YearClub 2026 Neurology session (infective conditions) Flashcards
What are the 4 types of meningitis?
Pyogenic - bacterial
Aseptic - (viral, non-infectious)
Focal Suppurative (abscess)
Chronic Bacterial (TB)
What are meningitis routes of infection?
Otitis media (most common)
Nasopharynx
Sinusitis
Haematogenous (IE - infective endocarditis)
Signs/symptoms of meningitis
MAIN TRIAD: headache, neck stiffness, and fever
Other symptoms can include:
- Photophobia
- Vomiting
- Sudden onset
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
Pyogenic meningitis indicates pathogen of viral origin. True/false?
False
Pyogenic = pus
Bacteria make pus! Viruses DO NOT
Risk factors of Pyogenic meningitis?
Immunocompromised in some way
I.e. extremes in age (old/young), unvaccinated
Community acquired bacterial meningitis bacterial cause (neonates)?
Listeria monocytogenes
Community acquired bacterial meningitis bacterial cause (children-unvaxxed)?
H.influenzae
Community acquired bacterial meningitis bacterial cause (age 10-21)?
Strep pneumoniae, neisseira meningitidis
Community acquired bacterial meningitis bacterial cause (age 21-65)?
Strep pneumoniae
Community acquired bacterial meningitis bacterial cause (age 65+)?
Strep pneumoniae
Community acquired bacterial meningitis bacterial cause (immunocompromised)?
Listeria monocytogenes
Community acquired bacterial meningitis bacterial cause (head trauma)?
Staph aureus (cribriform plate fracture = strep pneumoniae)
What does lumbar puncture show for bacterial meningitis?
Neutrophils (polymorphic cells)
High protein (causing cloudy CSF)
Reduced glucose
What does lumbar puncture show for viral cause?
Lymphocytes
Normal protein
Normal glucose
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.
