Meningitis and Encephalitis Flashcards

1
Q

Inflammation of leptomeningeal (pia mater + arachnoid) coverings of the brain

A

Meningitis

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2
Q

Inflammation of brain parenchyma (functional tissue, so inflam of the brain itself)

A

Encephalitis

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3
Q

Condition characterised by clinical and laboratory evidence for meningeal inflammation and negative routine bacterial cultures

A

Aseptic meningitis

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4
Q

Causative organisms meningitis

A

Bacteria - strep pneumoniae, neisseria meningitidis, haemophilus influenzae type B

Viruses
Fungi
Parasites
Non-infectious

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5
Q

Aseptic meningitis causative organisms

A

Pathogens - Enterovirus, mycobacteria, fungi, sprochetes

Autoimmune - sarcoidosis, Behcet’s, SLE

Malignancy - lymphoma, leukaemia, metastatic, carcinomas

Medication - NSAIDs, trimethoprim, azathioprine

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6
Q

Encephalitis causative organisms

A

Infectious and non-infectious causes

- main cause is herpesvirus

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7
Q

Meningitis symptoms

A

Photophobia
Neck stiffness
Headache
Fever

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8
Q

Encephalitis symptoms

A
Altered consciousness
Seizures
Personality changes
Cranial nerve palsies
Speech problems
Motor/sensory deficit
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9
Q

Investigations for meningitis

A

LP for CSF

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10
Q

Management of meningitis

A

Empirical antimicrobial should be started promptly

  • ceftriaxone
  • vancomycin
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11
Q

Investigations for encephalitis

A

Blood cultures
Neuroimaging (MRI)
CSF analysis (LP)

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12
Q

Neonates - Extended labour, infection in previous pregnancy

A

Group B strep

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13
Q

Neonotes - Late neonatal infection

A

E. coli

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14
Q

Neonates - Do not forget

A

Listeria monocytogenes

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15
Q

Children/teenagers - Gram negative diplococci

A

Neisseria menigitides

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16
Q

Children/teenagers - unvaccinated

A

Haemophillus influenzae

17
Q

Adults/elderly - gram positive cocci

A

Strep pneumoniae

18
Q

Adults/elderly - elderly, cheese/unpasteurised milk, alcoholics

A

Listeria monocytogenes

19
Q

Brudzinski’s sign

A

Meningitis

Severe neck stiffness causes patient’s hips and knees to flex when neck is flexed

20
Q

Kernig’s signn

A

Meningitis

Severe hamstring stiffness causes inability to straighten the leg when hip is flexed to 90 degrees

21
Q

Signs of infection in meningitis

A
Fever
Tachycardia
Hypotension
Altered mental state
Skin rash - petechiae = meningococcal septicaemia
22
Q

Petechiae + meningitis

A

Meningococcal septicaemia

23
Q

Meningitis investigations

A

Bloods (2 blood cultures)
Imaging (CT to exclude raised intracranial pressure)
LP (CSF for MCS+Gram-staining)

24
Q

Indications for avoiding LP in meningitis

A
  • Neurological signs suggesting raised ICP
  • Superficial infection over LP site
  • Coagulopathy
25
Q

Lumbar puncture site

A

Between L3/4 or L4/5 (pick lower one in children to be safe)

26
Q

Management of meningism + non-blanching rash or meningococcal septicaemia

A
  • admit

- single dose IV benzylpenicillin

27
Q

Management of bacterial meningitis

A
  • IV ceftriaxone (3rd gen cephalosporin)
  • Consider steroids, dexamethasone (but NOT if meningococcal septicaemia is suspected)
  • Cover listeria with ampicillin
  • Cover encephalitis (any consciousness affect) with IV acyclovir
28
Q

Prophylactic management to meningitis patient close contacts

A

Rifampicin or ciprofloxacin

29
Q

CSF results

  • appearance - clear
  • WCC - very low
  • protein - normal
  • glucose - normal
  • Gram stain - normal
A

Normal CSF

30
Q

CSF results

  • appearance - turbid
  • WCC - very high w/ neutrophils
  • protein - very high
  • glucose - very low
  • Gram stain - positive
A

Bacterial meningitis

31
Q

CSF results

  • appearance - clear/cloudy
  • WCC - high w/ lymphocytes
  • protein - high
  • glucose - normal
  • Gram stain - normal
A

Viral meningitis

32
Q

CSF results

  • appearance - clear/cloudy
  • WCC - high w/ lymphocytes
  • protein - high
  • glucose - low
  • Gram stain - normal
A

TB/Fungal meningitis