial non-blanching
What is the rash in meningitis a hallmark of?
meningococcal meningitis (can also occur in viral in meningitis)
Some symptoms of meningitis
cerebral dysfunction, cranial nerve palsy, focal neurological signs
Differential diagnosis for meningitis
infective = bacterial, viral, fungal
Inflammatory = sarcoidosis
Drug induced = NSAIDS, IVIG
malignant = metastatic, haematological
2 bacterial causes of meningitis
Neisseria meningitidis - meningococcus
streptococcus pneumoniae - pneumococcus
Viral cause of meningitis
Enterovirus
Give 2 differences between bacterial and viral encephalitis
viral onset is slower and the cerebral dysfunction is a more prominent feature
Differential diagnosis of encephalitis
Infective = viral (HSV)
Inflammatory = limbic encephalitis
metabolic eg hyperglycaemia
migraine
How many important antibodies are there in autoimmune encephalitis? What are they?
2
anti VGKC
Anti NMDA receptor
What is the priority with meningitis and encephalitis?
exclude and treat infection
Meningitis investigation
blood cultures and lumbar puncture
Encephalitis investigation
blood culture, lumbar puncture, imaging scans, EEG
2 contraindications of lumbar puncture
Focal symptoms or signs suggesting a focal brain mass
Reduced conscious level suggesting a raised ICP
Why is glucose in CSF with bacterial meningitis reduced?
bacteria use glucose as a food source
Compare CSF findings in bacterial and viral meningitis with white cell count
both increased
bacterial - neutrophils
viral - lymphocytes
How is HSV encephalitis diagnosed?
PCR of CSF for viral DNA
How is HSV encephalitis treated?
Aciclovir
What do type 1 and type 2 HSV cause?
type 1 - cold sores
Type 2 - genital herpes
Where is HSV latent in the CNS?
neurological ganglia
What type of HSV usually causes encephalitis except in neonates?
1
Do enterovirus cause gastroenteritis?
No
How are enteroviruses spread?
faecal-oral
Are enteroviruses a large family of DNA or RNA viruses?
RNA
How are arbovirus encephalitides transmitted?
by vector (tick,mosquito) from a non human source
What does arbo mean?
Arthropod borne
Why is arbovirus encephalitides relevant to travel?
Common in other parts of the world and can be immunised to prevent
What is a brain abscess?
Localised area of pus within the brain