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Nervous System > Meningitis > Flashcards

Meningitis Flashcards

1
Q

def

A

inflammation of the leptomeningeal (pia mater and arachnoid) coverings of the brain
most commonly by infection

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2
Q

aetiology

A

infection:
1 bacterial
2 viral
3 fungal

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3
Q

what are common bacterial causes of meningitis in neonates

A

group B strep
E. coli
listeria monocytogenes

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4
Q

what are common bacterial causes of meningitis in children

A

haemophilus influenzae
neisseria meningitidis
streptococcus pneumoniae

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5
Q

what are common bacterial causes of meningitis in adults

A

neisseria meningitidis (meningococcus)
streptococcus pneumoniae
TB

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6
Q

what are common bacterial causes of meningitis in the elderly

A

streptococcus pneumoniae

listeria monocytogenes

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7
Q

what are the viral causes of meningitis

A

enteroviruses (nonpolio)
CMV
HSV

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8
Q

what are the fungal causes of meningitis

A

cryptococcus (associated with HIV infection)

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9
Q

what are enteroviruses

A 
four groups of enteroviruses
1 polioviruses
2 Coxsackie A viruses
3 Coxsackie B viruses
4 echo viruses
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10
Q

what are the risk factors

A 
close communities
basal skull fractures
sinusitis
inner ear infections
alcoholism
immunodeficiency/splentectomy
intracranial surgery
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11
Q

epi

A

common with foreign travel to Haj or Africa

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12
Q

history

A

should include questioning on foreign travel + exposure to rodents, ticks, mosquitoes etc

1 early features
-headache
2 later features
-neck stiffness
-photophobia
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13
Q

examination

A

1 signs of meningism

2 signs of infection

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14
Q

what are the features of meningism

A

neck stiffness or aching
photophobia
kernigs sign positive

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15
Q

what is kernigs sign

A

pain + resistance on passive knee extension with hip fully flexed

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16
Q

what are the features of infection in meningitis

A

fever
tachycardia + hypotension
decreased consciousness

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17
Q

what is the characteristic feature of meningococcal septicaemia

A

petechial rash which is non-blanching

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18
Q

investigations

A

1 bloods
-one for bacteria, one for virology
2 CT scan
-exclusion of mass lesion or increased ICP
3 lumbar puncture
4 staining of petechiae scrapings may detect meningococcus in 70%

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19
Q

why must a CT scan be done before a lumbar puncture

A

mass lesion or increased ICP may lead to cerebral herniation during subsequent CSF removal

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20
Q

when must a CT scan be done before a lumbar puncture

A

if GCS <15
suspected raised ICP
symptoms of focal neurology
papilloedema

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21
Q

what is the normal opening pressure in a lumbar puncture

A

7-18cm

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22
Q

what is the opening pressure in a lumbar puncture with meningitis

A

can be >40cm

but will typically be raised

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23
Q

what are typical findings of a bacterial meningitis on LP

A

cloudy CSF
raised neutrophils, protein
decreased glucose

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24
Q

what is the ratio of CSF glucose to plasma glucose in bacterial meningitis

A

<0.5

25
Q

what are typical findings of viral meningitis on LP

A

clear/cloudy CSF
raised neutrophils, protein
normal glucose

26
Q

what are typical findings of TB on LP

A

fibrinous CSF
raised lymphocytes, protein
low glucose

27
Q

what is the ratio of CSF glucose to plasma glucose in viral meningitis

A

> 0.5

28
Q

management

A 
1 immediate IV/IM antibiotics
2 IV dexamethasone
3 resuscitation
-managed in ITU
-vaccination against meningococcal serogroups A +C
-notify public health services
29
Q

when are antibiotics started in meningitis

A

started when meningitis is suspected, can be before confirmation with CT/LP

30
Q

what antibiotics are given in meningitis

A

<55yrs: cefotaxime

>55yrs: cefotaxime + ampicillin (if listeria)

31
Q

what is the benefit of dexamethasone

A

continued in pneumococcal or h. influenzae as decreases deaths in s. pneumoniae and decreases hearing loss in h. influenzae

32
Q

when should dexamethasone not be used

A

in HIV infection

33
Q

what is the most common meningococcal serogroup in the UK

A

serogroup B

34
Q

complications (5)

A 
septicaemia
shock
DIC
renal failure
peripheral gangrene
35
Q

what is waterhouse friderichsen syndrome

A

compication of meningitis

bilateral adrenal haemorrhage

36
Q

prognosis

A

bacterial meningitis has high mortality

viral meningitis is self limiting

37
Q

what are the common organisms which cause meningitis in 0-3months

A

group B strep (most common)
e coli
listeria monocytogenes

38
Q

what is group b strep

A

streptococcus agalactiae

39
Q

what are the common organisms which cause meningitis in 3months-6yrs

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

40
Q

what are the common organisms which cause meningitis in 6-60yrs

A

Neisseria meningitidis

Streptococcus pneumoniae

41
Q

what are the common organisms which cause meningitis in >60yrs

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

42
Q

what are the common organisms which cause meningitis in the immunocompromised

A

listeria monocytogenes

43
Q
  1. A 22 year old university student comes in with a headache, neck stiffness and photophobia. You are such a pro that you clinically diagnose him with meningitis. Which is the most common form of meningitis in a patient of his age?
    Bacterial meningitis due to Haemophilus influenzae
    Bacterial meningitis due to Neisseria meningitides
    Bacterial meningitis due to Streptococcus pneumoniae
    Fungal meningitis
    Viral meningitis
A

Viral meningitis

44
Q 
2.  What investigation do you think is most likely to give you the diagnosis of meningitis?
Bloods
CT scan
Lumbar puncture
MRI scan
Ultrasound scan
A

Lumbar Puncture

45
Q 
3.  You are given the following results of the lumbar puncture. The appearance of the fluid is clear, there is raised protein and normal glucose.  Lymphocyte count is raised. What is the most likely cause now?
Bacterial meningitis
Drug-induced meningitis
Fungal meningitis
TB meningitis
Viral meningitis
A

Viral meningitis

46
Q

what are common bacterial causes of meningitis in children

A

strep pneumoniae
neisseria meningitidis
haemophilus influenzae type B

47
Q

what are common bacterial causes of meningitis in adults

A

strep pneumoniae

neisseria meningitidis

48
Q

what are common bacterial causes of meningitis in elderly

A

streptococcus pneumoniae
neisseria meningitidis
listeria monocytogenes

49
Q

what are bacterial causes of meningitis in neonates

A

group B strep
e coli
listeria monocytogenes

50
Q

what sort of bacteria is streptococcus pneumonia

A

gram +ve cocci

51
Q

what sort of bacteria is neisseria mengitides

A

gram -ve diplococci

52
Q

what causes listeria monocytogenes in neonates and elderly

A

cheese/milk

alcohol

53
Q

what is associated with group B strep causing meningitis in neonates

A

extended labour

infection in previous pregnancy

54
Q

what causes a non-blanching purpuric rash in meningitis

A

meningococcal septicaemi

55
Q

what is the most important investigation in meningitis

A

LP

56
Q

what are features of bacterial meningitis on LP

A

turbid
very high (neutrophils)
very high protein
low glucose

57
Q

what are features of viral meningitis on LP

A

clear/cloudy
high (lymphocytes)
high protein
normal glucose

58
Q

what are features of TB/fungal meningitis on LP

A

clear/cloudy
high (lymphocytes)
high protein
low glucose

59
Q

what is the management for meningitis for adults

A

ceftriaxone +/- dexamethasone

Nervous System (27 decks)

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