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Neurology > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What is meningitis

A

inflammation of the meninges

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2
Q

how does bacteria reach the meninges

A

through bloodstream

direct contact between the meninges and either nasal cavity or the skin

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3
Q

how does meningitis lead to cerebral oedema?

A

blood brain barrier becomes more permeable - vasogenic cerebral oedema (fluid leaks from blood vessels)
white blood cells enter CSF leading to interstitial oedema (fluid between cells)
walls of blood vessels become inflamed, leads to decreased blood flow and cytotoxic oedema

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4
Q

what are the 5 types of meningitis

A 
acute pyogenic (bacterial) meningitis 
acute aseptic (viral) meningitis
acute focal suppurative infection (brain abscess, subdural and extradural empyema)
Chronic bacterial infection (TB)
acute encephalitis
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5
Q

What pathological features are seen in pyogenic meningitis

A

suppurative exudate covers leptomeninges

exudate in basal and convexity surfaces

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6
Q

what are the complications of meningitis

A

arachnoiditis - impacts on CSF absorption
Hydrocephalus and ventriculitis - communicating + non communicating
death
abscess formation
cerebral oedema
exudate can form around nerves (3+6)

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7
Q

what are the common causative organisms of pyogenic meningitis

A

neisseria meningitidis - gram negative bacterium
haemophilus influenzae - gram negative cornebacterium
streptococcus pneumoniae - gram posistive bacilli
listeria monocytogenes

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8
Q

what are the most likely causative organisms based on age group? (pyogenic meningitis)

A

neonates - listeria, streptococcus agalachie
children - h.influenzae
ages 10-21 - neisseria meningitidis
age over 21 - strep pneumoniae > neisseria meningitidis
over 65 - strep pneumoniae > listeria

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9
Q

which bacteria commonly affects students?

A

neisseria meningitidis

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10
Q

who are the three risk groups of listeria monocytogenes?

A

elderly, neonates, pregnancy

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11
Q

what are some common risk factors and their associated causative organisms? (pyogenic meningitis)

A

DECREASED CELL MEDIATED IMMUNITY: LISTERIA MONOCYTOGENES
NEUROSURGERY/ HEAD TRAUMA: STAPHYLOCOCCUS, GRAM NEGATIVE BACILLI
FRACTURE OF THE CRIBIFORM PLATE: STREPTOCOCCUS PNEUMONIAE

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12
Q

clinical features of pyogenic meningitis

A

fever, stiff neck, alteration in consciousness, headache, vomiting, pyrexia, photophobia, lethargy, confusion, petechial or purpuric rash, seizures,

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13
Q

neurological features of meningitis

A

focal neurological deficit, abnromal eye movement, facial palsy, balance problems/hearing impairment

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14
Q

clinical features of infants with meningitis

A

hypothermia, irritability, lethargy, poor feeding, apnoea, bulging fontanelle. high pitched cry

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15
Q

what are your first line investigations in meningitis?

A 
CT
lumbar puncture (CSF analysis)
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16
Q

what other investigations could you consider in meningitis?

A

blood cultures, throat swab, blood EDTA for PCR

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17
Q

management of pyogenic meningitis

A

Ceftriaxone 2g bd + Dexamethasone

add ampicillin/amoxicillin if listeria suspected, or aciclovir if encephalitis

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18
Q

what are the indications for hospital admission?

A

signs of meningeal irritation, an impaired conscious level, petechial rash, who are febrile or unwell and have had a recent fit, Any illness, especially headache, and are close contacts of patients with meningococcal, infection, even if they have received a prophylactic antibiotic

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19
Q

what are the common prophylactic regimes of pyogenic meningitis?

A

600 mg rifampicin orally 12-hourly for four doses (adults and children over 12 years), 10 mg/kg orally 12-hourly for four doses (aged 3-11 months) (IV).
500 mg ciprofloxacin orally as a single dose for adults and children aged more than 12 years (IV)
250 mg ceftriaxone intramuscularly as a single dose in adults, 125 mg iv as a single dose in children under 12 years

20
Q

What is the management of penicillin allergic pyogenic meningitis?

