Meningitis And Ecephalitis Flashcards by matt reid

What is meningitis

Inflammation of the meninges

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Name the tree layer of the meninges from outside

Dura matter
Arachnoid
Pia matter

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What is encephalitis

Inflammation of the brain

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What three bacteria are the most common cause of bacterial meningitis

Neiseria meningitidis
Streptococcus pnumoniae
Listeria monocytogenes

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Describe the incidence of neiserria meningitidis (meningicoccal)

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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How is meningococcal disease spread

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

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What percentage does meningococcal present with meningitis and septicemia

25 percent septicemia 15% meningitis

60% both

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What is the prognosis for meningococcal meningitis

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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What is adverse outcome for meninitis associated with

Hypotension
Altered mental status
Seizures

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How do you treat bacterial meningitis

Prompt antibiotics
IV cefotaxime or ceftriaxone

Corticosteroids?

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What is streptococcus pneumoniae referred as?

Pneumococcal meningitis

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What is the main cause of meningitis in the elderly?

Pneumococcal meningitis infection from streptococcus pneumoniae

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In which type of meningitis is neurological sequelae more common?

Pneumococcal meningitis

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How is listeria monocytogenes acquired?

Ingestion. Ie meats and dairy

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

Approximately 55-70

25%

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What is the treatment for listeria

IV amoxicillin +/- gentamicin

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What type of viruses cause viral (aseptic) meningitis

Enteroviruses 
HSV (mollarets)
mumps 
Measles 
Adenovirus 
HIV

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Name three non viral causes of aseptic meningitis

Lyme disease
Syphilis
Drugs

How is Enterovirus meningitis spread?

Respiratory or conjunctival secretions, faeco oral

How can you treat Enterovirus meningitis

Symptomatically as it is self limiting

What are the risk factors for TB meningitis

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

What would a contrast CT show for TB meningitis

Hydrocephalus
Basel enhancement
Infarction
Tuberculoma

Name the pathogen that causes cryptococcal meningitis

Cryptococcus neoforms

What condition is cryptococcal meningitis associated with?

HIV/AIDS

What antifungal Is used to treat cryptococcal meningitis

Fluconazole 400mg daily

What is usually absent in cryptococcal meningitis

Classic meningitis symptoms Ie nuchal rigidity Photophobia Rash

How is cryptococcal meningitis caught?

Inhalation of yeasts | Often linked to bird droppings

Onset of cryptococcal meningitis is usually......

Insidious

Encephalitis is inflammation of the brain ..........

Parenchyma

What distinguishes encephalitis from meningitis

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

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

Meningoencephalitis

What are the five causes of encephalitis

``` Viruses Bacteria TB Parasites Fungi ```

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

Herpes simplex viruses Enteroviruses Paramyxovirus Other rarer viruses

How can a virus cause encephalitis

Direct invasion of the CNS Ie HSV, arboviruses Immune mediated post infection/vaccination ie ADEM (acute disseminated encephalomyelitis) Mumps, measles, rubella, influenza

What types of bacteria can cause encephalitis

Listeria Mycoplasma Lyme Syphilis

What types of parasites causes encephalitis

Cerebral malaria Toxoplasmosis Parastrongylus

Geographical describe the most common encephalitises

``` Americas- west nike encephalitis Europe- tick Bourne encephalitis Africa - west mile Asia- Japanese encephalitis Australia - Murray valley encephalitis ```

How prevalent is HSV encephalitis | What is the mortality rate

1-2/250000 each year | 70%

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

``` Neuropsychiatric sequelae Ie memory impairment Personality/behavior change Dysphasia Seizures ```

What is the clinical presentation of HSV ecephalitis

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

Name three reasons for missing the diagnosis of HSV encephalitis

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

What sort of MRI and CT abnormalities suggest HSV encephalitis

Temporal lobe Predominately unilateral With our without mass effect

What drugs can be used to treat HSV encephalitis

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

What is a further cause of encephalitis in HIV infection

AIDS dementia complex, HIV encephalopathy