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*Nervous System - Pathology > 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 brain substance

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3
Q

What is myelitis?

A

Inflammation/infection of spinal cord

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4
Q

In reality what is the distinction between meningitis, encephalitis and myelitis?

A

The distinction is artificial and patients often have a mixture

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5
Q

What is the classical triad of meningitis?

A
  • Fever
  • Neck stiffness
  • Altered mental status
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6
Q

How do patients with meningitis present?

A

With short history of progressive headache associated with fever (>38 degrees) and meningism (neck stiffness, photophobia, nausea + vomiting)

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7
Q

How is neck stiffness examined?

A

By passively bending the neck forward

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8
Q

What is commonly found in meningitis?

A

Cerebral dysfunction = confusion, delirium, declining conscious level, GCS <14 in 69%

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9
Q

What 2 symptoms can occur in about 30% of meningitis patients?

A
  • Cranial nerve palsy
  • Seizures
    (not necessarily both)
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10
Q

What symptoms occurs in 10-20% of meningitis patients?

A

Focal neurological deficits

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11
Q

What is the hallmark of meningococcal meningitis (but can also occur in viral meningitis)?

A

Petechial rash (tumbler test)

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12
Q

What are the infective causes of meningitis?

A

Bacterial (neisseria meningitidis (meningococcus), strep pneumoniae (pneumococcus))
Viral (enteroviruses)
Fungal

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13
Q

What is an inflammatory cause of meningitis?

A

Sarcoidosis

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14
Q

What are the drug related causes of meningitis?

A

NSAIDs

IVIG (IV immunoglobin)

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15
Q

What are the malignant causes of meningitis?

A

Metastatic
Haematological
e.g. Leukaemia, lymphoma, myeloma

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16
Q

What are the main features of encephalitis?

A
  • Flu-like prodrome (4-10 days)

- Progressive headache associated with fever

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17
Q

What are other features found in encephalitis?

A

+/- meningism
Progressive cerebral dysfunction (confusion, abnormal behaviour, memory disturbance, depressed conscious level)
Seizures
Focal symptoms/signs

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18
Q

What is the different between viral and bacterial encephalitis?

A

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

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19
Q

What is a viral cause of encephalitis?

A

Most commonly HSV

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20
Q

What are inflammatory causes of encephalitis?

A 
Limbic encephalitis (Anti VGKC, Anti NMDA receptors)
ADEM
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21
Q

What are metabolic causes of encephalitis?

A

Hepatic
Uraemic
Hyperglycaemic

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22
Q

What are malignant causes of encephalitis?

A

Metastatic

Paraneoplastic

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23
Q

What other form of encephalitis is as common as viral encephalitis?

A

Auto-immune encephalitis

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24
Q

What are the 2 important antibodies for auto-immune encephalitis?

A

Anti-VGKC (voltage gated potassium channel)

Anti-NMDA receptor

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25
Q

Describe anti-VGKC auto-immune encephalitis

A
  • frequent seizures
  • amnesia (not able to retain new memories)
  • altered mental state
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26
Q

Describe anti-NMDA receptor auto-immune encephalitis

A
  • flu-like prodrome
  • prominent psychiatric features
  • altered mental state and seizures
  • progressing to a movement disorder and coma
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27
Q

What is the priority when investigating meningitis and encephalitis?

A

To exclude (and treat) infection

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28
Q

What are the 2 methods of investigation for meningitis?

A
  • Blood cultures (bacteraemia)
  • Lumbar puncture (CSF culture/microscopy)
    No need for imaging if no contraindications to LP
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29
Q

What are the 4 methods of investigation for encephalitis?

A
  • Blood cultures
  • Imaging (CT scan +/- MRI)
  • Lumbar puncture
  • EEG
30
Q

What are the 5 indications for CT scan before lumbar puncture?

A

Focal neurological deficit, not inc cranial nerve palsies
New-onset seizures
Papilloedema
Abnormal level of consciousness, interfering with proper neurological examination (GCS <10(
Severe immunocompromised state

31
Q

What do focal symptoms and signs suggest?

A

A focal brain mass

32
Q

What does reduced conscious level suggest?

A

Raised ICP

33
Q

Is lumbar puncture safe to carry out in meningitis?

A

Yes as brain is ‘okay’; if problem is with brain - scan first

34
Q

Describe the CSF finding of opening pressure in bacterial meningitis vs viral meningitis and encephalitis

A

BM = increased
VM/E = normal/increased
(gives idea of what kind of infection you are dealing with)

35
Q

Describe the CSF finding of cell count in BM vs VM/E

A

BM = high, mainly neutrophils (polymorphs)
VM/E = high, mainly lymphocytes (mononuclear cells)
(main thing to look at in diagnosis)

36
Q

Describe the CSF finding of glucose in BM vs VM/E

A 
BM = reduced (bacteria use up glucose)
VM/E = slightly increased
37
Q

Describe the CSF finding of protein in BM vs VM/E

A 
BM = high 
VM/E = slightly increased
38
Q

First line treatment in suspected meningitis?

