Meningitis

Question 1

For viral and bacterial meningitis, describe the CSF findings in terms of:

protein level

glucose in proportion of plasma level

white cell count and type

culture

Answer 1

polymorphic cells = neutrophils = bacterial

mononuclear cells = lymphocytes = viral

Question 2

Describe the CSF findings for TB meningitis:

glucose in proportion of plasma level

white cell count and type

culture

Answer 2

Glucose less than half of plasma glucose

White cells 10-1000 and mononuclear lymphocytes

Nothing comes up on culture

Question 3

Cerebal Abscess

Clinical Features

Investigation Findings

Answer 3

Clinical Features: UMN

CT head ring enhancing lesion: give contrast

Question 4

Management

In primary care

In secondary care

Answer 4

Immediate primary care management for meningitis includes IV Benzylpenicillin and referral to hospital.

Immediate secondary care management for meningitis includes:

• IV Ceftriaxone (after blood cultures)
• IV Dexamethasone (to reduce oedema) in over 50 years old: unless meningococcal septicaemia
• lumbar puncture (unless there are signs of raised ICP, in which case ICU referral is needed), to differentiate between encephalitis and the three main types of meningitis

Question 5

Bacterial meningitis lumbar puncture

Answer 5

CSF predominantly polymorphs, with a cell count of 90-1000+;

CSF glucose is less than half of plasma glucose;

over 1.5g/L of protein is present;

bacteria grows on culture.

Question 6

Viral Menenigitis Lumbar puncture findings

Answer 6

CSF predominantly mononuclear cells, with a cell count of 50-1000;

CSF glucose is more than half of plasma glucose;

less than 1g/L of protein is present;

no bacteria grows on culture

Question 7

Tuberculosis Meningitis Lumbar puncture

Answer 7

CSF predominantly mononuclear cells (or lymphocytes), with a cell count of 10-1000;

CSF glucose is less than half of plasma glucose;

1-5g/L of protein is present;

no bacteria grows on culture

(Essentially bacterial meningitis with lymphocytes)