Meningitis

Question 1

What is Meningitis?

Answer 1

inflammation of the leptomeningeal (pia + arachnoid mater) coverings of the brain

Question 2

What is meningitis usually due to?

Answer 2

Infection

Question 3

Describe the aetiology of meningitis

Answer 3

Viral
Bacterial
Aseptic
Non-infective (cancer, AI, drugs)

Question 4

What is Meningococcal meningitis? What sign is indicative of this?

Answer 4

Neisseria meningitidis meningitis
Non-blanching rash/ cutanoues petechiae

Question 5

What is Pneumococcal meningitis?

Answer 5

Streptococcus pneumoniae meningitis

Question 6

What are the 3 most common causes of bacterial meningitis?

Answer 6

Neisseria meningitis
Haemophilus influenzae type B
Streptococcus pneumoniae (most common in adults)

Question 7

What is the classic triad of meningitis?

Answer 7

Fever
Meningismus: headache, neck stiffness, photophobia
Altered mental state

Question 8

List 4 symptoms of meningitis

Answer 8

Classic triad
N+V
Drowsiness
Seizures

Question 9

List 3 signs of meningitis

Answer 9

Neck stiffness
Kernig’s Sign
Brudzinski’s Sign

Question 10

What is Kernig’s sign?

Answer 10

Hips flexed, pain/ resistance on passive knee extension

Question 11

What is Brudzinski’s sign?

Answer 11

flexion of hips when neck is flexed

Question 12

List 3 risk factors for meningitis

Answer 12

Immunosuppression
Crowding (homes, students)
Close contact with infected person

Question 13

List 4 signs suggestive of meningoencephalitis

Answer 13

Focal neurological signs (e.g., paresis, extrapyramidal Sx, aphasia)
Seizures (focal-onset or generalized)
Behavioral changes, psychosis
Altered consciousness

Question 14

Describe immediate management of suspected meningitis in the community

Answer 14

Blue light to hospital
IM Benzylpenicillin

Question 15

What dose IM benzylpenicillin should be used in suspected meningitis?

Answer 15

<1y: 300 mg
1–9y: 600 mg
Adults + >10s: 1.2 g

Question 16

Describe immediate management of suspected meningitis in the hospital

Answer 16

A-E
Dexamethasone 10mg IV
Ceftriaxone or Cefotaxime 2g IV (empiric)

Question 17

What investigations are used in meningitis?

Answer 17

FBC
Blood cultures x 2
Blood glucose
U+Es
LFTs
Serum Pneumococcal + Meningococcal PCR
LP + CSF analysis

Question 18

When is imaging performed in suspected meningitis? What modality?

Answer 18

CT head
Before LP if raised ICP is suspected

Question 19

What would a lumbar puncture of bacterial meningitis show?

Answer 19

Cloudy CSF
High neutrophils/ polymorphs
High protein
High opening pressure
High lactate
Low glucose (<1/2 plasma glucose)

Question 20

What may be found on gram stain of CSF in bacterial meningitis?

Answer 20

Meningococci: -ve diplococci
Pneumococci: +ve diplococci
Haemophilus influenzae: -ve coccobacilli
Listeria: +ve rods

Question 21

What would a lumbar puncture of viral meningitis show?

Answer 21

Cloudy/ clear
High lymphocytes
N/ High protein
N/ High opening pressure
Variable lactate
Normal glucose

Question 22

What would a lumbar puncture of TB meningitis show?

Answer 22

CSF slightly cloudy, fibrin web
High lymphocytes + WCC
High protein
High opening pressure
High lactate
Low glucose

Question 23

Describe management of confirmed bacterial meningitis

Answer 23

Targeted Abx
+/- Dexamethasone 10mg IV

Question 24

In which patients with meningitis is dexamethasone indicated? Why?

Answer 24

Meningitis due to S. pneumoniae or H. influenzae
Reduces local + systemic inflammation

Question 25

What are 5 neurological complications of meningitis?

Answer 25

Sensorineural hearing loss (most common)
Seizures
Focal neurological deficit
Infective: sepsis, intracerebral abscess
Pressure: Herniation, Hydrocephalus

Question 26

Name a complication specific to meningococcal meningitis

Answer 26

Waterhouse-Friderichsen Syndrome
Adrenal failure secondary to adrenal haemorrhage

Question 27

Give 3 prognostic facts about meningitis

Answer 27

Bacterial: fatal if untreated
Mortality risk very low for other causes.
Viral: resolves spontaneously in most