Neuro Infections

Question 1

What is Acute Encephalitis

Answer 1

Infection of the brain parenchyma

Question 2

What does pyogenic meningitis show over the surface of the brain

Answer 2

A thick layer of suppurative exudate covering the leptomeninges

Question 3

What does pyogenic meningitis show microscopically?

Answer 3

Neutrophils in the subarachnoid space

Question 4

How do you diagnose viral meningitis?

Answer 4

Viral stool culture
Throat swab
CSF PCR

Question 5

What is the treatment for viral meningitis?

Answer 5

Supportive as self limiting

Question 6

What viruses can cause Viral Encephalitis?

Answer 6

Herpes simplex
Varicella Zoster
CMV
HIV
Measles

Question 7

What is the treatment for Herpes Simplex and Varicella Zoster?

Answer 7

High dose IV Aciclovir

Question 8

What are clinical features of Encephalitis?

Answer 8

Insidous onset
Meningismus
Stupor, coma
Seizures
Partial paralysis
Confusion, psychosis
Speach/memory issues

Question 9

What are ivestigations for Encephalitis?

Answer 9

LP
EEG
MRI

Question 10

What is found on MRI with Encephalitis?

Answer 10

Inflamed portion of temporal lobe involving uncus and adjacent parahippocampal gyrus, in brightest white

Question 11

What are causes for bacterial meningitis in Neonates?

Answer 11

Listeria
Group B Strep
E.Coli

Question 12

What are causes for bacterial meningitis in Children?

Answer 12

H. Influenza

Question 13

What are causes for bacterial meningitis in ages 10 to 21?

Answer 13

meningicoccal

Question 14

What are causes for bacterial meningitis in over 21’s?

Answer 14

Pneumococcal > meningicoccal?

Question 15

What are causes for bacterial meningitis in the elderly?

Answer 15

Pneumococcal > listeria

Question 16

What are risk factors for bacterial meningitis?

Answer 16

Decreased CMI (listeria)
S/P neurosurgery/ open head trauma (Staph + gram -ve rods)
Fracture of cribiform plate (Pneumococcal)

Question 17

What is listeria and what do you use to treat it?

Answer 17

Gram +ve bacilli

IV Ampicillin/Amoxicillin

Question 18

Describe Cryptococcal meningitis?

Answer 18

Fungal
High in HIV
Serum and CSF Cryptococcal antigen
IV AmphotericinB/Flucytosine
Fluconazole

Question 19

What are clinical signs of Bacterial Meningitis?

Answer 19

Fever
Stiff neck
Alteration in consciousness

Question 20

What are signs and symptoms of bacterial meningitis?

Answer 20

Headache
Vomiting
Pyrexia
Neck Stiffness
Photophobia
Lethargy
Confusion
Rash

Question 21

What are differential diagnosis of meningitis?

Answer 21

Encephalitis 
Cerebral abscess
Severe sepsis from other source
Subarachnoid haemorrhage
Cerebral tumour

Question 22

What is Aseptic meningitis?

Answer 22

Non-pyogenic bacterial meningitis

Question 23

What is the spinal fluid like in Aseptic Meningitis?

Answer 23

Low number of WBC
Minimally elevated protein
Normal glucose

Question 24

What should be done in all patients with papiloedema or focal neurological signs?

Answer 24

An urgent CT scan

Question 25

What are warning signs?

Answer 25

Depressive conscious level GCS

Question 26

What is tje empirical therapy for bacterial meningitiss?

Answer 26

1. IV Ceftriaxone 2g bd
   add IV Ampicillin/Amoxicillin of listeria suspected
2. Penicillin allergy? - chloramphenicol IV with IV Vancomycin
   If listeria suspected then give trimoxazole

Question 27

What should be givenalongside the first dose or before the first dose of antibiotics in bacterial meningitis?

Answer 27

Steroids unless post-surgical meningitis

Question 28

What can be given as contact prophylaxis?

Answer 28

600mg Rifampicin
500mg Ciprofloxacin
250mg ceftriaxone