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NEURO > Infections of the Nervous System > Flashcards

Infections of the Nervous System Flashcards

1
Q

How does meningitis tend to present clinically?

A
  • Short history of progressive headache
  • Fever (>38 degrees)
  • Neck stiffness
  • Altered mental status
  • Photophobia / nausea / vomiting
  • GCS < 14 in 69%, cranial nerve palsy, seizures and focal neurological deficits may present
  • Petechial skin rash (Tumbler test)
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2
Q

What does a petechial skin rash associated with meningitis symptoms indicate?

A
  • Hallmark of meningococcal meningitis

Can also occur in viral meningitis

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3
Q

Differential diagnosis for meningitis?

A
  • Infective: Bacterial, viral, fungal
  • Inflammatory: Sarcoidosis
  • Drug induced: NSAIDS / IV Immunoglobulin
  • Malignant: Metastatic / Haematological
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4
Q

Bacterial causes of meningitis? Viral?

A

Bacterial:

  • Neisseria meningitidis (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • Myobacterium Tuberculosis

Viral: enteroviruses

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5
Q

How does encephalitis tend to present clinically?

A
  • Flu-like prodrome (4-10 days)
  • Progressive headache
  • Fever
  • Cerebral dysfunction (confusion, abnormal behaviour, memory disturbance, depressed conscious level)
  • Seizures
  • Stiff neck / photophobia / nausea / vomiting
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6
Q

Differences in how encephalitis and meningitis tend to present?

A
  • Onset of viral encephalitis slower than bacterial meningitis
  • Cerebral dysfunction more prominent in encephalitis
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7
Q

Causes of encephalitis?

A
  • Infective: viral, most common is HSV
  • Autoimmune
  • Inflammatory: Limbic encephalitis, ADEM
  • Metabolic: Hepatic, uraemic, hyperglycaemic
  • Malignancy
  • Migraine
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8
Q

What are the two important antibodies for autoimmune encephalitis?

A
  • Anti-VGKC (voltage gated potassium channel)

- Anti-NMDA receptor

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9
Q

How do the types of autoimmune encephalitis tend to present?

A

Anti-VGKC:
- Frequent seizures, amnesia, altered mental state

Anti-NMDA:
- Flu prodrome, psychiatric features, altered mental state and seizures, progresses to movement disorder and coma

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10
Q

Investigations for meningitis?

A
  • Blood cultures
  • Lumbar puncture (CSF culture / microscopy)

No need for imaging if no contraindications to LP

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11
Q

Investigations for Encephalitis?

A
  • Blood cultures
  • Imaging (CT +/- MRI)
  • Lumbar puncture
  • EEG
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12
Q

What are the contraindications to Lumbar Puncture? (indications for CT brain before LP)

A
  • Focal neurological deficits (suggest focal brain mass)
  • Abnormal consciousness level (suggests raised ICP)
  • New onset seizures
  • Papilloedema
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13
Q

What CSF findings after lumbar puncture help differentiate between bacterial meningitis and viral meningitis + encephalitis?

A
  • Cell count high in both, mainly neutrophils in bac meningitis, mainly lymphocytes in viral men. + encephalitis
  • Glucose reduced in bacterial men., normal in viral men. + encephalitis
  • Protein high in bacterial meningitis, only slightly increased in viral men. + encephalitis
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14
Q

How is herpes simplex (HSV) encephalitis diagnosed? How is it treated?

A
  • Diagnosed via PCR of CSF for viral DNA
  • Treat with aciclovir if clinical suspicion
    over 70% mortality if untreated
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15
Q

What are some signs of HSV infection?

A
  • Cold sores
  • Genital herpes

Once infected virus remains latent in trigeminal or sacral gnaglion, encephalitis is a rare complication of HSV

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16
Q

What does infection with enteroviruses tend to cause? How do they spread?

A
  • Tend to cause CNS infections (non-paralytic meningitis), DO NOT cause gastroenteritis
  • Spread faecal-oral route
  • Include polioviruses, coxsackieviruses, echoviruses
17
Q

What is an arbovirus and what does infection with them tend to cause?

A
  • Athropod borne virus (mosquito / ticks)
  • Cause encephalitis, travel history important
  • Examples: West Nile virus, St Louis Encephalitis, Tick Borne encephalitis (place names are where first described not based on geographical distribution)
18
Q

What is a brain abscess? What is a subdural empyema?

