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Neurology Clinical > Infections Of The Nervous System > Flashcards

Infections Of The Nervous System Flashcards

1
Q

What microbes cause meningitis?

A 
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae

Viral - enteroviruses

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2
Q

What the traid symptoms of meningism?

A

stiff neck
photophobia
headache

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3
Q

What is the clinical presentation of meningitis?

A

Short history of progressive headache with fever and meningism (stiff neck, photophobia, nausea & vomiting)
Cerebral dysfunction (dementia, delirium, decreased conscious level)
Cranial nerve palsies
Seizures
Focal neurological symptoms/signs
Petechia rash

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4
Q

How would you investigate a rash suspected of meningitis and what would classify it as meningitis?

A

Petechial rash which doesnt blanch with tumbler test

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5
Q

What are the differential diagnoses of meningitis?

A

Bacterial, viral or fungal infection
Sarcoidosis
NSAIDS, IVIG
Metastatic, haematological i.e. leukaemia, lymphoma, myeloma

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6
Q

What investigations are carried out for suspected meningitis?

A

Blood cultures
Lumbar puncture
CT if contraindications for LP

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7
Q

What are the clinical features of encephalitis?

A 
Flu like prodone 4-10 days
Progressive headache with fever
\+/- meningism
Progressive cerebral dysfunction (confusion, abnormal behaviours, memory loss)
Seizures
Focal symptoms/signs
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8
Q

What is the difference in the clinical presentation of meningitis vs encephalitis?

A

Encephalitis will present with more neurological cerebral dysfunction but meningitis can present with this too
But meningitis will present with a petechial rash but encephalitis wont
Onset of encephalitis is also typically slower

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9
Q

What are the microbiological causes of encephalitis?

A

Viral;

  • herpes simplex virus
  • enteroviruses
  • arboviruses

Autoimmune

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10
Q

What antibodies cause autoimmune encephalitis?

A

Anti - VGKC

Anti NMDA receptor

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11
Q

What is the difference in the presentation of bacterial encephalitis vs viral encephalitis?

A

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

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12
Q

What are the features of meningism?

A

Neck stiffness
Photophobia
Nausea & Vomiting

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13
Q

Why can meningitis cause a CN palsy?

A

Because the cranial nerves run within the meninges so they can be affected

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14
Q

What viruses can cause meningitis?

A

Enteroviruses

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15
Q

What is the most common cause of encephalitis?

A

HSV (herpes simplex virus)

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16
Q

What antibody is responsible for causing encephalitis which can cause amnesia?

A

Anti-VGKC

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17
Q

What are the contraindications for a LP?

A

Focal symptoms or signs suggesting a brain mass
Reduced concious level suggesting raised ICP
Severe immunocompromised state

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18
Q

What are the cell counts like in meningitis and encephalitis?

A

Both are high
Meningitis = mainly neutrophils
Encephalitis = mainly lymphocytes

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19
Q

What is the glucose levels like in meningitis and encephalitis?

A 
Meningitis = reduced
Encephalitis = 60% is normal
20
Q

In which infection (meningitis or encephalitis) is the protein high?

A

Meningitis

In encephalitis it is slightly increased

21
Q

What si the treatment for bacterial meningitis?

A

At least 2 weeks of penicillin

22
Q

What is the treatment for viral encephalitis caused by HSV?

A

Aciclovir

23
Q

Where des the HSV virus remain latent after primary infection?

A

Trigeminal or sacral ganglion

24
Q

How is viral encephalitis investigated?

A

PCR of CSF

25
Q

What causes non paralytic meningitis?

A

Enteroviruses

I.e. poliovirus, coxsackie virus, echoviruses

26
Q

How is arbovirus encephalitis transmitted?

A

Via a vector such as mosquito or tick

27
Q

What is the difference between a brain abscess and subdural empyema?

A

Brain abscess is a localised area of pus within the brain

Subdural empyema is a thin layer of pus between the dura and arachnoid membrane over the brain surface

28
Q

Why might you not get fever or neck stiffness with a brain abscess?

A

Because it is localised

29
Q

What are the clinical features of a brain abscess / empyema?

A

Fever
Headache
Focal symptoms i.e. seizures, dysphasia, hemiparesis etc
Signs of raised ICP i.e. papiloedema, false localising signs, depressed conscious level
Meningism
Features of underlying source i.e. dental, sinus or ear infection

30
Q

What are the causes of a brain abscess?

A

Penetrating head injury
Spread from adjacent infection i.e. dental, sinusitis, ottitis media
Blood borne infection i.e. bacterial endocarditis
Neurosurgical procedure

31
Q

How do you diagose a brain abscess?

A

CT/ MRI
Blood cultures
Biopsy (by draining pus)

32
Q

What is the management for a brain abscess?

A

Surgical drainage
Penicillin or ceftriaxone for streptococci
Metronidazole for anaerobes

33
Q

What drug is given to treat a brain abscess caused by streptococci?

A

Penicillin or ceftriaxone

34
Q

What drug is given to treat a brain abscess caused by anaerobes?

A

Metronidazole

35
Q

What is the stage 1 presentation of Lyme disease?

A

Expanding rash at site of tick bite

Flu like symptoms i.e. fever, myalgia, arthralgia, headache, fever, chills, neck stiffness

36
Q

What investigations would you carry out if you suspected Lyme disease?

A 
Serological tests
CSF lymphocytosis 
PCR of CSF
MRI brain/spine 
Nerve conduction studies
37
Q

What is the treatment for Lyme disease?

A 
Prolonged antibiotics (3 weeks)
IV ceftriaxone 
Oral doxycycline
38
Q

What is the treatment for neurosyphillis?

A

High dose penicillin

39
Q

What is the pre exposure prevention and post exposure treatment for rabies encephalitis?

A

Pre exposure active immunisation with killed vaccine
Post exposure treatment ;
- wash wound
- give active rabies immunisation
- give rabies immunoglobulin (passive immunisation)

40
Q

What is the clinical presentation of botulism?

A

Descending symmetrical flaccid paralysis
Pure motor.
Respiratory failure
Autonomic dysfunction - pupil dilatation

41
Q

What is the treatment for botulism?

A

Anti-toxin
Penicillin / metronidazole
Radical wound debriment

42
Q

What is the difference in the presentation of Guilin barre syndrome and botulism?

A

GBS will have ascending paralysis with sensory involvement whereas botulism is descending paralysis with no sensory involvement

43
Q

What bacteria is responsible for botulinum toxin and what type of bacteria is this?

A

Clostridium botulinum

Anaerobic, spore producing gram positive bacillus

44
Q

How do you diagnose botulinum toxin?

A

Nerve conduction studies

Culture from debrieded wound

45
Q

What are the modes of infection of botulism toxin?

A

Food borne
Infantile (intestinal colonization)
IV drug injections

46
Q

What does rabies infection present with?

A

Ascending paralysis with encephalitis

Neurology Clinical (21 decks)

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