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AH extra cards > Viral meningitis > Flashcards

Viral meningitis Flashcards

1
Q

What is aseptic meningitis?

A

Clinical meningitis but not bacterial source

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2
Q

What are possible causes of aseptic meningitis? (8)

A 
Viruses
Partially treated bacterial meningitis
Listeria
TB 
Autoimmune
Malignancy
Syphilis
Drugs
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3
Q

2 peak ages of viral meningitis?

A

Neonate and about 5yo

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4
Q

Viruses that cause meningitis (18)

A 
Enteroviruses (echoviruses, coxsackie, parecho, enterovirus 70/71, poliovirus)
Herpes viruses (HSV 2, VZV, CMV, EBV, HHV6/7)
Arboviruses
Mumps
HIV
Adenovirus
Measles
Influenza
Parainfluenza type 3
Lymphocytic choriomeningitis virus
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5
Q

Pathogenesis of viral meningitis?

A

colonisation of mucosal surfaces
invasion of epithelial surface
replication in cells
dissemination and cns invasion (cerebral microvascular endothelial cells, choroid plexus epithelium, olfactory nerve)

Inflammation in CNS=symptoms

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6
Q

What are the 3 features of meningism?

A

Stiff neck
Headache
Photophobia

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7
Q

What signs are present in infants (possibly in the absence of meningism)

A

Nuchal rigidity

Bulging anterior fontanelle

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8
Q

What are two clinical tests/signs?

A

Kernig’s sign (hip and knee flexed to 90 degrees, knee can’t be extended due to pain/stiffness in hamstrings)

Brudzinski’s sign (flexing neck causes hips and knees to flex)

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9
Q

What would viral meningitis blood tests show?

A

WBC count and CRP normal

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10
Q

What 4 investigations?

A

Bloods (tests and culture, MC&S)
CT head
Lumbar puncture ASAP
Viral PCR

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11
Q

What does the head CT look for?

A

Raised ICP- contraindicates an LP as removing CSF can cause brain to herniate through foramen magnum (‘coning’) and also to look for other diagnoses

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12
Q

What is the gold standard test for viral meningitis?

A

Viral PCR

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13
Q

CSF findings in viral meningitis?

A

Lymphocytic
Protein normal/mildly elevated
Glucose normal/slightly low

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14
Q

Most common and second most common cause of viral meningitis in uk?

A

Enterovirus

HSV2

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15
Q

Treatment of viral meningitis?

A

Supportive
If any risk that it is bacterial then IV Abx
NOTIFIABLE

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16
Q

Is aciclovir effective against HSV2 and VZV meningitis?

A

No evidence that it is

17
Q

Mollaret’s meningitis is what?

A

Recurrent aseptic meningitis, major cause is HSV2

18
Q

4 associated symptoms of HIV meningitis

A

fever
lymphadenopathy
pharyngitis
rash

19
Q

Prognosis of viral meningitis

A

Full recovery expected

20
Q

4 causes of viral encephalitis that are not also causes of meningitis?

A

HSV1
Rubella
Rabies
Acute disseminated encephalomyopathy

21
Q

Major presenting features of encephalitis

A 
Altered mental state
Fever
Headache
Meningism
Focal neurology (seizures, weakness, dysphagia, CN palsy, ataxia)
22
Q

Investigations of viral encephalitis (5)

A 
Blood tests
CT
MRI
LP (MC&S, protein and glucose, viral PCR)
EEG
23
Q

What would EEG show in HSV encephalitis?

A

75% show abnormal temporal lobe activity

24
Q

Rx viral encephalitis?

A

High dose IV aciclovir- start on clinical suspicion as is a medical emergency

25
Q

CSF results?

A

Same as viral meningitis

26
Q

HSV encephalitis prognosis?

A

High mortality if untreated (70%), even if treated remains high. Best if aciclovir within 4 days

27
Q

HSE peak age?

A

50

28
Q

HSE pathogenesis

A

Virus moves along neural/olfactory pathways, reactivated in the trigeminal ganglia
Acute focal necrotising encephalitis

29
Q

What often happens to survivors of HSE?

A

neurological sequelae e.g. paralysis, speech loss, personality change

30
Q

What is acute disseminated ecephalomyopathy?

A

Immune-mediate demyelination of CNS, can follow virus or vaccination.
Clinical features same as encephalitis
CSF findings = viral meningitis
MRI helpful

31
Q

Rx ADEM

A

Steroids/immune suppressants

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