Other (Non-Bacterial) Types of Meningitis

Question 1

What are the 2 types of viral CNS infection?

Answer 1

Viral encephalitis

Progressive multifocal leukoencephalopathy (PMLE)

Question 2

List 3 causes of viral encephalitis.

Answer 2

Herpes simplex/varicella zoster virus
Enterovirus
Mumps

Question 3

Describe the clinical features of viral encephalitis. (3)

Answer 3

Confusion
Fever
Seizures

Question 4

Which investigations would you do for viral encephalitis? (3)

Answer 4

Lumbar puncture
EEG
MRI

Question 5

What features would you see on a lumbar puncture in viral encephalitis? (3)

What further tests could you do? (1)

Answer 5

Lymphocytes
Normal glucose
Raised protein

FURTHER TESTS:
PCR (viral DNA)

Question 6

How would you treat viral encephalitis? Consider:

a) Caused by HSV/VZV (1)
b) Caused by enterovirus (1)
c) Caused by mumps (1)

Answer 6

HERPES SIMPLEX/VARICELLA ZOSTER:
IV aciclovir (2-3 weeks)

ENTEROVIRUS:
None

MUMPS:
None

Question 7

List 1 virus which can cause progressive multifocal leukoencephalopathy.

When would it cause PMLE?

Answer 7

John Cunningham virus

Only causes PMLE in severe immunosuppression (most commonly due to HIV)

Question 8

Describe the clinical features of progressive multifocal leukoencephalopathy. (3)

Answer 8

Progressive motor dysfunction
Behaviour change
Alien hand syndrome

Question 9

How would you manage progressive multifocal leukoencephalopathy? (1)

Answer 9

Anti-retrovirals (to treat underlying HIV)

Question 10

What is the main type of fungal CNS infection?

Answer 10

Cryptococcal meningitis

Question 11

List 3 causes of cryptococcal meningitis.

Answer 11

Cryptococcus neoformans
Cryptococcus gattii
Underlying immunodeficiency

Question 12

Describe the clinical features of cryptococcal meningitis. (7)

Answer 12

Headache
Nausea and vomiting
Neurological changes
Cognitive changes
Lethargy
Photophobia
Raised ICP (e.g. papilloedema)

Question 13

How would you treat cryptococcal meningitis? (3)

Answer 13

IV amphotericin B
Flucytosine
Fluconazole

Question 14

What investigations would you do for fungal CNS infections? (1)

What features would you see on this? (3)

What further tests could you do? (2)

Answer 14

Lumbar puncture, showing:

• Lymphocytes
• High protein
• Reduced glucose

FURTHER TESTS:

• India ink stains
• Serum cryptococcal antigen (CrAg)

Question 15

What is the main type of parasitic CNS infection?

Answer 15

Intracerebral toxoplasmosis

Question 16

What is intracerebral toxoplasmosis caused by? (1)

Where is this found?

Answer 16

Toxoplasma gondii, e.g.

• Undercooked meat
• Cat faeces

Question 17

List 2 risk factors for intracerebral toxoplasmosis.

Answer 17

HIV

Immunocompromise

Question 18

Describe the clinical features of intracerebral toxoplasmosis. (3)

Answer 18

Headaches
Seizures
Focal CNS signs

Question 19

What investigations would you do for intracerebral toxoplasmosis? (1)

What features would you see on this?

Answer 19

CT head, showing:

-Multiple enhancing lesions

Question 20

How would you manage intracranial toxoplasmosis? (3)

Answer 20

Sulphadiazine
Pyramethamine
Restoring immune function (e.g. treating HIV)