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Year 3 SBOM > Meningitis and Encephalitis > Flashcards

Meningitis and Encephalitis Flashcards

1
Q

What is the definition of meningitis?

A

Inflammation of the protective membranes covering the brain and spinal cord

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2
Q

What is the protective covering of the brain called?

A

Meninges

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3
Q

Which on an LP would indicate meningitis?

A

Elevated CSF, WCC and protein

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4
Q

At what age is the highest incidence of bacterial meningitis?

A

45-65 years

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5
Q

What is the mortality rate of bacterial meningitis?

A

20%

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6
Q

What type of bacterial meningitis has a higher mortality rate?

A

Pneumococcal meningitis

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7
Q

What type of meningitis are older adults and immunocompromised individuals more likely to get?

A

Listeria monocytogenes

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8
Q

What % of meningitis is viral?

A

50-80%

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9
Q

What is Kernig’s sign?

A

Flex hip at 90 degrees and extend knee.
Patient resists full knee extension when hip flexed.
Sign of meningeal irritation

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10
Q

What is Brudzinki sign?

A

Passive flexion of neck causes flexion of both legs and thighs.
Sign of meningeal irritation.

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11
Q

How is suspected meningitis managed (no signs of brain shift)?

A

A-E
Blood cultures
Lumbar puncture
Ceftriaxone or Cefotaxime 2g immediately after LP
Dexamethasone 10mg IV

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12
Q

When can cause papilloedema and what is it?

A

Swelling of the optic disc due to elevated intracranial pressure

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13
Q

If LP is not done within first hour of suspecting meningitis, when are abx given?

A

straight after blood cultures

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14
Q

Is a CT head indicated in suspected meningitis?

A

Not usually as it’s a clinical diagnosis.
Not indicated if no shock, sepsis or signs of brain shift.

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15
Q

How is suspected meningitis managed (with signs of brain shift)?

A

Brain shift = raises ICP
A-E
High flow O2
Bloods - FBC, U+E’s, Clotting, cultures
Dexamethasone 10mg IV
Ceftriaxone or Cefotaxime 2g immediately after blood cultures
Delay LP
Arrange neuroimaging

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16
Q

What is the difference between the management of meningitis with and without signs of brain shift?

A

With brain shift - delay LP and get neuro imaging. Abx (Ceftriaxone/Cefotaxime 2g) after blood cultures.

Without brain shift - Urgent LP with abx (Ceftriaxone/Cefotaxime 2g) after LP. Neuro-imaging not usually indicated.

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17
Q

How is severe sepsis or a rapidly evolving rash managed (with or without signs of meningitis)?

A

ITU support
A-E
Sepsis 6
Delay LP
Ceftriaxone or Cefotaxime 2g IV after blood cultures

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18
Q

What type of rash do you see in meningococcal septicaemia?

A

Petechial rash
Can progress to purpura and ecchymoses and clotting system fails

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19
Q

What type of rash is this?

A
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20
Q

What type of rash is this?

A
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21
Q

Which alternative abx would be given in suspected meningitis if pen/Cephalosporin allergic?

A

Chloramphenical 25mg/kg

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22
Q

Which abx would you give in someone over 60 or immunocompromised with meningitis?

A

Cefttriaxone/Cefotaxime + Amoxicillin 2g IV

If allergic to amoxicillin - give Chloramphenicol and Co-trimoxazole 10-20mg/kg

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23
Q

Which abx would you give in someone with suspected meningitis who has had recent travel to somewhere with a risk of penicillin resistant pneumococci?

A

Ceftriaxone/Cefotaxime + Vancomycin 15-20mg/kg IV or Rifampacin 600mg IV/PO dependent on trust.

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24
Q

At which vertebral level is a LP done?

A

L3/4 or L4/5

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25
Q

What is CSF fluid in a LP sent off for?

A

Measure opening pressure
MCS
Protein
Glucose (with concurrent blood glucose)
Meningococcal and pneumococcal PCR
Enteroviral, Herpes Simplex + Varicella
Consider TB investigations

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26
Q

What are the common organisms in bacterial meningitis?

