Neuro Infections Flashcards
What is Acute Encephalitis
Infection of the brain parenchyma
What does pyogenic meningitis show over the surface of the brain
A thick layer of suppurative exudate covering the leptomeninges
What does pyogenic meningitis show microscopically?
Neutrophils in the subarachnoid space
How do you diagnose viral meningitis?
Viral stool culture
Throat swab
CSF PCR
What is the treatment for viral meningitis?
Supportive as self limiting
What viruses can cause Viral Encephalitis?
Herpes simplex Varicella Zoster CMV HIV Measles
What is the treatment for Herpes Simplex and Varicella Zoster?
High dose IV Aciclovir
What are clinical features of Encephalitis?
Insidous onset Meningismus Stupor, coma Seizures Partial paralysis Confusion, psychosis Speach/memory issues
What are ivestigations for Encephalitis?
LP
EEG
MRI
What is found on MRI with Encephalitis?
Inflamed portion of temporal lobe involving uncus and adjacent parahippocampal gyrus, in brightest white
What are causes for bacterial meningitis in Neonates?
Listeria
Group B Strep
E.Coli
What are causes for bacterial meningitis in Children?
H. Influenza
What are causes for bacterial meningitis in ages 10 to 21?
meningicoccal
What are causes for bacterial meningitis in over 21’s?
Pneumococcal > meningicoccal?
What are causes for bacterial meningitis in the elderly?
Pneumococcal > listeria
What are risk factors for bacterial meningitis?
Decreased CMI (listeria)
S/P neurosurgery/ open head trauma (Staph + gram -ve rods)
Fracture of cribiform plate (Pneumococcal)
What is listeria and what do you use to treat it?
Gram +ve bacilli
IV Ampicillin/Amoxicillin
Describe Cryptococcal meningitis?
Fungal High in HIV Serum and CSF Cryptococcal antigen IV AmphotericinB/Flucytosine Fluconazole
What are clinical signs of Bacterial Meningitis?
Fever
Stiff neck
Alteration in consciousness
What are signs and symptoms of bacterial meningitis?
Headache Vomiting Pyrexia Neck Stiffness Photophobia Lethargy Confusion Rash
What are differential diagnosis of meningitis?
Encephalitis Cerebral abscess Severe sepsis from other source Subarachnoid haemorrhage Cerebral tumour
What is Aseptic meningitis?
Non-pyogenic bacterial meningitis
What is the spinal fluid like in Aseptic Meningitis?
Low number of WBC
Minimally elevated protein
Normal glucose
What should be done in all patients with papiloedema or focal neurological signs?
An urgent CT scan
What are warning signs?
Depressive conscious level GCS
What is tje empirical therapy for bacterial meningitiss?
- IV Ceftriaxone 2g bd
add IV Ampicillin/Amoxicillin of listeria suspected - Penicillin allergy? - chloramphenicol IV with IV Vancomycin
If listeria suspected then give trimoxazole
What should be givenalongside the first dose or before the first dose of antibiotics in bacterial meningitis?
Steroids unless post-surgical meningitis
What can be given as contact prophylaxis?
600mg Rifampicin
500mg Ciprofloxacin
250mg ceftriaxone
