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Neuro > Meningitis/Encephalitis > Flashcards

Meningitis/Encephalitis Flashcards

Survive Neuro

1
Q

Define meningitis

A

infection/inflammation of meninges, subarachnoid space, including brainstem and spinal cord

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2
Q

Define encephalitis

A

diffuse infection of brain parenchyma

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3
Q

Infection of the spinal cord

A

Myelitis

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4
Q

Give 2 mechanisms by which the Blood-Brain Barrier protects the brain

A
  1. Tight junctions

2. Decreased permeability

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5
Q

What are the main routes of microbial infection to the meninges?

A
  1. Haematogenous
  2. Via the peripheral nerves
  3. Trauma
  4. Local extension (traveling between connected areas)
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6
Q

List the mechanisms of nervous system damage

A
  1. Inflammation
  2. Neural glia injury
  3. Immune-mediated damage
  4. Via toxins
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7
Q

Which condition is indicated by the symptoms below?

  1. Fever
  2. Headache
  3. Nuchal rigidity
  4. Photophobia
  5. Phonophobia
A

Meningitis

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8
Q

List some possible symptoms of meningitis besides the basic ones

A

Adults: petechiae on trunk/extremities

Infants: tense/bulging fontanel, high fever, extreme shivering, vomiting/refusing food, diarrhea, difficult to wake, blotchy skin (pale or turning blue), irritable on being picked up, either stiff body with jerky movements or floppy and lifeless, cold hands and feet, irritability from joint pain

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9
Q

Pain on flexion of the hip and knee

A

Kernig’s sign

an indication of meningitis

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10
Q

Pain in neck and flexion of knees on passive flexion of the neck

A

Brudzinski’s sign

an indication of meningitis

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11
Q

What is the condition described?

Infection of brain parenchyma and inflammation of meninges

A

Meningoencephalitis

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12
Q

What is the condition described?

Infection/inflammation of brain parenchyma, meninges, and spinal cord

A

Encephalomyelitis

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13
Q

What condition is indicated by the following?

Fever, headache, nuchal rigidty, focal neurological deficits

A

Encephalitis

note that photophobia, and phonophobia are NOT necessarily present

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14
Q

Diagnostics tests for encephalitis and meningitis

A

CSF analysis (lumbar puncture)
Microscopy (staining)
Culture (bacterial, fungal, blood)
Antigen testing

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15
Q

latex beads coated with a specific antigen/antibody that binds a complementary other.

Positive: grainy look of clumped beads
Negative: white emulsion

A

Latex Agglutination Test

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16
Q

CSF analysis:

↑↑↑ WBC (neutrophils)
↑↑ protein
↑↑ opening pressure
↓ glucose
turbid CSF
Gram stain yields results
A

Pyogenic (Bacterial) Meningitis/Encephalitis

17
Q

CSF analysis:

↑↑ WBC (lymphocytes)
↑ protein
↑ opening pressure
Normal glucose
Clear CSF
Gram stain yields NO results
A

Aseptic Meningitis/Encephalitis

18
Q

CSF analysis:

↑ WBC (lymphocytes)
Normal protein
(Opening pressure may be contraindicated due to papilloedema)
Normal glucose
Clear CSF
Gram stain yields NO results
A

Viral Encephalitis

19
Q

CSF analysis:

↑ WBC (lymphocytes)
↑↑ protein
Normal opening pressure
↓ glucose
Slightly turgid CSF w/COBWEB CLOT
No gram stain
Acid fast stain positive
A

Chronic tuberculosis

20
Q

List some characteristics of aseptic meningitis

A 
In-tact mental status;
Fever, headache, nuchal rigidity;
Altered sensorium;
NON BLANCHING RASH
Possible preceding upper respiratory tract infection
21
Q

List some causal organisms of aseptic meningitis

A

Eneteroviruses (poliovirus, coxsackie virus, ECHO virus);

HSV

22
Q

What is the likely causal organism for the following:

not immunised
recent travel outside the US (likely sub-Saharan Africa)
mild gastritis/stomach ache
flaccid paralysis
hyporeflexia
aseptic meningitis symptoms and labs
A

Polio virus

23
Q

Name the condition described:

not immunised
progressive weakness with pain and ↓ muscle mass
possibly travel outside the US in the past (whether recent or distant)

A

Postpolio Syndrome

24
Q

Salk vaccine

A

For: Poliovirus
Type: killed (sulking emo with skull tee)
Route: IV

Advantages: no risk of vaccine-relate disease; safe for immuno-compromised patients; effective

Disadvantages: requires booster (secretory antibody made); painful; virus can still spread from GI tract

