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Year 2 - Nervous > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

1
Q

What 3 symptoms does meningism refer to

A

Neck stiffness
Photophobia
Headache

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2
Q

Class triad of meningitis symptoms

A

Neck stiffness
Fever
Altered mental status

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3
Q

Symptoms (4) /signs (5) of meningitis

A 
Symptoms:
NECK STIFFNESS
Progressive headache
Nausea
vomiting

Signs:
FEVER
ALTERED MENTAL STATUS
Photophobia
Meningism = neck stiffness, photophobia + headache +/- nausea/ vomiting
Petechial skin rash (in meningococcal meningitis)

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4
Q

Meningococcal meningitis can present with what skin feature

A

Petechial skin rash

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5
Q

Bacterial/viral causes of meningitis

A

Bacterial - neisseria meningitidis (meningococcus), streptococcus pneumoniae (pneumococcus)

Viral - enteroviruses

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6
Q

Meningitis investigations (3)

A

Blood culture + gram stain

Lumbar puncture + CSF culture
-CSF BACTERIAL CULTURE IS GOLD STANDARD FOR BACTERIAL MENINGITIS

CT/MRI - don’t need this if LP not contra-indicated

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7
Q

When not to do an LP + why

A

When there are signs and symptoms to suggest an intracranial mass lesion or if there’s a known brain lesion as it may cause herniation syndrome

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8
Q

Microbiological features of CSF in BACTERIAL meningitis (4)

A

Increased opening pressure >25cm H2O
High cell count (neutrophils)
Low CSF glucose (<40% of serum glucose)
High CSF protein (–> cloudy CSF)

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9
Q

Microbiological features of CSF in VIRAL meningitis (4)

A

Opening pressure – normal/increased
Cell count – high (LYMPHOCYTES)
CSF glucose – normal (60% of blood glucose)
CSF protein – slightly increased

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10
Q

Commonest enterovirus that causes viral meningitis

A

Coxsackievirus

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11
Q

Definition of encephalitis

A

Inflammation of brain substance

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12
Q

Symptoms (2) /signs (4) of encephalitis

A

Symptoms:
Preceding FLU-LIKE symptoms (cough, sore throat, runny nose etc)
Progressive headache

Signs:
Fever
Cerebral dysfunction - CONFUSION, abnormal behaviour, memory disturbance, decreased consciousness
SEIZURES
Focal symptoms/signs
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13
Q

Causes of encephalitis (3)

A

Viral - herpes simplex virus, arbovirus

Autoimmune

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14
Q

Investigations of encephalitis (6)

A 
Blood culture 
CT +/-MRI
Lumbar puncture + CSF culture
EEG
CSF PCR
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15
Q

For all suspected viral encephalitis, what is the empirical treatment

A

Aciclovir

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16
Q

Pathophysiology of autoimmune encephalitis

-2 autoantibodies

A

2 antibodies attacking receptors in brain:

  • Anti-VGKC (voltage gated potassium channel) antibodies
  • Anti-NMDA antibodies,
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17
Q

Encephalitis typically presents with what features (5)

A 
Presents with acute onset of a: febrile illness (Fever)
altered mental status
headache, 
seizures,
focal neurological signs
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18
Q

Microbiological features of CSF in VIRAL encephalitis (4)

A

Opening pressure – normal/increased
Cell count – high (LYMPHOCYTES)
CSF glucose – normal (60% of blood glucose)
CSF protein – slightly increased

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19
Q

Viral encephalitis most commonly is caused by what virus

A

HSV

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20
Q

Encephalitis is a rare complication of which type of HSV

A

Type 1 HSV

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21
Q

Name 3 examples of HSVs

A

varicella zoster virus (VZV),
epstein barr virus (EBV),
cytomegalovirus (CMV)

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22
Q

Main diagnostic investigation of viral encephalitis

A

CSF PCR for viral DNA

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23
Q

Treatment of bacterial meningitis (4)

  • empirical antibiotics (2)
  • other medical
A

Empirical antibiotics for >1 months if <50yrs:
IV ceftriaxone + IV vancomycin

IV dexamethasone

Supportive care

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24
Q

Treatment of encephalitis (2)

A

Aciclovir + supportive care (treat symptoms - fever etc)

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25
Q

What is a brain abscess

A

Localised area of pus in brain

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26
Q

What is a subdural empyema

A

Layer of pus between dura and arachnoid

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27
Q

Brain abscesses can cause what type of meningitis - but rarely bacterial meningitis

A

Reactive meningitis

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28
Q

Abscess vs empyema

A

Abscess is a collection of pus anywhere in the body, usually inside an organ or under the skin

Empyema is a collection of pus in body cavities, e.g. pleural cavity or between layer of meninges

