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Year 2 Neuro (JK) > Infections of the nervous system > Flashcards

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 substance

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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 name given to the artificial distinction with a mixture of CNS infection?

A

encephalomyelitis

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5
Q

Classic triad of clinical features of meningitis

A

fever, neck stiffness and altered mental status

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6
Q

3 symptoms of meningism

A

neck stiffness
photophobia
nausea and vomiting

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7
Q

How do you test neck stiffness?

A

passively bend neck forward and lift head up and should fall down but it does not in meningitis

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8
Q

What kind of rash Is present in meningitis?

A

petechial non-blanching

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9
Q

What is the rash in meningitis a hallmark of?

A

meningococcal meningitis (can also occur in viral in meningitis)

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10
Q

Some symptoms of meningitis

A

cerebral dysfunction, cranial nerve palsy, focal neurological signs

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11
Q

Differential diagnosis for meningitis

A

infective = bacterial, viral, fungal
Inflammatory = sarcoidosis
Drug induced = NSAIDS, IVIG
malignant = metastatic, haematological

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12
Q

2 bacterial causes of meningitis

A

Neisseria meningitidis - meningococcus

streptococcus pneumoniae - pneumococcus

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13
Q

Viral cause of meningitis

A

Enterovirus

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14
Q

Give 2 differences between bacterial and viral encephalitis

A

viral onset is slower and the cerebral dysfunction is a more prominent feature

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15
Q

Differential diagnosis of encephalitis

A

Infective = viral (HSV)
Inflammatory = limbic encephalitis
metabolic eg hyperglycaemia
migraine

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16
Q

How many important antibodies are there in autoimmune encephalitis? What are they?

A

2
anti VGKC
Anti NMDA receptor

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17
Q

What is the priority with meningitis and encephalitis?

A

exclude and treat infection

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18
Q

Meningitis investigation

A

blood cultures and lumbar puncture

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19
Q

Encephalitis investigation

A

blood culture, lumbar puncture, imaging scans, EEG

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20
Q

2 contraindications of lumbar puncture

A

Focal symptoms or signs suggesting a focal brain mass

Reduced conscious level suggesting a raised ICP

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21
Q

Why is glucose in CSF with bacterial meningitis reduced?

A

bacteria use glucose as a food source

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22
Q

Compare CSF findings in bacterial and viral meningitis with white cell count

A

both increased
bacterial - neutrophils
viral - lymphocytes

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23
Q

How is HSV encephalitis diagnosed?

A

PCR of CSF for viral DNA

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24
Q

How is HSV encephalitis treated?

A

Aciclovir

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25
Q

What do type 1 and type 2 HSV cause?

A

type 1 - cold sores

Type 2 - genital herpes

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26
Q

Where is HSV latent in the CNS?

A

neurological ganglia

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27
Q

What type of HSV usually causes encephalitis except in neonates?

A

1

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28
Q

Do enterovirus cause gastroenteritis?

A

No

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29
Q

How are enteroviruses spread?

A

faecal-oral

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30
Q

Are enteroviruses a large family of DNA or RNA viruses?

A

RNA

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31
Q

How are arbovirus encephalitides transmitted?

A

by vector (tick,mosquito) from a non human source

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32
Q

What does arbo mean?

A

Arthropod borne

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33
Q

Why is arbovirus encephalitides relevant to travel?

A

Common in other parts of the world and can be immunised to prevent

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34
Q

What is a brain abscess?

A

Localised area of pus within the brain

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35
Q

What is a subdural empyema?

A

Thin layer of pus between the dura and arachnoid mater membranes over the surface of the brain

36
Q

Clinical features of brain abscess/empyema

A

fever headache, focal signs eg seizure, dysphasia, hemiparesis

37
Q

What are the signs of raised ICP?

A

papilloedema, depressed conscious level

38
Q

What are common underlying sources of infection for a brain abscess/empyema?

A

sinusitis, dental, ear infection

39
Q

Causes of brain abscess and empyema

A

penetrating head injury
spread of adjacent infection
blood borne infection eg bacterial endocarditis
Neurosurgical procedure

40
Q

Diagnosis of brain abscess/empyema

A

CT/MRI
investigate source
blood cultures
biopsy and drainage of pus

41
Q

What are the 2 main organisms present in the mixture of empyema?

A

streptococci

anaerobes

42
Q

Management of brain abscess

A

1st line = surgical drainage
penicillin for streps
metronidazole for anaerobes

43
Q

What is HIV encephalopathy?

