Meningitis

Question 1

What is meningitis?

Answer 1

It is inflammation of the meninges (dura mater, arachnoid mater and Pia mater) usually caused by bacterial or viral infections.

Question 2

What is the most common bacterial infection causing meningitis in adults and children?

Answer 2

Neiserria meningiditis (meningococcal). its a gram negative circular bacteria which comes in pairs (diplococcal).

Question 3

What does neiserria meningiditis also cause?

Answer 3

Meningococcal septicaemia - where it invades the blood, this causes disseminated intravascular coagulopathy - seen as a NON-BLANCHING RASH.

Question 4

What is another common bacteria causing meningitis in adults and children?

Answer 4

Streptococcus pneumonias (pneumococcus) - this does not appear with the non-blanching rash as it doesn’t cause septicaemia.

Question 5

What is the most common bacteria causing meningitis in neonates?

Answer 5

Group B streptococcus. IT is a bacteria found as part of the normal flora of the mothers vagina and is often picked up during childbirth.

Question 6

What is the presentation of meningitis?

Answer 6

Stiff neck, fever, photophobia, vomiting, seizures, altered mental status, loss of consciousness.
some get cranial nerve palsy
petechial skin rash - meningococcal meningitis

Question 7

Which bacteria causes the non-blanching rash?

Answer 7

Neiserria meningiditis (meningococcal bacteria).

Question 8

Which two clinical tests are used for meningitis?

Answer 8

Kernig’s test- when the patient has their hip flexed at 90 degrees with the knee flexed, then as the knee is straightened they feel pain and there is resistance.
Brudzinskis test - when the patient is lying supine, and you pull their chin to their test, they will involuntarily also flex their hips and knees.

Question 9

What is done in the community if someone has suspected meningitis and a non-blanching rash?

Answer 9

An IM injection of benzylpenicillin while waiting for the ambulance.

Question 10

What is the treatment for bacterial meningitis?

Answer 10

< 3 months - cefotaxime and amoxicillin
> 3 months - ceftriaxone

+ steroids (dexamethasone - 4x daily for 4 days) - to reduce the complications like hearing loss.

Question 11

What is the treatment for post exposure prophylaxis of meningitis?

Answer 11

One oral dose of ciprofloxacin.

Question 12

What is the treatment for viral meningitis?

Answer 12

Supportive treatment + Aciclovir.

Question 13

What level of the spine is a lumbar puncture performed at?

Answer 13

L2-3

Question 14

What are the complications of meningitis?

Answer 14

Hearing loss
epilepsy
memory loss
cognitive impairment
learning difficulties
limb weakness and spasticity.

Question 15

what is encephalitis

Answer 15

inflammation of brain

Question 16

what causes encephalitis

Answer 16

viral - HSV, enteroviruses 
bacterial meningitis 
TB
malaria 
auto-immune

Question 17

how does encephalitis present

Answer 17

weird behaviour 
confusion 
coma
reduced GCS
headache
focal neurological signs 
fever 
history of travel 
flu - 4-10 days 
memory disturbance 
seizures 
cerebral dysfunction more common in viral

Question 18

what investigations should you do in encephalitis

Answer 18

blood cultures
CT with contrast
lumbar puncture - unless focal symptoms that suggest brain mass or raised ICP
EEG

Question 19

how do you manage encephalitis

Answer 19

aciclovir within 30min of arrival

supportive