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

Give 3 epidemiological facts about meningitis

Answer 3

1.5/ 100,000/ year
Viral most common
Infants most at risk

Question 4

Describe the aetiology of meningitis

Answer 4

Viral
Bacterial
Aseptic
Non-infective

Question 5

List 5 symptoms of meningitis

Answer 5

Severe headache  
N+V
Irritability  
Lethargy 
Leg pain

Question 6

List 6 signs of meningitis

Answer 6

Photophobia
Neck stiffness
Non-blanching rash
Fever
Kernig’s Sign: hips flexed, pain/ resistance on passive knee extension
Brudzinski’s Sign: flexion of the hips when the neck is flexed

Question 7

List 7 risk factors for meningitis

Answer 7

Young age
Immune suppression.
Smoking.
CSF shunts or dural defects
Spinal procedures (eg, spinal anaesthetics)
IV drug abuse
Crowding (college students) .

Question 8

List 10 conditions that increase risk of meningitis

Answer 8

Bacterial endocarditis
Alcoholism 
Diabetes mellitus
Renal/ adrenal insufficiency
Hypoparathyroidism
CF
Malignancy 
Splenectomy
Thalassaemia major
Sickle cell disease

Question 9

What 5 signs of infection may be seen in a patient with meningitis?

Answer 9

Fever  
Tachycardia 
Hypotension 
Skin rash  
Altered mental state

Question 10

What would a lumbar puncture of bacterial meningitis show?

Answer 10

Cloudy CSF
High neutrophils
High protein
Low glucose

Question 11

What would a lumbar puncture of viral meningitis show?

Answer 11

High lymphocytes
High protein
Normal glucose

Question 12

What would a lumbar puncture of TB meningitis show?

Answer 12

Fibrinous CSF
High lymphocytes
High protein
Low glucose

Question 13

What 7 bloods are tested in suspected meningitis?

Answer 13

FBC.
CRP.
Coagulation screen. (DIC)
Whole-blood PCR for N. meningitidis.
Blood glucose. (Hypo or Hyper)
Blood gases (High lactate in shock)
U+Es

Question 14

Why perform a CXR in suspected meningitis?

Answer 14

Exclude lung abscess

Question 15

What samples may be cultured in suspected meningitis? Why?

Answer 15

Blood
Urine
Nasopharyngeal swabs
Stool
For virology

Question 16

What are the general principles of management for all viral meningitis?

Answer 16

Analgesia
Antipyretics
Nutritional support
Hydration

Question 17

What are the general principles of management in primary care for bacterial meningitis?

Answer 17

Urgent hospital transfer + IV Abx:
3rd gen. cephalosporin e.g. Ceftriaxone
or
Benzylpenicillin

Question 18

What are 5 immediate complications of meningitis?

Answer 18

Septicaemia  
Shock  
DIC    
Coma
Cerebral oedema

Question 19

What are 5 delayed complications of meningitis?

Answer 19

Hydrocephalus  
Waterhouse-Friderichsen Syndrome (adrenal failure by N. Meningitidis)
Seizures 
Peripheral gangrene
SIADH

Question 20

Give 3 prognostic facts about meningitis

Answer 20

Significant risk of death in bacterial meningitis
Mortality risk very low for other causes.
Viral meningitis is self-limiting