A

HIV related dementia

44
Q

Most common type of meningitis in HIV?

A

cryptococcal

45
Q

Diagnostics of HIV related illnesses

A

india ink - cryptococcal antigen - CSF makes circles
HIV PCR
JCV PCR
toxoplasmosis serology (IgG)

46
Q

3 spirochaetes in the CNS

A

lyme disease, syphilis, leptospirosis

47
Q

Lyme disease - how is it transmitted?

A

vector borne - wooded areas

48
Q

Systems lymes disease affects

A

skin, rheumatological, MSK, ophthalmological, cardiac, neurological

49
Q

How many stages of lymes disease is there?

50
Q

Stage 1 characteristic bite at site of tick bite

A

erythema migrans

51
Q

How many organ systems are affected in stage 2 of lymes disease?

A

1 or more

usually neurological and MSK

52
Q

When does stage 3 of lymes disease occur?

A

after a period of latency

53
Q

Investigation of lymes disease

A

serological tests
PCR of CSF
EMG
CSF lymphocytosis

54
Q

Treatment of lymes disease

A

prolonged antibiotic treatment for 3-4weeks

55
Q

What are the 3 stages of Neurosyphilis/syphilis

A

primary, secondary and latent

56
Q

What group of viruses are polioviruses and how many types are there?

A

enterovirus

1,2,3

57
Q

In polio what has to be affected for there to be paralysis?

A

anterior horn cell of LMN

58
Q

What is rabies?

A

Acute infectious diseases of CNS affecting almost all mammals

59
Q

How is rabies transmitted to humans?

A

bite

salivary contamination of an open lesion

60
Q

How is rabies neurotropic?

A

enters peripheral nerves and migrates to CNS

61
Q

Symptoms of rabies

A

paraesthesia at sight of lesion

ascending paralysis and encephalitis

62
Q

Diagnosis of rabies encephalitis

A

culture, detection, PCR or serology

63
Q

Where is rabies encephalitis mainly found and what animals?

A

Africa/Asia

dogs and bats

64
Q

Pre-exposure prevention method of rabies

A

active immunisation with killed vaccine

65
Q

what 3 groups are given pre-exposure prevention of rabies?

A

bat handlers
regular handlers of imported animals
selected travellers to enzootic areas

66
Q

What is meant by enzootic?

A

Regularly affecting animals in a particular area or at a particular season

67
Q

Post exposure treatment of rabies

A

wash wound
give active rabies immunisation
give human rabies Ig if risk is high

68
Q

Is human rabies immunoglobulins active or passive immunisation?

69
Q

What is the causative organism of tetanus?

A

clostridium tetani

70
Q

What type of bacteria is clostridium tetani and clostridium botulinum?

A

anaerobic gram positive spore forming bacillus

71
Q

What affects the NMJ in tetanus?

A

toxins produced by the bacteria

72
Q

What do the toxins in tetanus do to the NMJ?

A

block it and prevent inhibition of motor neurons

73
Q

Tetanus signs

A

rigidity and spasm

74
Q

Prevention of tetanus

A

immunisation - toxoid
give combined with other antigens eg DPaT
penicillin and IG for high risk wounds and patients

75
Q

Causative organism in botulism

A

clostridium botulinum

76
Q

What does the neurotoxin in botulism do and how does it work?

A

binds irreversibly to presynaptic terminal and prevent Ach release

77
Q

Where is clostridium botulinum naturally present?

A

soil, dust and aquatic environments

78
Q

3 modes of infection of botulism

A

infancy - intestinal colonisation
food borne - outbreaks
wound - drug users

79
Q

Incubation period of clostridium botulinum

80
Q

Presentation of botulism

A

ANS dysfunction - dilated pupils

descending symmetrical paralysis, respiratory failure

81
Q

How is botulism diagnosed?

A

nerve conduction studies
toxin in blood
culture from debrided wound

82
Q

Treatment of botulism

A

Anti-toxin (A,B,E)
Penicillin/metronidazole
radical wound debridement

83
Q

What is a prion?

A

transmissible protein particle

84
Q

Aetiology of CJD

A

sporadic, new variant, familial, acquired eg blood transfusion

85
Q

When should sporadic CJD be considered?

A

> 60

very rapidly progressive dementia

86
Q

What is new variant CJD linked to?

A

bovine - infected material

genetic susceptibility

87
Q

Investigation of CJD

A

MRI
EEG
CSF

Year 2 Neuro (JK) (50 decks)

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