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Neurology > Infections of the Nervous System > Flashcards

Infections of the Nervous System Flashcards

1
Q

What may untreated infection cause?

A

Brain herniation and death

Cord compression and necrosis with subsequent permanent paralysis

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2
Q

What are the common infections of the CNS?

A

Encephalitis, meningitis, meningoencephalitis, encephalomyelitis, epidural abscesses, neuritis, sepsis syndrome

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3
Q

What are the types of meningitis?

A

Acute pyogenic = bacterial
Acute aseptic = viral
Acute focal suppurative infection = brain abscess, subdural/epidural empyema
Chronic bacterial infection = TB

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4
Q

What is acute encephalitis?

A

Infection of the brain parenchyma

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5
Q

What would indicate a diagnosis of pyogenic meningitis?

A

Thick layer of suppurative exudate that covers leptomeninges over surface of brain = exudate in basal and convexity surface

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6
Q

How does pyogenic meningitis appear microscopically?

A

Neutrophils in subarachnoid space

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7
Q

How is pyogenic meningitis treated?

A

Ceftriaxone and dexamethosone

Amoxicillin if Listeria suspected

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8
Q

What are some features of viral meningitis?

A 
Common = late summer/autumn
Usually enteroviruses (e.g ECHO virus)
Treated supportively as self limiting
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9
Q

How is viral meningitis diagnosed?

A

Viral stool culture

Throat and CSF swab

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10
Q

How is encephalitis treated?

A

Aciclovir = if delay predicted in getting test results then give preemptively

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11
Q

What are the features of encephalitis?

A

Stupor, coma, seizures, partial paralysis, confusion, psychosis, speech and memory symptoms, meningismus = insidious onset but may be sudden

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12
Q

What investigations are done for encephalitis?

A

Lumbar puncture, EEG and MRI

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13
Q

What are the symptoms of bacterial meningitis?

A

Fever, cold extremities, vomiting, drowsy, confusion, severe muscle pain, non-blanching rash, headache, stiff neck, photophobia

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14
Q

What organisms cause bacterial meningitis in children?

A

Neonates = listeria, group B strep, ecoli
Children = h, influenzae
Age 10-21 = neisseria meningitidis

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15
Q

What organisms cause bacterial meningitis in adults?

A

Age >21 = strep pneumoniae

Age >65 = strep pneumoniae

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16
Q

What are some risk factors for bacterial meningitis?

A

Decreased cell mediated immunity = listeria
Neurosurgery/head trauma = staph, gram negative rods
Cribrifrom plate fracture = strep pneumoniae

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17
Q

How common are complications from bacterial meningitis?

A

Very common = 25% of people who survive meningitis and septicaemia will life with life altering complications

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18
Q

What are some complications of bacterial meningitis?

A

Purulence, invasion, cerebral oedema, ventriculitis and hydrocephalus

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19
Q

What are some features of the purulence that arises from bacterial meningitis?

A

Clusters at base of brain
Convexities of rolandic and sylvian sulci
Exudate around nerves = especially CN III and VI

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20
Q

How can bacterial meningitis arise?

A

Nasopharyngeal colonisation
Direct extension of bacteria
Spread from remote foci of infection elsewhere

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21
Q

What organisms cause bacterial meningitis in immunocompromised patients?

A

Strep pneumoniae, staph aureus, listeria monocytogenes, m. tuberculosis, nocardia asteroides, cryptococcus neoformans

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22
Q

What causes meningococcal meningitis?

A

Neisseria meningitis = found in throats of healthy carriers

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23
Q

How does neisseria meningitis gain access to the meninges?

A

Probably via the bloodstream = bacteria may be found in leukocytes in CSF

24
Q

What are some features of meningococcal meningitis?

A

Symptoms are caused by endotoxin

Most often occurs in children

25
Q

Where can neisseria meningitis infection occur from?

A

Local disease, meningitis with septicaemia or fulminant septicaemia

26
Q

What does haemophilus influenzae require for growth?

A

Blood factors

27
Q

How many types of haemophilus influenzae are there?

