Neurology\Meningitis

Question 1

Causes of bacterial meningitis according to age group-

< 1 month

Answer 1

• Group B streptococcus > gram negative bacilli > Strep. pneumoniae

Question 2

Causes of bacterial meningitis according to age group-

1 - months

Answer 2

• Group B Strep > E. coli > Listeria monocytogenes

Question 3

Causes of bacterial meningitis according to age group-

3 months - 3 years

Answer 3

• Strep pneumoniae > Neisseria meningitidis > Group B Strep

Question 4

Causes of bacterial meningitis according to age group-

3 years - 10 years

Answer 4

• Streptococcus pneumoniae > Neisseria meningitidis

Question 5

Causes of bacterial meningitis according to age group-

10 year to 19 years

Answer 5

• Neisseria meningitidis

Question 6

Causes of bacterial meningitis according to age group-

20 - 60 years

Answer 6

• Strep. pneumoniae > Neisseria meningitidis > Haemophilus influenza

Question 7

Causes of bacterial meningitis according to age group-

Adults > 60 years

Answer 7

• Strep. penumoniae > Listeria monocytogenes

Question 8

What are the signs and symptoms of acute bacteral meningitis in adults?

Answer 8

• fever
• nuchal rgidity
• change in mental status (confusion and lethargy)
• headache(severe and generalised)
• seizure
• focal neurologic deficits

Question 9

What is the sensitivity of having at least one of the classic findings of fever, neck stiffness and altered mental status for diagnosing bacterial meningitis.

Answer 9

99%.

Question 10

Does the absence of all the three of - fever, neck stiffiness and altered mental status- findings exclude persons of bacterial meningitis?

Answer 10

Typically yes.

Question 11

What are Kernig and Brudzinski signs, which are sometimes seen in menigitis?

Answer 11

• Kernig sign: with the patient supine and hip and knee flexed to 90^o , the patient resists full extension while passively flexing the neck
• Brudzinski sign: spontaneous hip flexion while passivley flexing the neck

Question 12

What are the relative contraindications for performing a lumbar puncture in patients with suspected meningitis?

Answer 12

• mass effect on neuroimaging
• thrombocytopaenia
• spinal epidural abscess

all other patients with suspected menigitis should have CSF “taped”

Question 13

Which patients should have a CT scan before performing lumbar puncture?

Answer 13

• immunocompromised sate
• history of CNS disease
• New onset seizure
• papilledema
• abnormal consciousness
• focal neurolgic deficit

Question 14

What are the typical lumbar puncture and CSF findings in acute bacterial meningitis?

Answer 14

• elevated opening pressure (> 200 mm H₂O)
• WCC 1000 - 5000/ml
  
  • Neutrophils > 80%
• Elevated protein 100 - 500 mg/dL
• low glucose < 40 mg/dL
  
  • CSF:serum glucose ratio < 0.4

Question 15

What is the overall mortality rate of bacterial menigitis?

Answer 15

25%