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29
Q

Symptoms (1) /signs (5) of brain abscess/empyema

A

Symptoms:
Headache

Signs:
Fever
Focal symptoms/signs (focal neurological deficit)
Cranial nerve palsy 
Signs of raised ICP
-Papilloedema
-Decreased conscious level
Meningism
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30
Q

Causative microbes of brain abscess (3) + name 2 bacteria that commonly cause brain abscesses

A

Bacterial - often a mix of strep milleri & anaerobes
Fungal
Parasitic

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31
Q

5 risk factors for brain abscess

A 
Sinusitis
Dental infection
Otitis media
Meningitis
Recent neurosurgery
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32
Q

Bacterial brain abscess treatment (5) + specify which of the empirical antibiotics is targeted towards anaerobes

A

Empirical antibiotics:

IV:
Vancomycin +
Metronidazole - for anaerobes +
Ceftriaxone

Anticonvulsant

If doesn’t respond to antibiotics then:
surgical drainage

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33
Q

Brain abscess investigations

  • imaging (2)
  • bloods (4)
A

CT/MRI

Blood culture
FBC - elevated WBCs
ESR - elevated
CRP - elevated

Biopsy of abscess

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34
Q

Name 3 conditions caused by spirochaetes (GRAM -VE)

A

Lyme disease
Syphilis
Leptospirosis

35
Q

Name the spirochete causing lyme disease

A

Borrelia burgdorferi

36
Q

Transmission of lyme disease

A

Vector borne - e.g. tick

37
Q

Most common sign of Lyme disease

A

Erythema migrans - expanding red rash at site of tick bite

38
Q

How many stages are there in lyme disease

39
Q

Describe stage 1 of lyme disease (+ symptom /signs)

A

Early localised infection in 1st month

FLU like symptoms:
Fever, 
headache, 
myalgias, 
fatigue,
arthralgias

Signs:
Erythema migrans - expanding rash

40
Q

Describe stage 2 of lyme disease
+ name 2 ways it spreads
+ name 3 systems it can start to affect

A 
Early disseminated (spread) infection 
-characterised by DIFFUSE macular-papular rash all over (esp hands and soles and chest)

Blood or lymphatic spread

MSK, nervous, cardiovascular

41
Q

Name 5 complications of lyme disease (i.e. when it’s spread to other systems)

A

Radiculopathy
Myelopathy
Atrioventricular (AV) block - specifically 3rd degree heart block

Late complications:
Encephalomyelitis
Peripheral neuropathy

42
Q

Describe stage 3 lyme disease

A

= chronic version of stage 2 (disseminating infection via blood or lymph to other body systems)

Further impairment of MSK, nervous and cardio systems

  • 3rd degree heart block
  • arthritis
43
Q

Investigations of lyme disease (2)

A

Blood serology - ELISA (to detect antibody to B. burgdorferi)

Immunoblot test - lyme specific IgM and IgG (detecting antibodies to proteins of B.burgdorferi) - confirms a positive ELISA

44
Q

Lyme disease treatment (2)

-medical

A

Oral doxycycline (antibiotic)

+ IV ceftriaxone (only if high grade heart block or CNS complications)

45
Q

Name the spirochaete (type of bacteria) that causes syphilis

A

Treponema pallidum

46
Q

Describe how neurosyphilis arises from syphilis

A

Primary stage –> secondary stage –> latent –> tertiary stage (= neurosyphilis)

Tertiary stage occurs after years of primary infection; is uncommon

47
Q

2 ways syphilis is spread (2)

A

Sexual

Congenital (mother to baby)

48
Q

2 main signs of primary syphilis (usually asymptomatic; only signs present)

+ symptoms (2) /signs (4) of secondary syphilis

A

Signs:
Ulcer (chancre) often on genital area - firm, round, painless - PRIMARY
Lymphadenopathy - PRIMARY

Symptoms :
Fatigue - secondary
Malaise - secondary

Signs:
Diffuse rash all over - secondary
Fever - secondary 
Myalgia - secondary
Arthralgia - secondary
49
Q

Latent stage of syphilis is usually

A

Asymptomatic

50
Q

Syphilis investigations (3) + how long do you have to wait before serology can be detected

A

Non-treponemal specific serology - venereal disease research laboratory test (VDRL) or rapid plasma reagin test

Treponemal specific serology/antibodies

Lumbar puncture + CSF analysis

5-6 weeks

51
Q

Syphilis treatment

-medical combo (2)

A

Penicillin + prednisolone

If penicillin allergic:
Oral doxycycline + oral prednisolone

52
Q

Name the spirochaete (bacteria) causing leptospirosis

A

Leptospira interrogans

53
Q

Name post infective inflammatory syndromes in the CNS and PNS

A

CNS:
acute disseminated encephalomyelitis (post-infectious encephalitis)

