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Phase 3a - Neurology > Neurological Infections > Flashcards

Neurological Infections Flashcards

1
Q

Define Brain Abscess

A

A localized collection of pus in the brain parenchyma caused by infection, often bacterial or fungal.

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2
Q

What are the 3 different ways Brain Abscesses spread?

A

Direct, Haematogenous, Post surgical/ Traumatic

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3
Q

How are Brain Abscesses directly spread?

A

From sinusitis, otitis media, or dental infections.

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4
Q

How are Brain Abscesses spread Haematogenously?

A

From a distant infection (e.g., infective endocarditis, lung abscess).

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5
Q

How are Brain Abscesses spread post-surgery/traumatically?

A

Penetrating head injuries or neurosurgical procedures.

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6
Q

Name 3 risk factors for developing a Brain Abscess

A

Immunosuppression (e.g., HIV, chemotherapy).
Poorly controlled diabetes.
Congenital heart disease (e.g., right-to-left shunts).

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7
Q

Clinical features of Brain Abscess

A

Fever: May be absent in immunosuppressed patients.
Headache: Persistent and localized.
Neurological deficits: Focal symptoms such as hemiparesis, aphasia.
Signs of raised ICP: Vomiting, papilledema, confusion.
Seizures: Common presentation.

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8
Q

Ix for Brain Abscess

A

Neuroimaging:

MRI brain with contrast: Gold standard for diagnosis.
CT brain: May show ring-enhancing lesion.
Blood cultures:

Identify causative organisms.
Lumbar puncture:

Contraindicated in raised ICP.
Other tests:

Full blood count, inflammatory markers, and testing for immunosuppression (e.g., HIV).

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9
Q

Management of Brain Abscess

A

Medical:

Empirical antibiotics: Ceftriaxone + metronidazole ± vancomycin (tailored once cultures are available).
Dexamethasone: To reduce cerebral edema.
Surgical:

Aspiration or drainage: For larger abscesses (>2.5 cm) or those causing mass effect.
Monitoring:

Repeat imaging to assess response to treatment.

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10
Q

The most common imaging modality for diagnosing a brain abscess is ________.

A

MRI with contrast.

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11
Q

True or False: Lumbar puncture is routinely performed in patients with suspected brain abscess.

A

False. Lumbar puncture is contraindicated if there are signs of raised intracranial pressure.

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12
Q

What is the initial empirical antibiotic regimen for a brain abscess?

A

Ceftriaxone + metronidazole ± vancomycin.

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13
Q

Define Meningitis

A

Inflammation of the meninges surrounding the brain and spinal cord, usually caused by infection.

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14
Q

Name 4 causes of Meningitis

A

Bacterial, viral, fungal, non-infectious

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15
Q

Bacterial causes of Meningitis

A

Neisseria meningitidis (meningococcal).
Streptococcus pneumoniae (pneumococcal).
Listeria monocytogenes (in neonates, elderly, immunocompromised).

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16
Q

Viral causes of Meningitis

A

Enteroviruses, herpes simplex virus (HSV).

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17
Q

Fungal causes of Meningitis

A

Cryptococcus neoformans (common in HIV).

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18
Q

Non-infectious causes of Meningitis

A

Autoimmune diseases, malignancies.

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19
Q

Classic triad of Meningitis symptoms

A

Fever, neck stiffness, altered mental status.

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20
Q

Other clinical features of Meningitis

A

Photophobia, headache, nausea/vomiting, seizures, and rash (purpuric rash in meningococcal meningitis).

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21
Q

Ix for Meningitis

A

Lumbar Puncture. Blood Cultures + PCR testing, Imaging

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22
Q

What would a lumbar puncture show for bacterial meningitis?

A

High WBC count (neutrophils), low glucose, high protein.

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23
Q

What would a lumbar puncture show for viral meningitis?

A

High WBC (lymphocytes), normal glucose, normal or slightly raised protein.

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24
Q

What are blood cultutes and PCR testing for when investigating Meningitis?

A

Identify causative organisms.

25
Q

What type of imaging is used in Meningitis?

A

CT/MRI: Rule out contraindications to lumbar puncture (e.g., mass effect).

26
Q

Management of Meningitis

A

Empirical antibiotics:

Ceftriaxone + ampicillin (covers Listeria).
Add dexamethasone to reduce inflammation.
Supportive care:

Fluids, seizure management, and close monitoring.

27
Q

True or False: A purpuric rash is commonly associated with pneumococcal meningitis.

A

False. It is associated with meningococcal meningitis.

28
Q

Bacterial meningitis typically shows ______ glucose and ______ protein levels in cerebrospinal fluid analysis.