25
Q

Sabin Vaccine

A

For: Poliovirus
Type: live (“savin’ a life”)
Route: Oral

Advantages: painless; specific antibodies made (lifelong, no booster); virus can’t spread by GI tract; can be otherwise spread to contacts and cause indirect immunisation; HERD IMMUNITY

Disadvantages: risk of vaccine-associated poliomyelitis in patient and contacts; possible spread of vaccine to contacts without consent; not safe for immunodeficient patients

26
Q

Give the characteristics of Lymphocytic Choriomeningitis

Virus, signs, labs

A

Virus: arenavirus –> segmented RNA virus, can cross placenta;
Rodent borne (transmitted in faeces);
Infection route: inhalation, skin abrasion, GIT;

Signs: flu-like symptoms; meningitis; encephalitis; hydrocephalus

Labs: leukopenia; thrombocytopenia; CSF; pleocytosis; ↑ liver enzymes; ↑ protein; ↓ glucose

27
Q

Give the etiology of nosocomial (hospital-derived) meningitis

A

post neurosurgery (S. aureus; S. epidermidis)

VP shunts (S. aureus; S. epidermidis; E. faecalis; gram neg. rods)

Cranial trauma:
Basilar skull fracture
CSF rhinorrhea (S. pneumoniae; H. influenzae; Group A Strep)

Lumbar puncture (skin flora; nosocomial microbes)

28
Q

What are the likely causative microbes of community-acquired meningitis by age?

A

Neonatal:
E. coli; L. monocytogenes; S. agalatiae; Enteroviruses

3 mos - 5 years:
S. pneumoniae; H. influenzae b; N. meningitidis

5 to <50 years:
N. meningitidis; S. pneumoniae

> 50 years:
S. pneumoniae; H. influenzae b; N. meningitidis; Gram NEGATIVE rods; L. monocytogenes; S. aureus

ELSE SHiN’s NeeM SoaP SHiNGLeS

29
Q

List causes and sources of neonatal aseptic meningitis

A

Enteroviruses (<3 mos.)
HSV 2 (neonatal herpes)
VSV (mother had varicella last wk of pregnancy)
CMV (cytomegalic inclusion disease)

30
Q

List causes and sources of neonatal bacterial meningitis

A

E. coli (K capsule) - birth canal; neonatal sepsis and meningitis

S. agalactiae - birth canal;
neonatal sepsis, meningitis, pneumonia (<7 days/early onset);
sepsis and meningitis (>7 days/late onset)

L. monocytogenes - in utero transmission (amneonitis and foetal death); perinatal transmission (<5 days; meningitis; sepsis; granulomatosis infantilisepticism); via breastfeeding (>5 days; meningitis);
Pregnant mother shows sepsis and flu-like illness

31
Q

Infections caused by N. meningitidis

A
  1. Meningitis

2. Meningococcemia

32
Q

Meningococcemia

A

Previously health with recent upper respiratory tract infection
Prodrome: headache, nausea, vomiting, myalgias, arthralgias, and rash (usually petechiae over extremities)

33
Q

List some characteristics of N. meningitidis as a pathogen

A

MOST COMMON CAUSE OF COMMUNITY-ACQUIRED MENINGITIS (college dorms, army barrack, shelters);
Asymptomatic carriage common;
Found in the meningitis belt (Sub-Saharan Africa);
6 mos. - 5 years;

34
Q

List the meningococcus vaccines

A
  1. Meningococcal conjugate (Mentactra, Menveo)

2. Serogroup B meningococcal vaccines (Bexsero, Trumenba)

35
Q

List some causal organisms of bacterial/pyogenic meningitis

A
  1. N. meningitidis
  2. S. pneumoniae (immuno-competent and -compromised)
  3. H. influenzae b (in unvaccinated children and elderly)
  4. L. monocytogenes (immuno-compromised and -suppressed; neonates; elderly; 5-10% of all US community-acquired meningitis)
36
Q

List the empirical treatment of meningitis by age group

A

0-6 mos: Ampicillin + Gentamycin

6 mos - 6 yrs: Ceftriaxone + Vancomycin

6-60 yrs: Ceftriaxone + Vancomycin

60+ yrs: Ceftriaxone + Vancomycin + Ampicillin

37
Q

State the causal organism:

meningitis in an adult following upper respiratory infection
Gram stain: gram +ve, lancet-chaped cocci in pairs

A

S. pneumoniae

38
Q

Risk factors for S. pneumoniae-derived meningitis?

A

Recent URI
Asplenic
Sickle cell (functionally asplenic)
Alcoholics

Neuro (2 decks)

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