A

Six types based on capsule differences = type b is most common cause of meningitis in children <4

28
Q

What kind of vaccine is available for haemophilus influenzae meningitis?

A

Conjugated vaccine directed against the capsular polysaccharide antigen

29
Q

Where is strep pneumoniae commonly found?

A

The nasophaynx = causes pneumococcal meningitis

30
Q

What patients tend to get strep pneumoniae meningitis?

A

Hospitalised patients, patients with CSF skull fracture, diabetics, alcoholics and young children
May be related to CNS devices like cochlear implants

31
Q

Is there a vaccine for pneumococcal meningitis?

A

Yes = new conjugate vaccine has been developed

32
Q

What are some features of listeria monocytogenes?

A

Gram positive bacilli
Sporadic cases but on the rise
Mainly causes bacteraemia illness

33
Q

What patients get listeria meningitis?

A

Neonates, patients >55 and those who are immunosuppressed (especially malignancy)

34
Q

What is the antibiotic of choice for listeria?

A

IV ampicillin or amoxicillin

35
Q

How does tuberculous meningitis occur?

A

Due to reactivation of latent infection or in elderly patients

36
Q

What are some features of tuberculous meningitis?

A

Often non-specific ill health
Previous TB on CXR or poor yield from CSF
High morbidity if not treated

37
Q

What is the treatment for tuberous meningitis?

A

Isoniazid and rifampicin

May add pyrazinamide and ethambutol

38
Q

What are some features of cryptococcal meningitis?

A

Fungal = mainly seen in HIV when CD4 < 100
Disseminated infection
Subtle neurological presentation and aseptic picture on CSF
Serum and CSF cryptococcal antigen

39
Q

How is cryptococcal meningitis treated?

A

IV amphotericin b/flucytosine and fluconazole

40
Q

What are the signs of bacterial meningitis?

A

Fever, stiff neck, alteration in consciousness

41
Q

When should you be cautious about performing a lumbar puncture?

A

If increased ICP is possible and in the setting of delerium

42
Q

What are some features of a lumbar puncture?

A

Utilise sitting position if necessary
Measure opening pressure if flow is fast
Give antibiotics before doing the procedure

43
Q

How is the CSF obtained from a lumbar puncture sent for interpretation?

A

Tube 1 = haematology
Tube 2 = microbiology
Tube 3 = chemistry
Tube 4 = haematology

44
Q

What is PCR used for?

A

To differentiate between causes of meningitis

45
Q

Can bacterial meningitis be culture negative?

A

Yes

46
Q

What does aseptic meningitis refer to?

A

Non-pyogenic bacterial meningitis

47
Q

What is the spinal fluid like in aseptic meningitis?

A

Low number of WBC, minimally elevated protein and normal glucose

48
Q

What are the infectious causes of aseptic meningitis?

A

HSV 1 and 2, syphilis, listeria, TB, cryptococcus, leptospirosis, cerebral malaria, Lyme disease

49
Q

What are the non-infectious causes of aseptic meningitis?

A

Carcinomatous, sarcoidosis, vasculitis, dural venous sinus thrombosis, migraine

50
Q

What patients should go for a CT before having a lumbar puncture done?

A

Immunocompromised, history of CNS disease, new onset seizure, papilloedema, abnormal level of consciousness, focal neurological deficit

51
Q

What are the red flags in meningitis?

A

GCS < 12 or fall in GCS >2
Focal neurology, seizure or shock
Bradycardia and hypertension
Papilloedema

52
Q

When are steroids indicated?

A

In all patients with bacterial meningitis (don’t gove for viral)

53
Q

When do steroids have the biggest benefit?

A

Treating pneumococcal meningitis

54
Q

What are the contraindications for using steroids to treat meningitis?

A

Post surgical meningitis, severely immunocompromised, meningcoccal/septic shock, steroid hypersensitivity

55
Q

Do Public health need to be notified of meningitis cases?

A

Yes

56
Q

What are close contacts of meningitis cases given as prophylaxis?

A

Ciprofloxacin

Neurology (48 decks)

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