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Neurology > Patho- CNS infections > Flashcards

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
Q

What can cause aseptic meningitis?

A

Virus
Bacteria
Tumor
Inflammation- sarcoidosis and vasculitis

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26
Q

What viruses can cause meningitis?

A 
Enterovirus
Herpes simplex
Coxsackie
HIV
Epstein Barr
27
Q

How do you diagnose viral meningitis?

A

Viral stool culture
Throat swab
CSF PCR
CSF analysis

28
Q

What will you find in the CSF in viral meningitis?

A

Low WBC- Neutrophils then lymphocytes
Little protein- up to 0.8g/l
Normal glucose

29
Q

How do you treat viral meningitis?

A

Support

30
Q

What fungi can cause meningitis?

A

Cryptococcal neoformans- Cryptococcal meningitis

31
Q

Who mainly suffers from fungal meningitis?

A

HIV sufferers

32
Q

How do you treat Cryptococcal meningitis?

A

IV amphotericin B

33
Q

What how do you test for Cryptococcal meningitis?

A

India ink
Antigen
CSF analysis

34
Q

What will the CSF of Cryptococcal meningitis show?

A

High lymphocytes
Raised protein
Low glucose

35
Q

How do you treat inflammatory aseptic meningitis?

A

Steroids

36
Q

How will the CSF appear in tumor caused meningitis?

A

Raised Cell Count
High protein
Low glucose

37
Q

What are some general symptoms of meningitis?

A 
Fever
Cold hands and feet
Vomiting
Drowsiness
Confusion and irritability
Severe muscle pain
Rash
Severe headache
Stiff neck
Photophobia
Convulsions or seizures
38
Q

How do you diagnose meningitis?

A

LP
Blood cultures- looking for cause of infection
Throat swab- looking for cause of infection

39
Q

What are you looking for in the LP for meningitis?

A

Hematology- Cell count
Microbio
Chemistry- Glucose, proteins

40
Q

When should you CT before LP in meningitis?

A 
Immunocompramised
History of CNS disease
New onset siezures
Papilloedema
Altered conciousness
Focal neurological deficit
41
Q

Do you diagnose or treat meningitis first?

A

Treat

42
Q

What tends to cause encephalitis?

A

Virus

43
Q

What viruses can cause encephalitis?

A 
HSV
Echovirus
Coxsackie
Mumps
EBV
44
Q

What are some symptoms of encephalitis?

A 
Headache
Stupor/coma
Speech and memory problems
Seizures and partial paralysis
Confusion and psychosis
45
Q

Describe encephalitis

A

Acute onset of febrile illness with mental status abnormalities with or without fever

46
Q

How do you diagnose encephalitis?

A

LP
CRP
CT/MRI to exclude other causes

47
Q

What will you see in the CSF on LP of encephalitis?

A

Raised WCC
Protein normal
Glucose slightly raised

48
Q

How do you treat encephalitis?

A

Support
IV acyclovir for 10d
Anticonvulsants for seizures

49
Q

What is limbic encephalitis?

A

Antibodies against VCKC

50
Q

How do you diagnose limbic encephalitis?

A

MRI

Antibodies for VCKC

51
Q

What two places in the CNS can an abscess form?

A

Brain

SC

52
Q

What organisms tend to cause a brain abscess?

A

Strep
Bacterioids
Staph

53
Q

Where can bacteria causing brain abscesses come from?

A

Chronic ear infection (40%)
Throat infection
Blood born

54
Q

What are some symptoms of a brain abscess?

A 
Headache
Focal signs 
Epilepsy 
Raised intracranial pressure 
Fever 
N+V
55
Q

How do you diagnose a brain abscess?

A

CT

56
Q

How do you treat a brain abscess?

A 
Treat underlying cause
Aspirate
Strep- Cefuroxime and metronidazole 
Staph- Flucloxacillin and cefuroxime 
Surgery
Do NOT LP!!!
57
Q

What should you not do to a patient with a brain abscess?

A

LP

58
Q

What is a complication of a brain abscess?

A

Epilepsy

59
Q

What is the most common cause of a spinal abscess?

A

Staph A

60
Q

What are some symptoms of a spinal abscess?

A

Fever
Back pain
Paraparesis and/or root lesions symptoms

61
Q

How do you treat a spinal abscess?

A

Staph- Flucloxacillin and cefuroxime

Surgery

62
Q

What is myelitis?

A

Spinal cord inflammation

63
Q

What can cause myelitis?

A

Varicela virus

Polio virus

64
Q

What are the normal CSF values?

A

WCC<5
RBC<5
Protein 150-450mg/l
Glucose 60-70% blood

Neurology (30 decks)

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