A

Neisseria Meningitidis
Streptococcus pneumoniae

27
Q

What type of bacteria is neisseria meningitidis?

A

Gram negative rod

28
Q

What type of bacteria is streptococcus pneumoniae?

A

Gram positive cocci

29
Q

When should you delay a LP?

A
30
Q

What are the signs of brain shift?

A
31
Q

How long does it take to develop symptoms of TB meningitis?

A

Weeks
Other types are more sudden

32
Q

Where is there a high incidence of TB meningitis?

A

Africa
Indian sub-continent

33
Q

How is TB meningitis treated?

A

Rifampicin, Isoniazid and Pyrazinamide for 9 months
+/- steroids

34
Q

What are the complications of TB meningitis?

A

Hydrocephalus
Tuberculomas (mass)
Seizures

35
Q

What is the mortality of TB meningitis?

A

60%

36
Q

What would you see in histology of TB meningitis?

A

Acid-fast bacilli on Ziehl-Neilson staining

37
Q

How long is TB meningitis samples kept for before they can be said to be negative?

A

6 weeks

38
Q

If all four ventricles of the brain are dilated, where would the site of obstruction be?

A

Either the foramina of Luschka or Magendie or in the subarachnoid space

39
Q

What type of fungus can be seen in meningitis?

A

Cryptococcus.
Treated with amphoteracin.

40
Q

How does viral meningitis present?

A

Neck stiffness, headache, photophobia.
Not usually reduced consciousness.

41
Q

How is viral meningitis treated?

A

Treated as if bacteria until proved otherwise.
CSF PCR - Enterovirus, herpes simplex, varicella roster.
No evidence for aciclovir
Treat with IVI and analgesia

42
Q

What is the definition of encephalitis?

A

Inflammation of the brain

43
Q

What is the difference between meningitis and encephalitis?

A

Meningitis - inflammation of meninges.
Encephalitis - inflammation of brain

44
Q

What is a combination of encephalitis and meningitis called?

A

Meningioencephalitis

45
Q

Is encephalitis a clinical or pathological diagnosis?

A

Pathological

45
Q

What markers can suggest encephalitis?

A

abnormal CSF or neuroimaging

46
Q

What causes encephalitis?

A
47
Q

What is ADEM?

A

Acute Disseminated Encephalitic Myelitis

Patient has had a vaccine or infection several weeks earlier (2-3), produce antibodies to fight infection that attacks brain instead.

48
Q

Which is the most common type of viral encephalitis?

A

Herpes simplex
Majority is HSV-1, 10% if HSV-2 (in immunocompromised)

Varicella zoster also common
Cytomegalovirus in immunocompromised.

49
Q

What age does viral encephalitis peak?

A

Young and elderly

50
Q

Which type of virus can cause an aseptic meningitis which can then cause encephalitis?

A

Enterovirus

51
Q

How does herpes simplex cause encephalitis?

A

The CNS infection is secondary to active infection elsewhere in the body, or more commonly reactivation of dormant infection.

52
Q

What are the neuropathological features of herpes simplex encephalitis?

A
53
Q

What is the clinical presentation of encephalitis?

A
54
Q

How is encephalitis managed?

A
55
Q

Where does herpes simplex encephalitis typically go in the brain?

A

Right temporal lobe

56
Q

Which abnormalities do you see on an EEG in encephalitis?

A

Periodic lateralising epileptiform discharges

57
Q

How is viral encephalitis treated?

A
58
Q

What is auto-immune encephalitis?

A

Body’s immune system attacking brain causing inflammation

59
Q

Which antibodies can cause autoimmune encephalitis?

A

NMDAR
LGI1
CASPR2

60
Q

How can autoimmune encephalitis present?

A

Altered cognition
Altered psychiatric state
Seizures

61
Q

What paraneoplastic conditions can cause auto-immune encephalitis

A

NMDA receptor encephalitis caused by teratomas

62
Q

How is auto-immune encephalitis managed?

A

Year 3 SBOM (5 decks)

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