Infectious Neuro Disease Flashcards
Difference between encephalitis and encephalopathy
Encephalitis is inflamation if brain tissue (needs histology or CSF to show (strictly)
Encephalopathy is clinical syndrome of altered mental status
Things to look for in encephalopathy hx
Altered level of conciousness, cognition or behaviour
New psychiatric symptoms
Recent fever
Headache
Seizures
Travel hx
Investigation of choice in encephalitis
Lumbar puncture
Some patients can’t due to concerns of brain stem herniation
Contraindications to lumbar puncture
Focal neurological signs
Papilloedems
Recent seizures
Moderate to severe LOC
Hypertension with bradycardia (Cushing sign)
Immunocompromise
What is Cushing triad and what does it mean
Bradycardia
Widened pulse pressure (hypertension)
Irregular respirations
Sign of raised intracranial pressure
CSF tap seen in encephalitis
Gin clear tap
Slight increased cells, mostly lymphocytes
Meningitis CSF tap
High opening pressure
Cloudy tap
High or very high cells
Mostly neutrophils
Low glucose
High protein
Most common viral causes of encephalitis
HSV (90% are type 1, type 2 in immunocomprimised patients)
Varicella zoster- look for shingles rash
Enterovirus
HIV
Distinguishing between meningitis and encephalitis clinically
Signs of meninigsim - neck stiffness, photophobia, Kernig and brudzinski signs
What is kernig and brudinzki sign
Brudiznki sign- neck flexion causes hip and knee flexion
Kernig- pain on passive extension of the knee
Treatment of HSV encephalitis and its side effect
IV aciclovir 10mg/kg three times daily
Can cause crystal nephropathy- renal function monitoring needed
Two main surface antibodies seen in auto immune encephalitis
NMDAR encephalitis
LGI-1 encephalitis
GAD
Causative agents of meningitis
Neonates is most commonly group B strep
Normally, neisseria meningitidis
And strep pneumoniae
Immunocomprimised, listeria monocytogenes
Treatment of choice in encephalitis
IV aciclovir
Imaging for encephalitis
CT to check exclude neoplasm or bleed
MRI shows medial temporal and inferior frontal changes
Most common causes of guillan barre
Campylobacter jejuni
Cytomegalovirus
Epstein Barr virus
Investigations for guillan barre
CSF- should show high protein with no cells (cyto-albunimic dissociation)
Nerve conduction studies- reduced conduction speed or conduction block
Immediate managment of guillan barre syndrome
IV immunoglobulins
Plasma exchange
VTE prophylaxis
Safe swallow assessment
What cancer is seen in female auto immune encephalitis patients
Ovarian teratoma
GP managment of meningitis
IM benzylpenecillin
Managment of meningitis for:
Less than 3 months and older than 60
Over 3 and less than 60
Pneumococcal
Meningococcal
Less than 3 and over 60 is cefotaxime/ceftriaxone with amoxicillin
Meningococcal is ceftriaxone for 7 days
Pneumococcal is ceftriaxone for 14
Who gets meningitis prophylaxis and what is it
Close contact and household within 7 days of sx
Oral ciprofloxacin
