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Undeleted > Meningitis And Ecephalitis > Flashcards

Meningitis And Ecephalitis Flashcards

0
Q

What is meningitis

A

Inflammation of the meninges

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1
Q

Name the tree layer of the meninges from outside

A

Dura matter
Arachnoid
Pia matter

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2
Q

What is encephalitis

A

Inflammation of the brain

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3
Q

What three bacteria are the most common cause of bacterial meningitis

A

Neiseria meningitidis
Streptococcus pnumoniae
Listeria monocytogenes

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4
Q

Describe the incidence of neiserria meningitidis (meningicoccal)

A

896 cases/ year in England and Wales
Mostly children <4 years
2nd highest incidence in 15-19 year olds
Significantly reduces since vaccinations

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5
Q

How is meningococcal disease spread

A 
Throat (10% 25% 15-19year olds)
Person to person 
Inhalation of respiratory secretions 
Close contact 
Kissing
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6
Q

What percentage does meningococcal present with meningitis and septicemia

A

25 percent septicemia 15% meningitis

60% both

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7
Q

What is the prognosis for meningococcal meningitis

A

10% fatal ( as low as 5% meningitis up to 50 septicemia )
1 in 8 long term morbidity
Headaches, joint stiffness, epilepsy
Early antibiotics improve prospect of recovery

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8
Q

What is adverse outcome for meninitis associated with

A

Hypotension
Altered mental status
Seizures

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9
Q

How do you treat bacterial meningitis

A

Prompt antibiotics
IV cefotaxime or ceftriaxone

Corticosteroids?

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10
Q

What is streptococcus pneumoniae referred as?

A

Pneumococcal meningitis

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11
Q

What is the main cause of meningitis in the elderly?

A

Pneumococcal meningitis infection from streptococcus pneumoniae

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12
Q

In which type of meningitis is neurological sequelae more common?

A

Pneumococcal meningitis

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13
Q

How is listeria monocytogenes acquired?

A

Ingestion. Ie meats and dairy

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14
Q

What percentage of listeria infections manifest as meningitis?
What percent fatal?

A

Approximately 55-70

25%

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15
Q

What is the treatment for listeria

A

IV amoxicillin +/- gentamicin

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16
Q

What type of viruses cause viral (aseptic) meningitis

A 
Enteroviruses 
HSV (mollarets)
mumps 
Measles 
Adenovirus 
HIV
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17
Q

Name three non viral causes of aseptic meningitis

A

Lyme disease
Syphilis
Drugs

18
Q

How is Enterovirus meningitis spread?

A

Respiratory or conjunctival secretions, faeco oral

19
Q

How can you treat Enterovirus meningitis

A

Symptomatically as it is self limiting

20
Q

What are the risk factors for TB meningitis

A

HIV, alcoholism, diabetes, steroids, anti-TNF agents, immigration from area of high prevalence

21
Q

What would a contrast CT show for TB meningitis

A

Hydrocephalus
Basel enhancement
Infarction
Tuberculoma

22
Q

Name the pathogen that causes cryptococcal meningitis

A

Cryptococcus neoforms

23
Q

What condition is cryptococcal meningitis associated with?

A

HIV/AIDS

24
Q

What antifungal Is used to treat cryptococcal meningitis

A

Fluconazole 400mg daily

25
Q

What is usually absent in cryptococcal meningitis

A

Classic meningitis symptoms
Ie nuchal rigidity
Photophobia
Rash

26
Q

How is cryptococcal meningitis caught?

A

Inhalation of yeasts

Often linked to bird droppings

27
Q

Onset of cryptococcal meningitis is usually……

A

Insidious

28
Q

Encephalitis is inflammation of the brain ……….

A

Parenchyma

29
Q

What distinguishes encephalitis from meningitis

A

Altered mental status
Motor or sensory deficits
Altered behavior/personality
Speech or movement disorder

30
Q

If a patient presents with features of both meningitis and encephalitis they are said to have ………

A

Meningoencephalitis

31
Q

What are the five causes of encephalitis

A 
Viruses 
Bacteria 
TB
Parasites 
Fungi
32
Q

What are two common types of virus that invade the CNS and cause encephalit

A

Herpes simplex viruses
Enteroviruses
Paramyxovirus
Other rarer viruses

33
Q

How can a virus cause encephalitis

A

Direct invasion of the CNS
Ie HSV, arboviruses

Immune mediated post infection/vaccination
ie ADEM (acute disseminated encephalomyelitis)
Mumps, measles, rubella, influenza

34
Q

What types of bacteria can cause encephalitis

A

Listeria
Mycoplasma
Lyme
Syphilis

35
Q

What types of parasites causes encephalitis

A

Cerebral malaria
Toxoplasmosis
Parastrongylus

36
Q

Geographical describe the most common encephalitises

A 
Americas- west nike encephalitis 
Europe- tick Bourne encephalitis 
Africa - west mile 
Asia- Japanese encephalitis 
Australia - Murray valley encephalitis
37
Q

How prevalent is HSV encephalitis

What is the mortality rate

A

1-2/250000 each year

70%

38
Q

2/3 of survivors of HSV encephalitis have significant……

A 
Neuropsychiatric sequelae 
Ie memory impairment 
Personality/behavior change
Dysphasia 
Seizures
39
Q

What is the clinical presentation of HSV ecephalitis

A 
Acute 
Flu like prodrome 
Fever (90%)
Headache 
Altered consciousness 
Disorientation 
Seizures (1/3-HSV1)
Focal neurological signs 
Speedy disturbances 
Behaviour change 
Memory impairment
40
Q

Name three reasons for missing the diagnosis of HSV encephalitis

A

Wrongly attributed fever+confusion to urinary/ chest infection

Wrongly attributed fever+confusion to post ictal pyrexia

Wrongly attributed altered consciousness or behavior change to drugs/alcohol/ psychiatric illness

41
Q

What sort of MRI and CT abnormalities suggest HSV encephalitis

A

Temporal lobe
Predominately unilateral
With our without mass effect

42
Q

What drugs can be used to treat HSV encephalitis

A

Acyclovir
Reduces mortality from 70 to 28%
Corticosteroids (efficacy unproven)

43
Q

What is a further cause of encephalitis in HIV infection

A

AIDS dementia complex, HIV encephalopathy

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