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CP > Viral meningitis/Encephalitis > Flashcards

Viral meningitis/Encephalitis Flashcards

1
Q

What is the definition of Meningitis?

A

inflammation of the meninges

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2
Q

What is the definition of Encephalitis?

A

inflammation of the brain

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3
Q

What is the definition of Meningo-encephalitis?

A

inflammation of brain and meninges

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4
Q

What is the microbiology of Aseptic Meningitis?

A

White cell count >5x106/L in CSF - allowed to be higher in children Negative bacterial culture of the CSF

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5
Q

What causes Aseptic Meningitis apart from viruses?

A

Bacteria e.g. TB, Syphilis non infectious agents e.g. malignancy, drugs etc.

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6
Q

What is the name of a Basic infectious virus particle?

A

virion

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7
Q

What does the Simple virus structure consist of?

A

Nucleic acid Capsid - protein coat possibly lipid envelope possibly other proteins/enzymes

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8
Q

Who is Viral Meningitis most common in?

A

neonates Around the age of 5 More common that bacterial meningitis

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9
Q

What is the leading cause of Viral Meningitis?

A

Enteroviruses e.g. echovirus HSV2

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10
Q

What is important to ask about in Viral Meningitis?

A

travel history sexual history check if the patient is immunocompromised

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11
Q

How does the virus enter the CNS?

A

Via cerebral microvascular endothelial cells Via choroid plexus epithelium from blood Spread along the olfactory nerve

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12
Q

What are the general Clinical features of Viral Meningitis in adults?

A

Fever Headache Neck stiffness Photophobia Sometimes ‘viral’ prodrome (e.g. lethargy, myalgias, arthralgias, sore throat, Diarrhea And Vomiting, rash)

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13
Q

What are the Clinical features of Viral Meningitis in children?

A

In neonates/infants meningeal signs may be absent Look for nuchal rigidity (neck stiffness) and bulging anterior fontanelle - sign of increased intercranial pressure

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14
Q

What are the two Examination signs for meningitis?

A

Kernig’s sign - hip and knee flexed to 90 degrees, the knee cannot be extended Brudzinski’s sign Flexing the neck causes the hips and knees to flex

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15
Q

What is the first investigation that should be carried out when suspecting meningitis?

A

Lumbar Puncture

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16
Q

When is the only time that care should be taken before doing a Lumbar Puncture for meningitis?

A

suspected raised inter-cranial pressure removing csf = herniation of the brain through the foramen magnum - can cause arrest perform CT head to check suspecting viral encephilitis

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17
Q

What are the CSF findings of Lymphocytes in viral meningitis?

A

Lymphocytic, usually

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18
Q

What does Pleocytosis stand for?

A

white cells in CSF

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19
Q

What are the CSF findings of protein in viral meningitis?

A

Protein (0.2-0.4 g/L) Normal, mildly elevated (0.5-1.0)

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20
Q

What are the CSF findings of Glucose in viral meningitis?

A

(ratio of CSF:plasma) Normal ratio is 50-66% In viral meningitis it is normal, or slightly low

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21
Q

What are the CSF differences to distinguish between bacterial and viral meningitis?

A

↑ opening pressure in bacterial ↑↑ WBC in bacterial ↑ protein in bacterial ↑ glucose in viral bacterial = gram stain

22
Q

When is it useful to do a Throat swab and/or stool sample?

A

for enterovirus/ anything transmitted by a faecal oral route

23
Q

What are the treatment options for meningitis?

A

Start appropriate IV antibiotics (e.g. cefotaxime) if any risk of bacterial meningitis - after LP preferred Mainly supportive therapy NOTIFIABLE - inform local public health dept

24
Q

What time of the year does the enteroviral epidemic occur?

A

late summer/autumn

25
Q

What are the symptoms of enteroviral meningitis?

A

fever vomiting anorexia rash upper respiratory tract symptoms

26
Q

What is the treatement of enteroviral meningitis?

A

No specific treatment Full recovery normal

27
Q

What is the 2nd most common cause of Viral Meningitis?

A

Herpes Simplex Virus - HSV2

28
Q

What is Mollaret’s meningitis?

A

recurrent aseptic meningitis wide differential but major cause = HSV2

29
Q

What is primary (varicella)?

A

chickenpox

30
Q

What is secondary (zoster)?

A

shingles

31
Q

When does meningitis develop in relation to Varicella zoster virus?

A

during chickenpox/shingles look for rash look after vaccination

32
Q

When does CNS symptoms develop after mumps?

A

5 days after onset of parotitis

33
Q

What are other features of Mumps meningitis?

A

Abdominal pain Orchitis - inflammation of one or both of the testicles

34
Q

What is the treatment of Mumps meningitis?

A

No specific treatment Full recovery normal Preventable with vaccination

35
Q

When can meningitis occur during HIV?

A

as part of primary infection

36
Q

What are the associated features of HIV meningitis?

A

Fever Lymphadenopathy Pharyngitis Rash = like glandular fever

37
Q

Which is more serious out of viral meningitis and viral encephalitis?

A

viral encephalitis - medical emergency

38
Q

What is the most common cause of viral encephalitis?

A

Herpes Simplex Virus (HSV1)

39
Q

what are the clinical presentations of viral encephalitis?

A

Altered mental state (confusion/bizarre behaviour -> coma - look at GCS) Fever Headache Meningism (may be absent) +/- Focal neurology i.e. seizures

40
Q

What does an EEG of a person with HSV encephalitis show?

A

75% will show abnormal temporal lobe activity

41
Q

What are the differences between viral encephalitis and viral meningitis?

A

They are the same!

42
Q

What is the treatment for viral encephalitis?

A

High dose IV aciclovir 10mg/kg tds 14-21 days

43
Q

Where does direct transmission of the virus that causes encephalitis occur?

A

along neural/olfactory pathways

44
Q

Where does reactivation of the virus that causes encephalitis occur?

A

trigeminal ganglia

45
Q

What does viral encephalitis cause?

A

Acute focal necrotising encephalitis Inflammation / swelling of brain tissue

46
Q

What are the neurological consequences of viral encephalitis?

A

Paralysis Speech loss Personality change

47
Q

What is Acute disseminated encephalomyelopathy (ADEM)?

A

autoimmune condition of CNS nerve demyelination Can follow viral illness or vaccination (e.g. influenza)

48
Q

What are the clinical features of Acute disseminated encephalomyelopathy (ADEM)?

A

same as encephalitis

49
Q

What are the CSF findings of Acute disseminated encephalomyelopathy (ADEM)?

A

same as viral meningitis.

50
Q

What is the treatement for Acute disseminated encephalomyelopathy (ADEM)?

A

Treatment is steroids/other immunosuppressants

51
Q

What other sample should you always take when taking a LP?

A

serum glucose sample

CP (50 decks)

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