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Infectious disease > Investigations in neuro infections > Flashcards

Investigations in neuro infections Flashcards

1
Q

Key principles around LP counselling

A

Capcity
Written consent
Strict aseptic technique

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2
Q

How to counsel paitents about LP

A

Explain procedure
Describe likely benefits - diagnosis, therapeutic if raised ICP
List common and important risks

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3
Q

Common risks of LP

A

Back pain
Shooting pain down legs - sciatic
Localised bleeding

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4
Q

Rare risks of LP

A

<1% of time
Persistent headaches (low ICP), leaking , infefction, lower limb weakness

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5
Q

INdications for LP

A

Diagnostic - infection - meningitis/encephalitis, SA haemorrhage, MS, malignancy etc
Therapeutic - Reduce ICP
Spinal epidural - pain relief in labour, anaesthesia - lower limb surgery

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6
Q

What is risk if raised ICP and do LP

A

Brain stem herniation through foramen magnum

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7
Q

Indications for brain imaging before LP

A

Focal neurological signs
Papilloedema (blurred optic disc)
Continious or uncontrolled seizures
Reduced or fluctuating consciousness level

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8
Q

Cautions and CI for LP

A

Raised ICP signs - brain imaging first
Bleeding risk - deranged blood clotting or low platelet count, on anticoagulation (eg warfarin if INR>1.4)
Severe sepsis signs, evolving rash
Infection at site of LP

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9
Q

LP position

A

Knees and hips and neck flexed
Better to use US technique

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10
Q

What is the pro and cons of sitting position

A

Easier to find landmark
Cant measure opening pressure due to gravity (elevated)

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11
Q

Where insert needle for LP

A

Below ornic matularis (end of spinal cord)
L3-4
Also can use:
L2-L3
L4-L5

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12
Q

What would red cells >10 in CSF suggest

A

Traumatic tap or SAH

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13
Q

What does high neutrophils on LP suggest

A

Bacterial meningitis

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14
Q

What does high lymphocytes on LP suggest

A

Viral and TB meningitis or encephalits, inflammatory and malignant conditions

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15
Q

Normal opening LP pressure

A

8-20cm
Elevated from most problems

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16
Q

Nomrla protein, glucose, WCC and RBC in LP

A

RBC - <10
WCC - <5 cells
Protein - 0.15-0.45g/L
Glucose - 60-80%

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17
Q

When is protein high LP

A

Infection - TB> bacterial > viral
Inflam conditions
GBS
oligoclonal bands - MS

18
Q

TB on LP

A

Lymphocytes
Low/v low glucose
Protein - high/v high

19
Q

Gram positive vs gram negative colour

A

Gram + (peptidoglycan wall) -> dark purple eg sterp pneumoniae gram + cocci
Gram negative -> pink (safarin stain) N.meningitidis diplococci

20
Q

What bacteria are most common cause of infective endocarditis

A

Streptococci

21
Q

Gram stain technique

A

Primary stain - crystal violet 1 minute
2 - Mordant - gram iodine for 1 min
3 - water rinse
3 - decolourisation - acetone 2-3s or thyl alcohol 20-30s, water rinse
4 - counter stain safarin 30-60s, water rinse and blot

22
Q

What colour are gram positive bacteria on stain

A

Purple

23
Q

What colour are gram negative bacteria on stain

A

Pink

24
Q

What gram is strep (what colour on stain)

A

Gram positive cocci - purple
Round or oval shaped

25
Q

Strep pneumoniae appearance

A

Lancet shape in pairs

26
Q

Enterococci appearnaec

A

Short chain

27
Q

Oral viridians strep appearance

A

Long chains

28
Q

Strep pyogenes appearance

A

Medium to long chains

29
Q

How to differentiate strep and staph

A

Catalase test - scoop colony on small loop and dip in hydrogen peroxide
Staph bubbles - releases 02
Strep doesn’t

30
Q

What see in alpha haemolytic strep agar plate

A

Partial haemoltysis - greenish dicoularation

31
Q

What streps are alpha haemolytic

A

Pneumoniae (bile soluble, capsule, optochin sensitive)
Viridans- mutans, sanguis (oppostie to all brackets)
Oral

32
Q

Beta haemolytic streptococcus appearance on agar

A

Complete haemolyiss - clear

33
Q

What streps are Beta haemolytic

A

Pyogenes (group A), agalactiae (group B)
V pathogenic

34
Q

Gamma haemolytic strep appearance on agar plate

A

Enterococcus
E.faecalis, e.faecium

35
Q

Techniques used to identify bacterial specific species if complex infection

A

Mass spectometry
Panel of biochemical reactions (slower)

36
Q

Method for susceptibility testing

A

Discs of filter paper impregnated with specific antibiotic concs on agar plate
zone of inhibition - whether effective - if has zone, susceptible

37
Q

How find speciifc level of sensitivity to an antibiotic

A

E test for MIC - minimum inhibitory concentration

38
Q

When use E test/MIC

A

Long course antibiotics for deep infections, endocarditis

39
Q

How do strep appear on blood agar

A

Smooth white/grey colonies, catalase negative
Alpha, beta or non haemolytic

40
Q
A

Infectious disease (37 decks)

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