A
  • Brain abscess: localized area of pus within the brain

- Subdural empyema: thin layer of pus between dura and arachnoid membranes

19
Q

What is meningism?

A
  • Neck stiffness
  • Photophobia
  • Nausea
  • Vomiting
20
Q

Clinical features of brain abscesses and empyema?

A
  • Fever
  • Headache
  • Signs of raised ICP (papilloedema, depressed conscious level)
  • +/- Meningism
  • Underlying infection features (sinus / ear / dental)
21
Q

What causes brain abscesses and empyema?

A
  • Penetrating head injuries
  • Spread from adjacent infection (dental/sinus/ear)
  • Blood borne infection (bacterial endocarditis)
  • Neurosurgical procedures
22
Q

Investigations for suspected brain abscess / empyema?

A
  • Imaging (CT or MRI)
  • Blood cultures
  • Biopsy (drainage of pus)
  • Investigate source (associated infection)
23
Q

Management of brain abscesses?

A
  • Surgical drainage if possible

Antibiotics, culture can provide useful guide:

  • Penicillin / Ceftriaxone to cover strep. bacteria
  • Metronidazole for anaerobe bacteria
24
Q

Who is at increased risk of CNS infection?

A
  • Immunocompromised individuals
  • HIV infections / AIDS patients
  • Individuals taking immunosuppressants
25
Q

Which diseases that can affect the CNS are caused by spirochaetes infection?

A
  • Lyme Disease (Borrelia Burgorferi)
  • Syphilis (Trepomena pallidum)
  • Leptospirosis (Leptospira interrogans)
26
Q

How is Lyme disease spread? How can the infection present?

A
  • Vector borne (ticks), spread Borrelia Burgdorferi

- Can have multi-system presentation: skin, rheumatological, neurological, cardiac, opthalmological

27
Q

Stages of Lyme disease and brief descriptions?

A
  • Stage 1: early localized infection. Rash at site of tick bite, 50% have flu symtoms (fatigue, myalgia, fever, headache)
  • Stage 2: early disseminated infection. One or more organ systems involved, MSK & Neuro most common. Signs of infection depend on system
  • Stage 3: Chronic. Occurs after latency period, MSK and neuro symptoms most common
28
Q

Investigation and treatment of Lyme disease?

A

Investigation

  • Serology
  • CSF PCR & lymphocytosis
  • MRI brain & spine
  • Nerve conduction studies / EMG

Treatment: Antibiotics

  • IV Ceftriaxone
  • Oral doxycycline
29
Q

How does neurosyphilis tend to progress? Investigations if suspected? Treatment?

A

Primary - secondary - latent, possible tertiary disease years after but rare

  • VDRL antibody tests, CSF lymphocytes, CSF PCR
  • High dose penicillin to treat
30
Q

How do rabies and polio tend to present neurologically?

A
  • Rabies: spread by bites/saliva, ascending paralysis and encephalitis
  • Polio: Infects anterior horns of LMNs, asymmetric, flaccid paralysis especially of legs

BOTH HAVE VACCINES, PREVENTION.

31
Q

What bacteria causes tetanus? How does it present? Treatment?

A
  • Clostridium tetani
  • Toxin acts at NMJ, rigidity and spasm of muscle
  • Can prevent with immunisation, treat high risk wounds with penicillin and immunoglobulins
32
Q

How does botulism tend to present? Pathophysiology?

A
  • Binds irreversibly to presynaptic membranes of PNS and ANS nerve junctions, blocks ACh release. Recovery by sprouting new axons

Presentation:

  • Descending symmetrical flaccid paralysis
  • Resp. failure and autonomic dysfunction
33
Q

Investigations and treatment of Botulism?

A

Investigations:

  • Nerve conduction studies
  • Blood bioassay and culture from debrided wound

Treatment:

  • Anti-toxin + Penicillin / Metronidazole
  • Radical wound debridement
34
Q

What are the main post infective inflammatory syndromes? How do they tend to progress?

A
  • CNS: Acute disseminated encephalomyelitis (ADEM)
  • PNS: Guillain Barre Syndrome (GBS)

Long interval between precipitating infection and onset of neurological symptoms

35
Q

What is Creutzfeldt-Jakob Disease? Investigations? What causes it?

A
  • fatal degenerative brain disorder.
  • MRI, EEG and CSF assay for investigations

Spread from animals (cattle), Sporadic or familial.
Poor prognosis, often dead within 6 months

NEURO (52 decks)

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