A

IV CEFTRIAXONE

39
Q

What does a cloudy CSF indicate?

A

Large number of cells in sample

40
Q

What should you do if the patient is presenting septic or pyrexial?

A

Do lumbar puncture but not blood culture

41
Q

What is the commonest cause of encephalitis in Europe?

A

HSV (herpes simplex virus)

42
Q

How is herpes simplex encephalitis diagnosed in the lab?

A

By PCR of CSF for viral DNA

43
Q

What treatment should be given on clinical suspicion of herpes simplex encephalitis?

A

ACICLOVIR (then take sample and adapt with results)

44
Q

What does a blood culture gram stain look like in bacterial meningitis?

A

Gram positive cocci in chains (look like streptococci)

Culture strep pneumoniae sensitive to penicillin

45
Q

What is an appropriate investigation for herpes simplex encephalitis?

A

Lumbar puncture

46
Q

What are the other 3 of the herpes group of viruses other than HSV?

A

VZV, EBV, CMV

47
Q

What does HSV generally cause (types 1 + 2)?

A
  • Cold sores (type 1 > 2)

- Genital herpes (type 1 + 2)

48
Q

Where does the virus remain latent in HSV after primary infection?

A

In trigeminal or sacral ganglion (as with all herpes viruses - once infected, always infected - dormant until reduction of immunity etc)

49
Q

What is a rare complication of HSV?

A

Encephalitis

50
Q

Other than neonates, what type of HSV is encephalitis caused by?

A

Type 1

51
Q

What are enteroviruses a large family of?

A

RNA viruses

52
Q

What do enteroviruses have a tendency to cause?

A

CNS infections (neurotropic) (human infections, no animal reservoir)

53
Q

How are enteroviruses spread?

A

Faecal-oral route

54
Q

What type of meningitis can enteroviruses cause?

A

Non-paralytic

55
Q

What 3 viruses are included in enteroviruses?

A

Polioviruses, coxsackieviruses, echoviruses

56
Q

What other cause of encephalitis is common in other parts of the world?

A

Arbovirus encephalitides

57
Q

How are arbovirus encephalitides transmitted?

A

To man via a vector (mosquito or tick) from non-human host

58
Q

What types of encephalitis are caused by arbovirus encephalitides (variety of virus groups)?

A
  • West Nile groups
  • St Louis encephalitis
  • Western Equine encephalitis
  • Tick Borne encephalitis
  • Japanese B encephalitis
59
Q

Why is arbovirus called arbovirus?

A

ARthropod BOrne

60
Q

What part of clinical history is crucial in diagnosing arbovirus encephalitide caused encephalitis?

A

Travel (travel history; some preventable by immunisation)

61
Q

What is brain abscess?

A

Localised area of pus within the brain

62
Q

What is a subdural empyema?

A

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

63
Q

What are some features found in a patient with brain abscess and empyema?

A
  • Fever/pressure headache
  • Focal headache/signs
  • Signs of raised ICP
  • Meningism may be present (esp w empyema)
  • Features of underlying source
64
Q

What are focal symptoms/signs of brain abscess/empyema?

A

Seizures, dysphasia, hemiparesis

65
Q

What are signs of raised ICP?

A

Papilloedema, false localising signs, depressed conscious level

66
Q

What are some features of underlying source found in brain abscess/empyema?

A

Dental, sinus or ear infection

67
Q

What are some differential diagnoses for brain abscess and empyema?

A
  • Any focal lesion, but most commonly tumour

- Subdural haematoma

68
Q

List 4 causes of brain abscess and empyema

A

Penetrating head injury
Spread from adjacent infection (dental, sinusitis, otitis media)
Blood borne infection (bacterial endocarditis)
Neurosurgical procedure

69
Q

List 4 methods of diagnosing brain abscess/empyema

A
  • Imaging (CT or MRI)
  • Investigate source
  • Blood cultures
  • Biopsy (drainage of pus)
70
Q

What types of organisms are present in brain abscess?

A

Often mixtures of organisms present (polymicrobial) - dependant on predisposing condition
Strep in 70% cases (esp penicillin-sensitive strep milleri)
Anaerobes in 40-100% cases (bacteroides, prevotella)

71
Q

What are 6 methods of management for brain abscess? (high mortality without appropriate treatment)

A
  • Surgical drainage if possible
  • Penicillin or ceftriaxone to cover strep
  • Metronidazole for anaerobes
  • High doses required for penetration
  • Culture and sensitivity tests on aspirate provide useful guide

*Nervous System - Pathology (13 decks)

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