Revision Flashcards
What are the 5 most common viral causes of meningitis?
1) Enteroviruses e.g. coxsackie
2) HSV
3) VZV
4) CMV
5) Mumps
Describe different aspects of CSF in viral meningitis:
a) appearance
b) glucose
c) protein
d) white cell count
a) clear
b) normal or mildly raised
c) normal or mildly raised
d) raised, lymphocytes
Describe different aspects of CSF in bacterial meningitis:
a) appearance
b) glucose
c) protein
d) white cell count
a) cloudy
b) low
c) raised
d) raised, neutrophils
Describe different aspects of CSF in TB meningitis:
a) appearance
b) glucose
c) protein
a) cloudy, fibrin web
b) low
c) ++ raised
Mx of viral meningitis
Typically viral meningitis is self-limiting, with symptoms improving over the course of 7 - 14 days.
Can give aciclovir in HSV meningitis
What are the 5 main causes of bacterial meningitis?
1) Neisseria meningitidis
2) Strep. pneumoniae
3) H. influenzae
4) GBS (neonates)
5) Listeria monocytogenes (neonates)
What is the most common cause of bacterial meningitis?
Neisseria meningitidis (meningococcus)
What 2 special tests can look for meningeal irritation?
1) Kernig’s
2) Brudzinski’s
Where is the needle inserted in an LP?
L3/4 or L4/5
Spinal cord ends at L1/2
Where does spinal cord end?
L1/2
Management of children in 1ary care with suspected meningitis AND a non-blanching rash?
Urgent dose of IM or IV benzylpenicillin whilst waiting transfer to hospital (shouldn’t delay transfer).
If true penicillin allergy, transfer should be the priority rather than other antibiotics.
If meningococcal meningitis is suspected, what investigation should be done?
Meningococcal PCR
There should be a low threshold for treating suspected meningitis, particularly in babies and younger children. Always follow the local guidelines.
What are the typical antibiotics used in babies:
a) under 3 months
b) over 3 months
a) IV cefotaxime + amoxicillin
b) IV ceftriaxone
When & why are steroids indicated in meningitis?
Indicated in bacterial meningitis
To reduce risk of hearing loss
Who are steroids avoided in in meningitis?
Babies <3 months old
What steroids are given in bacterial meningitis?
Dexamethasone
Which types of meningitis are notifiable diseases to the UK Health Security Agency?
Bacterial
What is the usual post-exposure prophylaxis against meningococcal infection?
Single dose of ciprofloxacin
What is the most common complication of meningitis?
Sensorineural hearing loss
Patients with meningococcal meningitis are at risk of Waterhouse-Friderichsen syndrome.
What is this?
Failure of adrenals 2ary to adrenal haemorrhage
What is the most common cause of encephalitis in neonates?
HSV-2 (from genital herpes contracted during birth)
What GCS is a contraindication for an LP?
<9
What is anti-NMDA receptor encephalitis?
A paraneoplastic syndrome.
What is detected in up to 1/2 of female adult patients with anti-NMDA receptor encephalitis?
Ovarian teratoma
Mx of anti-NMDA encephalitis?
IV steroids
What testing is indicated in all patients with encephalitis?
HIV testing
Mx of CMV encephalitis?
ganciclovir
What is usually performed to ensure successful treatment prior to stopping antivirals in encephalitis?
Repeat LP
When should patient’s with Bell’s palsy be referred urgently to ENT?
If no improvement in symptoms after 3 weeks
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) 2ary to haemorrhage or infarction.
Precipitating factors for pituitary apoplexy? (4)
1) HTN
2) pregnancy
3) trauma
4) anticoagulation
Clinical features of pituitary apoplexy?
1) sudden onset headache (similar to SAH)
2) vomiting
3) neck stiffness
4) visual field defects: classically bitemporal superior quadrantic defect
5) features of pituitary insufficiency
- hypotension/hyponatraemia 2ary to hypoadrenalism
6) extraocular nerve palsies
What investigation is diagnostic of pituitary apoplexy?
MRI
Mx of pituitary apoplexy?
1) urgent steroid replacement due to loss of ACTH
2) careful fluid balance
3) surgery
Is IV or oral ciprofloxacin used as prophylaxis for contacts of patients with meningococcal meningitis?
Oral
What triad is seen in shaken baby syndrome?
1) retinal haemorrhages
2) subdural haematoma
3) encephalopathy
Is a history of rash with penicillin a contraindication to using benzylpenicillin or ceftriaxone in meningococcal sepsis?
No
What features of trigeminal neuralgia suggest a serious underlying cause?
- Sensory changes
- Deafness or other ear problems
- History of skin or oral lesions that could spread perineurally
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- A family history of multiple sclerosis
- Age of onset before 40 years
URGENT referral for specialist assessment
Gold standrd for diagnosis of venous sinus thrombosis?
MRI venography
Is HIV a notifiable disease?
No
What is Ramsay Hunt syndrome?
AKA herpes zoster oticus
Caused by reactivation of the VZV in the geniculate ganglion of CN VII.
What is often the 1st feature of Ramsay Hunt syndrome?
Auricular pain
Features of Ramsay Hunt syndrome?
- auricular pain
- facial nerve palsy
- vesicular rash around the ear
- other features include vertigo and tinnitus
Mx of Ramsay Hunt syndrome?
Oral aciclovir & steroids
Give 2 key neurocomplications of HIV?
Focal neuro lesions:
1) Toxoplasmosis (most common)
2) Primary CNS lymphoma
CT results in HIV associated toxoplasmosis?
Usually single or multiple ring enhancing lesions, mass effect may be seen
CT results in HIV associated primary CNS lymphoma?
single or multiple homogenous enhancing lesions
What is cryptococcus neoformans?
An encapsulated yeast and an obligate aerobe that can live in both plants and animals.
Infection with this organism is termed cryptococcosis.
What can cryptococcus infection in immunocompromised cause?
Fungal meningitis and encephalitis can occur
A key group of patients are HIV +ve