A

Low glucose and high protein.

29
Q

What are the first-line antibiotics for bacterial meningitis in adults?

A

Ceftriaxone and ampicillin (to cover Listeria).

30
Q

What is the purpose of dexamethasone in bacterial meningitis treatment?

A

To reduce inflammation and the risk of long-term complications such as hearing loss.

31
Q

Define Encephalitis

A

Inflammation of the brain parenchyma, most commonly caused by viruses.

32
Q

Causes of Encephalitis

A

Viral: HSV-1 (most common), varicella-zoster virus, enteroviruses.
Non-viral: Autoimmune (anti-NMDA receptor encephalitis).

33
Q

Clinical features of Encephalitis

A

Altered mental status: Confusion, agitation.
Seizures.
Focal neurological deficits.
Fever and headache.

34
Q

Ix for Encephalitis

A

MRI brain:

Key for identifying areas of inflammation.
Lumbar puncture:

Lymphocytic pleocytosis, normal glucose, elevated protein.
PCR testing:

Detects viral DNA/RNA (e.g., HSV).

35
Q

Management of Encephalitis

A

Empirical antiviral therapy: Acyclovir started promptly.
Supportive care: Airway management, seizure control, fluids.

36
Q

True or False: PCR testing on cerebrospinal fluid is the gold standard for diagnosing HSV encephalitis.

A

t

37
Q

Fill-in-the-blank:
HSV encephalitis is often associated with abnormalities in the ________ lobe on MRI.

A

Temporal

38
Q

What is the initial treatment for suspected viral encephalitis?

A

Intravenous acyclovir.

39
Q

Name two non-infectious causes of encephalitis.

A

Autoimmune encephalitis (e.g., anti-NMDA receptor encephalitis) and paraneoplastic syndromes.

40
Q

What is Herpes Zoster Virus (shingles)?

A

Reactivation of the varicella-zoster virus (VZV), causing a painful vesicular rash in a dermatomal distribution.

41
Q

Clinical Features of HZV

A

Prodrome:

Tingling, itching, or pain in the affected dermatome.
Rash:

Vesicular lesions along a single dermatome, unilateral.
Complications:

Postherpetic neuralgia, ophthalmic involvement, Ramsay Hunt syndrome.

42
Q

Managment of HZV

A

Antiviral therapy: Acyclovir, valacyclovir (within 72 hours).
Analgesia: NSAIDs, gabapentin for neuralgia.
Vaccination: Shingles vaccine for prevention.

43
Q

Fill-in-the-blank:
The dermatomal rash seen in herpes zoster is caused by reactivation of the _______ virus.

A

Varicella-zoster virus.

44
Q

True or False: Antiviral therapy is only effective if started within 7 days of rash onset.

A

False. It is most effective within 72 hours.

45
Q

What is the most common complication of herpes zoster?

A

Postherpetic neuralgia.

46
Q

Name one vaccine used to prevent herpes zoster in adults.

A

Shingrix or Zostavax.

47
Q

What is Malaria?

A

A parasitic disease caused by Plasmodium species, transmitted by Anopheles mosquitoes.

48
Q

Causes of Malaria

A

Plasmodium falciparum (most severe).
Plasmodium vivax, P. ovale, P. malariae, P. knowlesi.

49
Q

Clinical features of Malaria - prodrome

A

Fever, malaise, headache, myalgia.

50
Q

Classic triad of Malaria

A

Cyclical fever (every 48-72 hours), anemia, splenomegaly.

51
Q

Severe Malaria features

A

(P. falciparum): Altered consciousness, respiratory distress, multi-organ failure.

52
Q

Ix for Malaria

A

Blood smear microscopy: Giemsa staining to identify parasite.
Rapid diagnostic tests (RDTs).
FBC: Anemia, thrombocytopenia.

53
Q

Management of uncomplicated Malaria

A

Artemisinin-based combination therapy (ACT).
Chloroquine (if sensitive).

54
Q

Management of severe malaria

A

IV artesunate.

55
Q

Prevention of Malaria

A

Prophylaxis (e.g., atovaquone-proguanil, doxycycline).
Use of insecticide-treated bed nets.

56
Q

Name the five species of Plasmodium that cause malaria in humans.

A

Plasmodium falciparum.
Plasmodium vivax.
Plasmodium ovale.
Plasmodium malariae.
Plasmodium knowlesi.

57
Q

True or False: Plasmodium falciparum is the most severe form of malaria.

A

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58
Q

Fill-in-the-blank:
Malaria is transmitted by the bite of an infected ________ mosquito.

A

Anopheles.

Phase 3a - Neurology (18 decks)

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