A

If there is a clear history of anaphylaxis to beta-lactams give chloramphenicol iv 25 mg/kg 6-hourly with vancomycin iv 500 mg 6-hourly or 1g 12-hourly.
If listeria suspected and penicillin allergy co-trimoxazole alone has been used successfully for this infection.

21
Q

when should you give steroids in the management of pyogenic meningitis?

A

give to all patients suspected of bacterial meningitis (10mg iv 15-20 min before or with the first dose of antibiotic and then every 6 hours for 4d)
do not give in post-surgical meningitis, severe immunocompromise, meningococcal or septic shock or those hypersensitive to steroids

22
Q

What is an causative organism of cryptococcal meningitis?

A

cryotococcus neoformo=us

23
Q

risk factor for cryptococcal meningitis

A

HIV

24
Q

management of cryptococcal meningitis

A

IV amphotericin B/flucytosine

Fluconazole

25
Q

clinical features of cryptococcal meningitis

A

subtle neurological presentation
disseminated infection
aseptic CSF

26
Q

what does aseptic meningitis mean?

A

non-pyogenic bacterial meningitis

27
Q

general features of CSF of aseptic meningitis

A

low WBC,
minimally elevated protei
normal glucose

28
Q

What are the common causes of viral meningitis

A 
human enteroviruses - 5 subgernera
coxsackieviruses
echoviruses
polioviruses
herpes viruses - HSV1 (encephalitis), HSV2 (meningitis)
arboviruses
29
Q

risk factors of viral meningitis

A 
exposure to mosquito or tick vector
unvaccinated for mumps
use of swimming pools and ponds
immunosuppression
exposure to rodents
30
Q

clinical features of viral meningitis

A

headache, nausea and vomiting, photophobia, neck stiffness, fever, rask, kernigs sign, brudzinskis sign

31
Q

investigations for viral meningitis

A

viral stool culture, throat swab, CSF PCR

32
Q

treatment for viral meningitis

A

self limiting, supportive

aciclovir only if herpes

33
Q

What are 2 types of brain abscesses?

A

single or multiple

34
Q

pathological features of single abscesses

A

occur adjacent to source

35
Q

pathological features of multiple abscesses

A

haematogenous spread

36
Q

causes of single abscesses

A 
local extension (e.g. mastoiditis)
direct implantation of infectious agent (skull fracture)
37
Q

causes of multiple abscesses

A

bronchopneumonia, bacterial endocarditis

38
Q

risk factors for development of abscesses

A

sinus and dental infections, penetrating trauma, pulmonary infections, congenital heart disease, HIV, transplantation, neutropenia

39
Q

symptoms of a brain abscess

A

fever, ICP

symptoms of underlying cause

40
Q

investigations for a brain abscess

A

CT or MRI

Aspiration for culture

41
Q

management of brain abscess

A

Aspiration and antibiotics

42
Q

CSF features of bacterial meningitis

A 
Appearance - cloudy
Pressure - raised
WBC - 500-10000 neutrophils
Glucose - decreased
Protein - >150
43
Q

CSF features of viral meningitis

A 
Appearance - clear
Pressure - normal
WBC - 10-100 lymphocytes
Glucose - normal
Protein - raised
44
Q

CSF features of fungal meningitis

A 
Appearance  - clear/cloudy
Pressure - normal
WBC - 10-500 mononuclear cells
Glucose - decreased 
Protein - >1000
45
Q

CSF features of TB meningitis

A 
Appearance - opaque
Pressure - rasied
WBC - 50-500 neutrophils/monocytes
Glucose - decreased
Protein - >100
46
Q

CSF of crytococcal meningitis

A 
Appearance - clear
Pressure - raised
WBC - 100-200 lymphocytes
Glucose - decreased
Protein - 50-200

Neurology (18 decks)

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