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Yr5 Neuro > Meningitis & Encephalitis > Flashcards

Meningitis & Encephalitis Flashcards

1
Q

What are the causes of bacterial meningitis in different age groups?

A

Neo-3m: GRAM +VE = Group B Strep, E.Coli, Listeria
3m-6yr: N.Meningitidis, Strep Pneumoniae, HiB
>6yr: N.Meningitidis, Strep Pneumoniae

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2
Q

What are the causes of viral meningitis?

A

Enterovirus
HSV1&2
EBV
Adenovirus

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3
Q

How do young children present w/meningitis?

A 
Poor feeding
Irritable
Fever
Convulsions
Vomiting
URTI +/- respiratory distress
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4
Q

What are the Sx of meningism?

A

1) Photophobia
2) Neck stiffness
3) Headache
Kernig: Hips/knees flexed, knee extension = back pain
Brudzinski: Flex neck = flex knee & hip

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5
Q

What are the signs of ↑ICP?

A

Babies: Irritability & HIGH PITCHED cry
Drowsy & lethargic
↓GCS
Bulging fontanelle
I/L dilated pupil
Headache
Opisthotopos: Infant lying w/stiff arched back

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6
Q

How is meningitis investigated?

A 
Bloods: FBC (↑Neut), ↑↑CRP, Glucose (for LP comparison), Coag Screen, cultures
ABG
LP
Throat/nasal swab & culture
Viral PCR
Rapid antigen screen
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7
Q

How is meningitis treated?

A

GP: IM BenPen & URGENT TRANSFER
<3m OR >5yo: IV Cefotaxime (50mg/kg) + Amoxicillin
3m-5yo: IV Cefotaxime/ Ceftriaxone (80mg/kg)
>50yo: Ampicillin (Listeria cover) + Cefotaxime
Dexamethasone: 0.15mg/kg QDS for 4days for ALL bacterial meningitis >1yo

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8
Q

How are close contacts treated prophylactically in meningitis?

A

PO Ciprofloxacin

Group C meningococcal: Vaccination

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9
Q

How can meningitis cause ↑ICP?

A

Release of endotoxin by meningococcus
Leads to inflammatory mediated CSF response
Results in leakage of protein & fluid from cerebral vasculature
Causes cerebral oedema & vascular thrombosis
Produces ↑ICP = ↓cerebral perfusion
Potential for brain death

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10
Q

How does meningitis cause septicaemia?

A

Bacteraemia & endotoxin release = ↑ vascular permeability
Water & proteins from IVS to EVS
Leads to tissue hypoxia & ischaemia

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11
Q

What are the Sx of meningococcal septicaemia?

A 
Fever
Cold &amp; painful peripheries
Pallor
Skin mottling → petechial rash
Neck stiffness
↓ consciousness
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12
Q

How is meningococcal septicaemia investigated?

A

Whole blood real time PCR

LP = Contraindicated

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13
Q

What are the complications of meningitis?

A

Deafness: Inflammatory damage to cochlear hair cells
Cerebral abscess: Swinging pyrexia
Epilepsy
Mental developmental delay

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14
Q

What are the contraindications to an LP?

A 
Signs of ↑ICP: Papilloedema, U/L pupil dilatation, Cushing's reflex
Meningococcal septicaemia
Local infection over LP site
Coagulopathy
Thrombocytopenia
Seizure
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15
Q

What is Cushing’s reflex?

A

Physiological response to ↑ICP

Bradycardia + Hypertension + irregular breathing

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16
Q

What are the signs of a bacterial infection on a LP sample?

A

Cloudy
↓Glucose
↑Protein
Neutrophil polymorphs

17
Q

What are the signs of a viral infection on a LP sample?

A

Clear
60-80% plasma glucose
Normal/↓ Protein
Lymphocytes

18
Q

What are the signs of a TB infection on a LP sample?

A

Cloudy
↓Glucose
↑Protein
Lymphocytes +++

19
Q

What is encephalitis?

A

Inflammation of the brain

20
Q

What are the infective causes of encephalitis?

A

HSV 1- MOST COMMON CAUSE IN ADULTS
Viral: CMV, EBV, VZV, HIV, measles, mumps
Non-Viral: Bacterial meningitis, TB, Listeria, Legionella

21
Q

What are the hallmarks of encephalitis?

A

Fever
Headache
Altered mental status

22
Q

What are the Sx of viral encephalitis?

A 
Meningism
Cold sores (HSV)
Fever
Rash
Lymphadenopathy
Conjunctivitis
?Recent travel/animal bite
23
Q

What are the investigations for encephalitis?

A

1) Bloods: Cultures, LFTs, Glucose (rule out DKA)
2) Contrast CT: HSV = focal B/L temporal lobe involvement
AFTER CT
3) LP: ↑↑Protein, ↑↑Lymphocytes, ↓Glucose, send for viral PCR
Other: Viral PCR (HSV)
Toxoplasma IgM titre
Malaria film, EEG

24
Q

How is encephalitis treated?

A

IV Aciclovir: 10mg/kg TDS for 14days- start within 30mins of arrival

25
Q

What are the different grades of hepatic encephalopathy?

A

1: ↓Awareness, impaired attention, altered sleep, euphoria/depression. Mild asterixis
2: Lethargy, disorientation, slurred speech, asterixis
3: Gross disorientation. Bizarre behavior, semi-stupor, asterixis absent.
4: Coma

26
Q

What is the pathophysiology of hepatic encephalopathy?

A

Impaired clearance of ammonia
Leads to build up of ammonia
Affects neurotransmitters

27
Q

How is hepatic encephalopathy treated?

A

Lactulose: 20-30g (approx 30ml) every 2hours until loose stools then titre so only 2-3 stools a day

Yr5 Neuro (8 decks)

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