YearClub 2026 Neurology session (infective conditions) Flashcards by Adam Iqbal

What are the 4 types of meningitis?

Pyogenic - bacterial
Aseptic - (viral, non-infectious)
Focal Suppurative (abscess)
Chronic Bacterial (TB)

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What are meningitis routes of infection?

Otitis media (most common)
Nasopharynx
Sinusitis
Haematogenous (IE - infective endocarditis)

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Signs/symptoms of meningitis

MAIN TRIAD: headache, neck stiffness, and fever

Other symptoms can include:
- Photophobia
- Vomiting
- Sudden onset

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Septicaemia what is it and appearance?

Another term used to describe blood poisoning. It is an infection caused by large amounts of bacteria entering the bloodstream.

(little clots/infections bud off)
Non-blanching, petechial rash
purpuric

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Pyogenic meningitis indicates pathogen of viral origin. True/false?

False

Pyogenic = pus
Bacteria make pus! Viruses DO NOT

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Risk factors of Pyogenic meningitis?

Immunocompromised in some way

I.e. extremes in age (old/young), unvaccinated

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Community acquired bacterial meningitis bacterial cause (neonates)?

Listeria monocytogenes

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Community acquired bacterial meningitis bacterial cause (children-unvaxxed)?

H.influenzae

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Community acquired bacterial meningitis bacterial cause (age 10-21)?

Strep pneumoniae, neisseira meningitidis

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Community acquired bacterial meningitis bacterial cause (age 21-65)?

Strep pneumoniae

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Community acquired bacterial meningitis bacterial cause (age 65+)?

Strep pneumoniae

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Community acquired bacterial meningitis bacterial cause (immunocompromised)?

Listeria monocytogenes

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Community acquired bacterial meningitis bacterial cause (head trauma)?

Staph aureus (cribriform plate fracture = strep pneumoniae)

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What does lumbar puncture show for bacterial meningitis?

Neutrophils (polymorphic cells)
High protein (causing cloudy CSF)
Reduced glucose

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What does lumbar puncture show for viral cause?

Lymphocytes
Normal protein
Normal glucose

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What is standard treatment for bacterial meningitis?

Antibiotic + steroid!
Ceftriaxone + dexamethasone
(give steroids immediately or 15 mins before antibiotics -> reduce oedema)

Antibiotic given if patient has penicillin allergy?

chloramphenicol - may be used if patient has history of immediate hypersensitivity reaction to penicillin or cephalosporins.

Cefotaxime - a cephalosporin option that can be used as alternative for those with penicillin allergy

Antibiotic given for listeria monocytogenes?

amoxicillin

Antibiotic given if patient presents with the symptoms and has undergone recent travel?

vancomycin

Viral meningitis summary?

Most common type of aseptic meningitis.

RF: late summer/autumn, travel

Cause: enterovirus e.g ECHO virus, coxsackie, mumps, HSV

Dx: viral stool PCR + culture, throat swab, LP PCR, HIV test

Tx: supportive - is self limiting

What is encephalitis (summary)?

Infection of the brain parenchyma.
Cause: VZV, HSV (older px/immunocomp)

Signs: meningitis + neuro symp
Partial paralysis
confusion/psychosis
Speech symptoms
Insidious onset (up to 10 days)
Neck stiffness
Seizures
Photophobia
Headache

Ix: LP PCR, EEG, MRI
MRI => bright white temporal lobe and parahippocampal gyrus

Tx: preemptive aciclovir IV (ASAP!!)

Risk factors and causative organisms of lyme disease?

RF: hikers, walkers, campers- outdoors!

Vector: ticks
Causative organism: borrelia burgdorferi (spirochaete)
(this and syphilis are only spirochaetes u gotta know)

Signs of lyme disease?

Signs:
RASH! (can be target/bullseye lesion) => 1-4 weeks post bite
Expanding rash
tick/tick bite
General - fatigue, myalgia, headache, fever

Investigations and treatments of lyme disease?

Investigations:
Clinical

Treatment:
Doxycycline for 3 weeks (adult)

(children - amoxicillin)

Botulism summary?

Causative Organism: Clostridium botulinum infection. Source: soil, food, can contaminate wounds RF: IVDU Botulinum toxic is an exotoxin. It acts on motor neuron terminals to block vesicle docking in presynaptic membrane, irreversibly inhibit Ach release. Signs: Rapid onset weakness w/out sensory loss Ascending paralysis

Difference between weakness and paralysis?

Weakness => reduction in power Paralysis => no contraction

What is Guillian Barre syndrome?

ACUTE, PARALYTIC polyneuropathy affecting PERIPHERAL nervous system. Acute, symmetrical, ascending weakness as well as sensory loss. Usually predisposed by infection (including but not limited to EBV, campylobacter jejuni {check: diarrhoea}, cytomegalovirus)

Signs/symptoms of Guillian Barre syndrome?

Symmetric, ascending weakness Reduced reflexes Peripheral loss of sensation Neuropathic pain MIGHT progress to CNS and cause facial weakness. Usually occurs within 4 weeks of infection Peak symptoms occur at 2-4 weeks (recovery takes months-years)

Diagnosis and treatment of Guillian Barre syndrome?

BRIGHTON CRITERIA Perform: Nerve conduction studies Lumbar puncture (raised protein in CNS)

Treatment/management of GBS?

IV immunoglobulins or plasma exchange Supportive care

Viral meningitis on CSF will show raised protein, decreased glucose and will be a cloudy/purulent colour. true/false?

False This is the case for bacterial meningitis. Viral meningitis will show: normal protein and glucose. raised lymphocytes clear or slightly haze colour

Level of lumbar puncture sample site in spine?

Between L3 and L4, advanced to the subarachnoid space Since it is below the spinal cord in majority of patients, so no risk of cord damage

Where is CSF contained in the spine?

In the subarachnoid space between the arachnoid mater and pia mater.

Contraindications to lumbar puncture?

Signs or causes of raised ICP i.e. papilloedema. Focal neurology Intracranial tumours

What symptoms differentiate meningitis from encephalitis?

Meningitis presentation: altered mental state, fever, neck stiffness, headache (any of the 2 mentioned). Encephalitis presentation: altered mental state (consciousness, cognition, personality, behaviour).

What are the 3H's of viral encephalitis?

Hot (fever) Hectic (seizures) Hysterical (personality changes)

What sign can be indicative of meningitis?

Kernig's sign

What is a positive kernig's sign?

Patient is kept in supine position, hip and knee are flexed to a right angle, and then knee is slowly extended by the examiner. The appearance of resistance or pain during extension of the patient's knees beyond 135 degrees indicates a positive Kernig's sign.