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Year 4 - Special Senses > Neurology - Infections > Flashcards

Neurology - Infections Flashcards

1
Q

What is Herpes simplex encephalitis?

A

Infection by herpes simplex virus that affects the temporal lobes.

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2
Q

Features of herpes simplex encephalitis.

A
  • fever
  • headache
  • psychiatric symptoms
  • seizures
  • vomiting
  • aphasia
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3
Q

Aetiology of herpes simplex encephalitis.

A

HSV-1 infecting temporal and inferior frontal lobes.

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4
Q

Diagnostic workup for herpes simplex encephalitis.

A
  • CSF (?lymphocytosis, elevated protein)
  • PCR (?HSV)
  • CT (medial temporal and inferior frontal changes)
  • EEG changes
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5
Q

Treatment of herpes simplex encephalitits.

A

Early IV aciclovir.

Left untreated mortality ~80%.

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6
Q

Species of malaria.

A
  • Plasmodium falciparum (most common)
  • Plasmodium vivax
  • Plasmodium ovale
  • Plasmodium malariea
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7
Q

Protective factors against malaria.

A
  • sickle cell trait
  • G6PD deficiency
  • HLA-B53
  • absence of Duffy antigens
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8
Q

Presentation of falciparum malaria.

A
  • feveer (cyclical)
  • n+v
  • splenomegaly
  • abdominal pain
  • diarrhoea
  • cough
  • generalised body aches
  • headache
  • dizziness
  • thrombocytopenia
  • AKI
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9
Q

Complications of falciparum malaria.

A
  • cerebral malaria (seizures, coma)
  • acute renal failure
  • acute respiratory distress syndrome
  • hypoglycaemia
  • DIC
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10
Q

Management of uncomplicated falciparum malaria.

A

Artesunate

plus

Mefloquine.

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11
Q

Features of severe falciparum malaria.

A
  • parasitaemia >2%
  • hypoglycaemia
  • acidosis
  • temperature >38°C
  • severe anaemia
  • acute complications
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12
Q

Management of severe falciparum malaria.

A
  • IV artesunate
  • exchange transfusion (parasite count >10%)

Haemodynamic instability usually indicates coexistant bacterial septicaemia; malaria rarely causes haemodynamic collapse.

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13
Q

Most common causes of meningitis.

0-3 months old.

A
  • GBS
  • E. coli
  • Listeria monocytogenes
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14
Q

Most common causes of meningitis.

3 months - 6 years old.

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
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15
Q

Most common causes of meningitis.

6-60 years old.

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
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16
Q

Most common causes of meningitis.

> 60 years

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Listeria monocytogenes
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17
Q

Most common causes of meningitis.

Immunocompromised.

A

Listeria monocytogenes

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18
Q

Features of meningitis.

A

Triad of meningism:
- neck stiffness
- photophobia
- headache

Other fetures:
- fever
- nausea / vomiting
- non-blanching rash
- decreased consciousness

19
Q

Pre-hospital management of suspected bacterial meningitis.

A
  • urgent hospital transfer
  • IM benzylpenicillin (as long as doesn’t delay transit to hospital)
20
Q

In-hospital management of suspected meningitis.

A

Manage via ABCDE approach.

  • IV access > take bloods and blood culture
  • lumbar puncture
  • IV antibiotics
  • IV dexamethasone
21
Q

Contraindications to lumbar puncture.

A
  • signs of severe sepsis or rapidly evolving rash
  • severe respiratory / cardiac compromise
  • significant bleeding risk
  • signs of raised ICP
22
Q

Signs of raised ICP.

A
  • focal neurological signs
  • papilloedema
  • significant fontanelle bulging
  • DIC
  • signs of cerebral herniation
23
Q

CSF findings consistent with bacterial infection.

a) appearance

b) glucose

c) protein

d) white cells

A

a) cloudy

b) low (<1/2 plasma)

c) high (>1g/l)

d) raised granulocytes

24
Q

CSF findings consistent with viral infection.

a) appearance

b) glucose

c) protein

d) white cells

A

a) clear / cloudy

b) normal

c) normal / raised

d) raised lymphocytes

25
Q

IV antibiotics in meningitis.

a) 3-months to 50 years

b) >50 years

A

a) cefotaxime

b) cefotaxime + amoxicillin

26
Q

Management of patients with signs of raised intracranial pressure.

A
  • critical care input
  • secure airway
  • high flow oxygen
  • IV access (bloods / blood culture)
  • IV dexamethasone
  • IV antibiotics
  • arrange neuroimaging
27
Q

Bloods taken in suspected meningitis.

A
  • FBC
  • U&Es / renal function
  • glucose
  • lactate
  • clotting profile
  • CRP
28
Q

If an LP is performed, what tests should be requested?

A
  • glucose, protein, microscopy and culture
  • lactate
  • meningococcal and pneumococcal PCR
29
Q

Management of contacts of meningitis.

A

People who have been exposed to a patient with confirmed bacterial meningitis within 7 days before symptom onset should be given prophylactic antibiotics.

Single dose of ciprafloxacin used.

30
Q

Causes of viral meningitis.

A
  • non-polio enterovirus
  • mumps
  • HSV
  • HZV
  • CMV
  • HIV
  • measles
31
Q

Risk factors for viral meningitis.

A
  • extremes of age (<5 years, >60 years)
  • immunocompromised
  • IV drug user
32
Q

Management of viral meningitis.

A

IV aciclovir if risk factors.

Generally speaking, viral meningitis is self-limiting and will spontaneously resolve within 2 weeks.

33
Q

Complications of meningitis.

A
  • sensorineural hearing loss*
  • seizures
  • focal neurological deficit
  • sepsis
  • intracerebral abscess
  • brain herniation
  • hydrocephalus

*all patients offered audiology assessment as soon as they have recovered, to assess for hearing impairment.

34
Q

Examination findings consistent with meningitis.

A
35
Q

Causes of brain abscess.

A
  • extension of sepsis from middle ear / sinus
  • trauma
  • surgery to scalp
  • penetrating head injury
  • embolic events
36
Q

Presenting symptoms of brain abscess.

A

Abscesses have considerable mass effect in the brain and raised ICP is common.

  • headache
  • fever
  • focal neurology (e.g. oculomotor nerve palsy, abducens nerve palsy)
  • nausea
  • papilloedema
  • seizures
37
Q

Imaging for brain abscess.

A
  • CT scanning
38
Q

Management of brain abscess.

A
  • surgical drainage
  • IV antibiotics
  • dexamethasone (pressure management)
39
Q

Features of Lyme disease.

A
  • bulls-eye rash (erythema migrans)
  • headache
  • lethargy
  • fever
  • arthalgia
40
Q

Late features of Lyme disease.

a) cardiovascular

b) neuroloical

A

a) heart block; pericarditis; myocarditis

b) facial nerve palsy; radicular pain; meningitis

41
Q

Investigation of Lyme disease.

A

Clinical diagnosis if erythema migrans is present.

ELISA test first line investigation if warranted.

42
Q

Management of asymptomatic tick bites.

A
  • remove tick if present
  • do not give abx unless symptomatic
43
Q

Management of symptomatic tick bites.

A
  • remove tick
  • doxycycline (or amoxicillin if pregnant)
44
Q

Complication of treating Lyme disease.

A

Jarish-Herxheimer reaction - fever, rash and tachycardia after first dose of antibiotic.

Year 4 - Special Senses (17 decks)

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