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Patho- CNS infections Flashcards

1
Q

What are the three main infections of the CNS called?

A

Meningitis
Encephalitis
Abscess

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2
Q

What are the three forms of meningitis called?

A

Acute pyogenic
Acute aseptic
Chronic bacterial

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3
Q

What bacteria can cause acute pyogenic meningitis?

A

Strep Pneumonia- Pneumococcal meningitis
Neisseria meningitidis- Meningococcal meningitis
Listeria
Staph

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4
Q

Describe pneumococcal meningitis

A

Strep Pneumonia- gram +ive diplococci

Usually in >21

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5
Q

Who tends to get pneumococcal meningitis?

A

> 21YO

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6
Q

Describe meningococcal meningitis

A

Neisseria meningitidis- Gram -ive diplococci
10-21YO
Do NOT miss it!!!

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7
Q

Who tends to get meningococcal meningitis?

A

10-21YO

Do NOT miss it!!!

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8
Q

Describe listeria meningitis

A

Listeria- gram +ive bacilli

Neonates and immunosuppressed and >55

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9
Q

Who tends to get listeria meningitis?

A

Neonates and immunosuppressed and >55

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10
Q

Who tends to get staph meningitis?

A

Those with head injury

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11
Q

What are some symptoms of acute pyogenic meningitis?

A 
Headache
Stiff neck
Fever and N+V
Altered consciousness- GCS<12
Photophobia
Purpuric rash
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12
Q

What is the pathology of acute pyogenic meningitis?

A

Thick layer of exudate on the surface of the brain- causes adhesions and palsy
Neutrophils in SA space

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13
Q

What do measurement of the CSF look like in acute pyogenic meningitis?

A

10-10,000 polymorphic neutrophil cells
Protein>220mg/dl
<70% blood glucose
WBC>2000 (Neutrophils>1180)

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14
Q

What are some complication of pyogenic meningitis?

A

Purulence- mats of pus round neurons causing palsy
Cerebral oedema
Hydrocephalus

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15
Q

How do you treat pyogenic meningitis?

A

Start IV Ceftriaxone 2g immediately (unless penicillin allergic or suspect listeria)
Give steroids with first does (or upto 4 days if pneumococcal)
Take bloods and CSF sample

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16
Q

What antibiotics should you give to someone with penicillin allergy?

A

Chloramphenicol and vancomycin

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17
Q

What antibiotic should you give to someone with suspected listeria?

A

Amoxicillin 2g bd or Co-trimoxazole if allergic

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18
Q

What can cause chronic bacterial meningitis?

A

TB

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19
Q

What are some symptoms of chronic bacterial meningitis?

A 
Symptoms progress over 4-6 weeks
Headache
N+V
Anorexia
Neck stiffness
Papilloedema
Fever is uncommon
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20
Q

How do you investigate for TB caused meningitis?

A

CXR for granulomas
Tuberculin skin test
CT/MRI brain
CSF analysis

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21
Q

What will you see in the CSF of TB meningitis?

A

Raised WCC- all lymphocytes
Protein >1g/l
Low glucose

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22
Q

How do you treat TB meningitis?

A

Isoniazid + rifampicin
Add pyrazinamide
Avoid ethambutol

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23
Q

When should you admit someone with meningitis to the hospital?

A

Signs of meningeal irritation
Impaired conscious level
Petechial rash
Febrile/unwell/recent fit

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24
Q

What is acute aseptic meningitis?

A

Meningitis caused by anything other than bacteria

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25
What can cause aseptic meningitis?
Virus Bacteria Tumor Inflammation- sarcoidosis and vasculitis
26
What viruses can cause meningitis?
``` Enterovirus Herpes simplex Coxsackie HIV Epstein Barr ```
27
How do you diagnose viral meningitis?
Viral stool culture Throat swab CSF PCR CSF analysis
28
What will you find in the CSF in viral meningitis?
Low WBC- Neutrophils then lymphocytes Little protein- up to 0.8g/l Normal glucose
29
How do you treat viral meningitis?
Support
30
What fungi can cause meningitis?
Cryptococcal neoformans- Cryptococcal meningitis
31
Who mainly suffers from fungal meningitis?
HIV sufferers
32
How do you treat Cryptococcal meningitis?
IV amphotericin B
33
What how do you test for Cryptococcal meningitis?
India ink Antigen CSF analysis
34
What will the CSF of Cryptococcal meningitis show?
High lymphocytes Raised protein Low glucose
35
How do you treat inflammatory aseptic meningitis?
Steroids
36
How will the CSF appear in tumor caused meningitis?
Raised Cell Count High protein Low glucose
37
What are some general symptoms of meningitis?
``` Fever Cold hands and feet Vomiting Drowsiness Confusion and irritability Severe muscle pain Rash Severe headache Stiff neck Photophobia Convulsions or seizures ```
38
How do you diagnose meningitis?
LP Blood cultures- looking for cause of infection Throat swab- looking for cause of infection
39
What are you looking for in the LP for meningitis?
Hematology- Cell count Microbio Chemistry- Glucose, proteins
40
When should you CT before LP in meningitis?
``` Immunocompramised History of CNS disease New onset siezures Papilloedema Altered conciousness Focal neurological deficit ```
41
Do you diagnose or treat meningitis first?
Treat
42
What tends to cause encephalitis?
Virus
43
What viruses can cause encephalitis?
``` HSV Echovirus Coxsackie Mumps EBV ```
44
What are some symptoms of encephalitis?
``` Headache Stupor/coma Speech and memory problems Seizures and partial paralysis Confusion and psychosis ```
45
Describe encephalitis
Acute onset of febrile illness with mental status abnormalities with or without fever
46
How do you diagnose encephalitis?
LP CRP CT/MRI to exclude other causes
47
What will you see in the CSF on LP of encephalitis?
Raised WCC Protein normal Glucose slightly raised
48
How do you treat encephalitis?
Support IV acyclovir for 10d Anticonvulsants for seizures
49
What is limbic encephalitis?
Antibodies against VCKC
50
How do you diagnose limbic encephalitis?
MRI | Antibodies for VCKC
51
What two places in the CNS can an abscess form?
Brain | SC
52
What organisms tend to cause a brain abscess?
Strep Bacterioids Staph
53
Where can bacteria causing brain abscesses come from?
Chronic ear infection (40%) Throat infection Blood born
54
What are some symptoms of a brain abscess?
``` Headache Focal signs Epilepsy Raised intracranial pressure Fever N+V ```
55
How do you diagnose a brain abscess?
CT
56
How do you treat a brain abscess?
``` Treat underlying cause Aspirate Strep- Cefuroxime and metronidazole Staph- Flucloxacillin and cefuroxime Surgery Do NOT LP!!! ```
57
What should you not do to a patient with a brain abscess?
LP
58
What is a complication of a brain abscess?
Epilepsy
59
What is the most common cause of a spinal abscess?
Staph A
60
What are some symptoms of a spinal abscess?
Fever Back pain Paraparesis and/or root lesions symptoms
61
How do you treat a spinal abscess?
Staph- Flucloxacillin and cefuroxime | Surgery
62
What is myelitis?
Spinal cord inflammation
63
What can cause myelitis?
Varicela virus | Polio virus
64
What are the normal CSF values?
WCC<5 RBC<5 Protein 150-450mg/l Glucose 60-70% blood

Neurology (30 decks)

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