PNS:
Guillain barre syndrome

54
Q

Name a prion disease

A

CREUTZFELDT-JAKOB DISEASE (CJD) - very rare

55
Q

What is Creutzfeldt-Jakob disease caused by

A

Prions (proteinaceous infectious particles) - misshaped proteins that clump in the brain –> neurodegeneration

56
Q

What are prion diseases also known as

A

Transmissible spongiform encephalopathies

57
Q

Name 3 forms of CJD

A

Sporadic (85%)
Genetic
Acquired

58
Q

Signs of CJD (5)

A

Rapidly progressive dementia/cognitive impairment
Aphasia
behavioural/psychiatric changes - depression, anxiety
visual disturbances - double vision, hallucinations
ataxia - difficulty in balance, muscle co-ordination and speech

59
Q

What does CJD often present with neurologically

A

Rapidly progressive dementia

60
Q

What is aphasia

A

Difficulty comprehending and expressing language

61
Q

What is ataxia

A

Lack of co-ordination of muscle movements, balance and speech

62
Q

Name a type of acquired CJD

A

New variant CJD

63
Q

How is new variant CJD acquired

A

Through ingestion of prion-infected beef

64
Q

Sporadic CJD usually affects what age group

65
Q

Variant CJD usually affects what age group

A

Late 20s (so much younger compared to sporadic CJD which affects 60s)

66
Q

Investigations of CJD (3)

A

MRI brain
EEG
LP + CSF analysis

67
Q

Name 3 neurological diseases that can be prevented with vaccines

A

Poliomyelitis
Rabies
Tetanus

68
Q

Difference between active and passive immunisation

A

Active immunity involves your bodies direct response to an unknown pathogen by producing its own antibodies

Passive immunity is an immune response which involves antibodies obtained from outside the body

69
Q

Describe the natural + artificial examples of

  • active
  • passive immunity
A

ACTIVE:

  • Natural form of active immunity is the normal process of an individual contracting an infection and their immune system responding
  • Artificial form of active immunity is immunisation, where an individual is deliberately exposed to a weakened form of a particular pathogen in order to elicit an immune response

PASSIVE:

  • Natural form of passive immunity is antibodies transferred in breast milk as mentioned
  • Artificial form of passive immunity is the use of antidotes such as that for rabies where specific antibodies are injected into an infected individual.
70
Q

What type of immunisation - active or passive - is given for poliomyelitis to prevent it

A

Inactivated poliovirus vaccine

=Active (specifically artificial active)

71
Q

Spread of polio

A

Faecal-oral (ingesting infected faces)

72
Q

Spread of rabies (2)

A

Animal bites from infected animal

Salivary contamination of open wound

73
Q

What does the rabies virus cause

A

Acute viral encephalomyelitis

74
Q

Describe the prevention (1) and post exposure treatment of rabies (3)

A

Prevention with artificial active immunisation (with an inactivated vaccine)

Post exposure:
Clean wound
Give artificial active immunisation again
If have never been immunised for rabies, give artificial passive immunisation (human rabies immunoglobulin)

75
Q

Rabies investigations (3)

A

Saliva PCR + viral culture
Bloos serology
CSF analysis

76
Q

Name the bacteria that causes tetanus

A

Clostridium tetani

77
Q

Pathophysiology of tetanus

A

Clostridium tetani produces toxins which act at the NMJ and blocks inhibition of post synaptic motor neurons by preventing the inhibitory neurotransmitter GABA from being released

78
Q

Symptoms (2)/ signs (3) of tetanus

A

Signs:
trismus (Reduced jaw opening)
muscle rigidity,
tonic muscle spasms (rises sardonic)

Symptoms:
Back pain
Dysphagia

79
Q

Describe prevention (1) and post exposure (5) treatment of tetanus

A

Prevention with artificial active immunisation (tetanus toxoid (toxoid vaccine))

Post exposure:
Clean wound
Antibiotics
Benzodiazepine
Give tetanus toxoid again
Passive immunisation - tetanus immunoglobulin
80
Q

Name the causative agent of botulism

A

Clostridium botulinum

81
Q

Is there a preventative vaccine for botulism

82
Q

Post exposure treatment for botulism (4)

A

Supportive care
Botulism anti-toxin
Wound cleansing if wound involved
Penicillin or metronidazole if wound involved

83
Q

What test helps to confirm suspected VIRAL meningitis, i.e. differentiates it from bacterial meningitis

A

CSF PCR for viral DNA

84
Q

Lyme disease can cause what heart problem

A

3rd degree heart block

Year 2 - Nervous (39 decks)

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