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Clinical Neuroscience (My own) > Meningitis and subarachnoid haemorrhage > Flashcards

Meningitis and subarachnoid haemorrhage Flashcards

1
Q

What is a cistern?

A

An enlarged region located between arachnoid and pia

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2
Q

What is the function go a cistern?

A

Collects CSF

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3
Q

What are the functions of CSF?

A 
Physical support of neural structures
Excretion of brain metabolites
Intracerebral transport
Control of chemical environment
COlume change reciprocally with volume of inter cranial contents
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4
Q

What is the presentation of subarachnoid haemorrhage?

A 
headache
Dizziness
Orbital pain
Diplopia
Visual loss
nausea vomiting
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5
Q

What are the causes of subarachnoid haemorrhages?

A

Berry aneurysms (80%)

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6
Q

Why do berry aneurysms develop?

A

Due to pressure on the arterial wall of vessels in the subarachnoid space at bifurcation points

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7
Q

Which cerebral arteries are most affected?

A

Large anterior cerebral arteries in the anterior circle of willis
Anterior communicating artery

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8
Q

Describe features of intracranial arteries?

A

Lack external elastic lamina and have thin adventitia

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9
Q

What are risk factors of developing aneurysms?

A

Same as CVS- hypertension, smoking
Increased alcohol
Connective tissue disorders

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10
Q

What are signs of subarachnoid haemorrhage?

A

Normal mental state
Signs of meningism
Third nerve palsy
No motor or sensory deficits

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11
Q

What are signs of meningism?

A

Neck stiffness and photophobia

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12
Q

Why is there a nerve palsy?

A

Posterior communicating artery aneurysm

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13
Q

What are sentinel headaches in preceding months?

A

Minor leaks from aneurysms that seal up again

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14
Q

What happens after a subarachnoid haemorrhage?

A

Microthrombi which can occlude smaller arteries
Vasoconstriction from CSF irritation
Cerebral oedema
Sympathetic activation- myocardial damage
Early rebleeding
Acute hydrocephalus
Global cerebral ischaemia

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15
Q

What is the cerebral oedema a response to?

A

Hypoxia

Extravasated

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16
Q

What are the investigations of subarachnoid haemorrhage, in order of what you’d do?

A

1st line- CT scan
Lumbar puncture
Angiography

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17
Q

What would you see in a lumbar puncture after centrifugation?

A

Xanthochromia- blood breakdown/ bilirubin in CSF

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18
Q

What is the treatment of subarachnoid haemorrhage?

A

Assessment on whether they need airway support
Monitoring CVS parameters
CCB (Nimodipine)
Operate on patients with good neurological status within 72 hrs
Clipping (open craniotomy)
Coiling (mauro-radiologists)

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19
Q

What is involved in coiling treatment?

A

Insertion of wire into aneurysm sac which causes thrombosis of blood within aneurysm

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20
Q

What is the prognosis for a subarachnoid haemorrhage?

A 
Very poor prognosis
10-15% die before hospital
25% die within 24 hrs
40% within 1st month
Rebleeding occurs in up to 30% within 2 weeks in unoperated patients
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21
Q

What are the two broad categories of CNS infections?

A

Parenchyma (encephalitis)

Meninges (Meningitis)

22
Q

What is the more common area of meningitis?

A

Inflammation of the leptomeninges rather than dura

23
Q

WHat is the most common cause of meningitis?

A

Infection

24
Q

What are the signs and symptoms of meningitis?

A 
Headache
Neck stiffness
Photophobia
Flu like
Joint pains
Rash
Reduced GCS
25
Q

How long does it take to develop signs and symptoms?

A

Hours in bacterial and days in viral cause

26
Q

WHat are some signs and symptoms of meningitis in babies?

A

Inconsolable crying/ high pitched
Reduced feeds
Floppy
Bulging fontanelle

27
Q

What is the most common cause of a rash in meningitis?

A

Meningococcal meningitis

28
Q

What causes the rash?

A

Bleeding into skin or mucosa (microvascular thrombosis)

29
Q

What sort of rash is produced?

A

Non blanching rash

30
Q

What are large lesions in meningitis called and what are small called?

A

Large- purpuric

Smaller- petechial

31
Q

Where are the most common areas of the body where the rash is found?

A 
Trunk
Legs
Mucous membranes
Conjuctivae
Occasionally palms and soles
More common in younger
32
Q

What are the most common causative pathogens for meningitis?

A 
Streptococcus pneumonia (Pneumococcal meningitis)
Neisseria meningitides (Meningococcal meningitis)
Haemophilus influenza (Hib meningitis)
33
Q

What are the risk factors for community acquired bacterial meningitis?

A

Youngest and oldest are most affected
Crowding
Immune problems
Cochlear implants

34
Q

How does pneumococcus bacteria reach the CNS?

A

Colonisation of nasopharynx ascent from eustachian tube to the middle ear- prolonged infections like otitis media can cause spread of CSF
or
Seeding to lower respiratory tract (pneumonia) leading to lung inflammation allowing bacteria to enter blood

35
Q

What happens to the meningitis bacteria when in the subarachnoid space?

A

No resistance to multiplication
Inflammatory mediators induced
Lots of leucocytes enter CSF
Inflammatory cascade results in cerebral oedema and raised ICP

36
Q

What are the complications of meningitis?

A 
Septic shock
DIC
Coma
Seizures
Hearing loss
Hydrocephalus
Focal paralysis
37
Q

How do you make a diagnosis of meningitis?

A

Symptoms and signs
Physical exams
Kernig sign
Brudzinski

38
Q

What is Kernig sign?

A

Supine patient with thigh flexed at 90 degrees
Extension of knee is met with resistance
More common in children

39
Q

What is Brudzinski sign?

A

When knee is flexed there is an involuntary flexion of knee and hips when head is lifted up
More common in children

40
Q

What is the 1st line investigation of Meningitis?

A

Lumbar puncture

PCR

41
Q

What would you find in the lumbar puncture in bacterial meningitis?

A 
In untreated bacterial:
Cloudy, high numbers of white cells
Elevated protein
Low glucose
Positive gram stain
42
Q

What would you find in the lumbar puncture in viral meningitis?

A

Clear or cloudy (immune cells and protein)
Normal or raised protein
Normal glucose

43
Q

What is the treatment for viral meningitis?

A

Supportive fluids
Anti-pyrexials
NSAIDs
Body recovers on its own

44
Q

What is a risk of the raised ICP from meningitis?

A

Brain herniation

45
Q

What are the clinical signs of brain herniation?

A

Decreasing consciousness
Brainstem signs
Recent seizure

46
Q

What should be avoided in brain herniation?

A

Lumbar puncture

47
Q

Why is a PCR done?

A

Helpful to diagnose patients who received empirical antibiotic treatment
To distinguish bacterial from viral causes

48
Q

What is the treatment for bacterial meningitis?

A

Empirical antibiotics
Supportive therapy
Dexamethasone

49
Q

What are examples of empirical antibiotics?

A

Vancomycin and a cephalosporin (Ceftriaxone or Cefotaxime)

50
Q

WHat is the treatment for viral meningitis?

A

Aciclovir for Herpes

Clinical Neuroscience (My own) (9 decks)

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