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TCA 4 - Headache > Meningitits > Flashcards

Meningitits Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges

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2
Q

What are the risk factors for meningitis?

A
  • Extremities of age
  • Living in close proximity
  • Absence of vaccination Hx
  • Immunosuppression
  • Patients having spinal procedures
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3
Q

What are the important factors in a history?

A
  • Classic triad of symptoms
  • Onset
    More rapid = more likely bacterial
  • Patient’s travel Hx
    Some countries have high rates of pneumococcal penicillin resistance
  • Neurological state
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4
Q

What are the symptoms of bacterial meningitis?

A 
- Triad:
      Photophobia
      Meningism (neck stiffness)
      Headache
- Not-blanching petechial rash (non always present)
- Altered mental state
- Fever/vomiting
- Very sleepy/difficult to wake
- Seizures
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5
Q

What are the symptoms of meningococcal septicaemia?

A

Non-blanching rash plus:

  • Fever
  • Vomiting/nausea
  • lethargy
  • Muscle ache/joint pain
  • Cold hands/feet
  • Leg pain
  • Pale/mottled skin
  • Rapid breathing/dyspnoea
  • Confusion
  • Very sleepy/vacant/difficult to wake.
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6
Q

What is meningococcal disease?

A

Meningitis and/or septicaemia caused by Neisseria meningitidis

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7
Q

Is bacterial or viral meningitis more fatal?

A

Bacterial

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8
Q

Is bacterial or viral meningitis more common?

A

Viral

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9
Q

What are the most common bacteria that cause bacterial meningitis?

A
  • Neisseria meningitidis (meningococcus)

- Streptococcus pneumoniae (pneumococcus)

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10
Q

What is the most common viruses that cause viral meningitis?

A
  • Herpes Simplex Virus (HSV)
  • Enterovirus
  • Varicella zoster virus (VZV)
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11
Q

How is herpes simplex virus treated?

A

Aciclovir

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12
Q

What would you look for on examination for meningitis?

A 
- Glass test
      Purpuric non-blanching rash
- Sepsis 
- GCS
- Neck stiffness
- Kernig's sign
- Brudzinki's test
- Fundoscopy
- Neurological exam
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13
Q

What is Kernig’s sign?

A
  • Thigh is flexed at the hip and knee at 90-degree angles

- Subsequent extension in the knee is painful

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14
Q

What is Brudzinki’s test?

A
  • Lie patient flat on back, gently use your hands to lift their head and neck off the bed and flex their chin to their chest.
  • +ve test = involuntary flexion of hips and knees
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15
Q

What investigations would you order for a patient with meningitis who is NOT suspected to have sepsis?

A

Bloods

  • FBC
  • U&E
  • Creatinine
  • LFTs
  • Clotting screen
  • Blood cultures
  • Procalcitonin (or CRP if unavailable)
  • Meningococcal and Pneumococcal PCR
  • Serology sample

Throat swab
- Bacterial culture

CSF

  • Opening pressure
  • Microscopy, culture and sensitivity
  • Meningococcal and pneumnococcal PCR
  • Protein
  • Glucose
  • Lactate

Further tests
- PCR

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16
Q

What investigations would you order for a patient with meningitis who is suspected to have sepsis?

A

Bloods

  • FBC
  • U&E
  • Creatinine
  • LFTs
  • Clotting screen
  • Blood cultures
  • Procalcitonin (or CRP if unavailable)
  • Meningococcal and Pneumococcal PCR
  • Serology sample

Throat swab
- Bacterial culture

17
Q

When would you delay lumbar puncture?

A
  • Signs of severe sepsis or rapidly evolving rash
  • Respiratory or cardiac compromise
  • Anticoagulant therapy/known thrombocytopenia
  • Infection at the site of LP
  • Focal neurological signs (raised ICP)
  • Papilledema
  • Continuous or uncontrolled seizures
  • GCS ≤12
18
Q

Where would you insert the needle for lumbar puncture and why?

A
  • L3-4

- Spinal cord ends at L1-2

19
Q

What would bacterial meningitis look like on a lumbar puncture sample?

A
  • Appearance = Turbid/cloudy
  • WCC count = 500-10,000 polymorphs (high)
  • Glucose = very low
  • Protein = High

Bacteria swimming in the CSF will release proteins and use up glucose
Immune system releases neutrophils in response to bacteria

20
Q

What would viral meningitis look like on a lumbar puncture sample?

A
  • Appearance = Clear
  • WCC count = <1000 lymphocytes
  • Glucose = Normal
  • Protein = Raised

Viruses don’t use glucose but may release a small amount of protein
Immune system releases lymphocytes in response to viruses

21
Q

What is the ‘blind’ treatment for bacterial meningitis in a GP setting or the treatment of a non-blanching rash?

A

IM or IV benzylpenicillin
• <1 year – 300mg
• 1-9 years = 600mg
• > 10 years – 1200mg

DO NOT GIVE IF ALLERGIC TO PENICILLINS

22
Q

What is the treatment for bacterial meningitis in a hospital setting?

A

< 3 months
- Cefotaxime + amoxicillin/ampicillin

> 3 months
- Cefotaxime

ADDITIONAL
- Vancomycin rifampicin
If risk of penicillin resistant pneumococcal infection
- Dexamethasone

23
Q

What would you give for bacterial meningitis if the patient has a penicillin allergy?

A

Chloramphenicol and dexamethasone

24
Q

What are differentials for meningitis?

A
  • Encephalitis
  • Non-infectious causes
    Blood
    Trauma
    Drugs
  • Subdural empyema
25
Q

What is bacterial meningitis?

A

Bacteria infect the lining of the meninges and the spinal cord

26
Q

What is meningococcal septicaemia?

A

Bacteria in the blood multiply uncontrollably

TCA 4 - Headache (4 decks)

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