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Neurology > Infections of the Nervous System > Flashcards

Infections of the Nervous System Flashcards

1
Q

What is inflammation of the meninges known as?

A

Meningitis

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2
Q

What is inflammation of the brain substance known as?

A

Encephalitis

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3
Q

What is inflammation of the spinal cord known as?

A

Myelitis

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4
Q

What is the classic triad of symptoms of meningitis?

A

Fever
Neck stiffness
Altered mental status

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5
Q

What are the characteristics of meningitis?

A

Patients present with a short history of progressive headache associated with fever and meningism (neck stiffness, photophobia, N&V)
Cerebral dysfunction (confusion, delirium, declining consciousness level)
Cranial nerve palsy
Seizures
Focal neurological deficits
Petechial skin rash (Tumbler test)

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6
Q

What are the bacterial and viral causes of meningitis?

A

Bacterial- Nesseria meningitidis
Streptococcus pneumoniae
Viral- enteroviruses

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7
Q

What are the clinical features of encephalitis?

A

Flu-like prodrome
Progressive headache associated with fever
Potential meningism
Progressive cerebral dysfunction (confusion, abnormal behaviour, memory disturbance, depressed conscious level)
Seizures
Focal symptoms/signs

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8
Q

What are the causes of meningitis?

A

Infective- viral, bacterial, fungal
Inflammatory- sarcoidosis
Drug induced- NSAIDs, IVIG
Malignant- metastatic haematological

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9
Q

What are the causes of encephalitis?

A

Infective- viral (most commonly HSV)
Inflammatory- limbic encephalitis
Metabolic- Hepatic, uraemic, hyperglycaemic
Malignant- Metastatic, paraneoplastic

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10
Q

What two antibodies cause auto-immune encephalitis?

A

Anti-VGKC (voltage gated potassium channel)

Anti-NMDA receptor

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11
Q

What are the characteristics of auto-immune encephalitis that is mediated by anti-VGKC antibodies?

A

Frequent seizures
Amnesia
Altered mental state

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12
Q

What are the characteristics of auto-immune encephalitis that is mediated by anti-NMDA receptor antibodies?

A

Flu like prodrome
Prominent psychiatric features
Altered mental state and seizures
Progresses to movement disorder and coma

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13
Q

What tests can be used when investigating meningitis?

A 
Blood cultures (bacteraemia)
Lumbar puncture (CSF culture/microscopy)
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14
Q

What tests can be used when investigating encephalitis?

A

Blood cultures
Imaging- CT scan with additional MRI if necessary
Lumbar puncture
EEG

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15
Q

What features would indicate the need for a CT scan before a lumbar puncture?

A 
Focal neurological deficit- not including cranial nerve palsies
New onset seizures
Papilloedema
GCS <10
Severe immunocompromised state
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16
Q

What are the difference in findings in CSF in bacterial and viral meningitis?

A 
Bacterial:
-Increased opening pressure
-High cell count, mainly neutrophils
-Reduced glucose
-High protein
Viral:
-Normal/increased opening pressure
-High cell count, mainly lymphocytes
-Normal glucose
--Slightly increased protein
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17
Q

How is herpes simplex encephalitis diagnosed?

A

Lab diagnosis by PCR of CSF for viral DNA

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18
Q

How is herpes simplex encephalitis treated?

A

Treat with aciclovir on clinical suspicion

19
Q

What feature of a history is relevant to arbovirus encephalitides?

A

Travel abroad

20
Q

What is a brain abscess?

A

A localised area of pus within the brain

21
Q

What is subdural empyema?

A

A thin layer of pus between the dura and arachnoid mater

22
Q

What are the clinical features of brain abscess/empyema?

A

Fever
Headache
Focal symptoms- seizures, dysphagia etc
Signs of raised intracranial pressure- papilloedema, false localising signs, depressed conscious level
Mengism may be present, particularly for empyema
Signs of underlying source eg sinus, dental or ear infection

23
Q

What are the causes of brain abscess/empyema?

A

Penetrating head injury
Spread from adjacent infection
Blood borne infection
Neurosurgical procedure

24
Q

What investigations can be used in brain abscess/empyema?

A

CT or MRI
Investigate source
Blood cultures
Biopsy- drainage of pus

25
Q

How is a brain abscess managed?

A

Surgical drainage if possible
Penicillin or ceftriaxone to cover streps
Metronidazole for anaerobes

26
Q

What infections are common in HIV patients with low CD4?

A 
Cryptococcus neoformans
Toxoplasma gondii
Progressive multifocal leukoencephalopathy
Cytomegalovirus
HIV-encephalopathy
27
Q

What tests can be done in cases of suspected HIV related brain infection?

A

Cryptococcal antigen
Toxoplasmosis serology
CMV PCR
HIV PCR

28
Q

What is the causative organism of Lyme disease?

A

Borrelia burgdorferi

29
Q

What is the causative organism of leptospirosis?

A

Leptospira interrogans

30
Q

What is the causative organism of syphilis?

A

Treponema pallidum

31
Q

What are the characteristics of the first stage of Lyme disease infection?

A

Early localised infection
Expanding rash at site of tick bite
50% flu-like symptoms

32
Q

What are the characteristics of the second stage of Lyme disease?

A

Early disseminated infection
One or more organ systems may become involved through haematologic or lymphatic spread
Musculoskeletal and neurologic involvement common

33
Q

What are the characteristics of the third stage of Lyme disease?

A

Chronic infection

Musculoskeletal and neurologic involvement common

34
Q

How is Lyme disease investigated?

A

Complex range of serological tests
CSF lymphocytosis
MRI brain/spine
Nerve conduction studies/EMG

35
Q

How is Lyme disease treated?

A

Prolonged antibiotic treatment

36
Q

How is rabies encephalitis diagnosed?

A

PCR and serology

37
Q

What is the causative organism of tetanus?

A

Clostridium tetani

38
Q

What is the clinical presentation of botulism?

A 
Incubation period 4-14 days
Descending symmetrical flaccid paralysis
Pure motor
Respiratory failure
Autonomic dysfunction
39
Q

How is botulism diagnosed?

A

Nerve conduction studies
Mouse neutralisation bioassay for toxin in blood
Culture from debrided wound

40
Q

How is botulism treated?

A

Anti-toxin
Penicillin/ metronidazole
Radical wound debridement

41
Q

What is the causative organism of botulism?

A

Clostridium botulinum

42
Q

What are the clinical features of sporadic Creutzfeldt-Jakob disease?

A 
Insidious onset (usually 60+)
Early behavioural abnormalities
Rapidly progressive dementia
Myoclonus
Progressing to global neurological decline
Motor abnormalities
Cortical blindness
Seizures may occur
43
Q

How is Creutzfeldt-Jakob disease investigated?

A

MRI-Pulvinar sign in new variant CJD, no changes in sporadic
EEG- Generalised periodic complexes common, often normal in early stages
CSF- Normal or raised protein, immunoassay 14-3-3 brain protein

Neurology (29 decks)

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