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PAEDIATRICS > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Describe 4 effects of cytokines in pathophysiology of acute bacterial meningitis

A

Bacterial invasion > production of cytokines >
1. Hypercoagulability
2. Reduced cerebral blood flow
3. Raised ICP compensated by raised BP
4. Increased blood brain barrier permeability

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2
Q

Clinical signs of acute bacterial meningitis in an older child x4

A

Fever
Signs of raised ICP
Signs of meningeal irritation
Signs of cortical involvement

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3
Q

Causative organisms of acute bacterial meningitis in neonates x5

A

E.coli
GB strep
Klebsiella
Enterobacter
L.monocytogenes

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4
Q

When should Streptococcus pneumoniae be suspected x5

A

Skull fracture
Otorrhea
Paranasal sinuses
Frontal bone CSF leak
Sickle cell patient

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5
Q

Describe Pathogenesis of purpura in meningitis x2

A

Dermal microvessels thrombosis that result in hemorrhagic skin necrosis

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6
Q

Sequelae for haemophilus influenzae meningitis x5

A

Hearing loss
Epileptic fits
Subdural effusions
Mental retardation
Cerebral infarctions

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7
Q

State the toxin produced in neisseria meningitidis and its 3 effects

A

Lipooligosaccharide
Causes septic shock, bilateral adrenal hemorrhage, DIC

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8
Q

Define water-house Friderichsen syndrome and 3 causes

A

Massive bilateral hemorrhage into the adrenal glands
Caused by adrenal insufficiency, DIC, meningococcemia

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9
Q

State 4 clinical features of acute bacterial meningitis in a neonate x4

A

Irritability
Poor feeding
Bulging fontanelle
Hypo or hyperthermia

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10
Q

Complications of acute bacterial meningitis x5

A

Hydrocephalus
Epileptic fits
Brain abscess
Subdural effusions
Cerebral edema

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11
Q

Which steroid is given in meningitis and when

A

Dexamethasone 10-15 minutes before Abx initiation in children> 2M

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12
Q

Principles of treatment for meningitis x4

A

Antibiotics and steroids
Generalized care for unconscious child
Prevent or treat complications

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13
Q

Clinical features of brain abscess x4

A

Headache, vomiting and papilloedema
Focal neurological signs with seizures
Sepsis and fever
Meningitis if it breaks into ventricles

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14
Q

Define brain abscess and its predisposing factors x4

A

Localized suppuration within the brain tissue
1. CHD with R to L shunt
2. Otitis media
3. Mastoiditis
4. Sinusitis

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15
Q

Management of a brain abscess x2

A

Abx with repeat CT
Surgical drainage when unresponsive to abx

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16
Q

Subdural empyema is caused by sepsis originating from which conditions x5

A

Sinusitis
Meningitis
Mastoiditis
Brain abscess
Subdural hematomas

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17
Q

Features of progressive encephalopathy due to direct HIV brain infection x3

A

Loss of developmental milestones
Intellectual fall off
Motor deficits

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18
Q

Define encephalitis and its causes x2

A

Inflammation of the brain parenchyma
1. Invasion of the cns by virus
2. Immune reaction between the virus and host- post or para-infectious

19
Q

Clinical features of encephalitis x4

A

Seizures
Altered mental state
Altered consciousness
Focal neurological signs- paresis, aphasia

20
Q

Characteristics of Herpes simplex virus neuro infection x4

A

Focal hemorrhagic necrotic lesions
Site- temporal and orbital areas
Primary infection manifests with oral lesions
Disturbances of memory and behavioral changes
Focal fits and focal neurological signs

21
Q

State the 3 ways of spread in HSV encephalitis

A
  1. From site of primary oro-pharyngeal infection to brain via trigerminal and olfactory nerves
  2. CNS invasion by reactivation of infection in patients with history of recurrent infections
  3. Reactivation of the latent HSV in situ within the brain
22
Q

Define subacute sclerosing panencephalitis SSPE

A

A progressive fatal neurological disorder that usually occurs months or years after a measles infection

23
Q

State initial (4) and advanced (death) symptoms of SSPE

A

Initial- mild cognitive decline, changes in behavior, seizures, disturbances in motor function
Advanced- losing ability to walk, deterioration of comatose state, persistent vegetative state

24
Q

Pathophysiology of neurocysticercosis x4

A

Ingestion of ova of taenia solium
Larva lodge in the CNS vascular area
Surrounding inflammation and edema
Dead cysts induce intense inflammation

25
Q

Clinical features of neurocysticercosis x5

A

Obstructive hydrocephalus
Focal seizures + neurological signs
Raised ICP
Psychotic symptoms
Headache, coma

26
Q

Treatment of neurocysticercosis and doses x4

A

Albendazole 15mg/kg/d for 8 days
Praziquantel 50mg/kg/d for 14 days
Anticonvulsants if seizures present

Steroids to prevent systemic reaction caused by release of endotoxin like substances when large numbers of cysts are killed

27
Q

Pathophysiology of cryptococcosis x3

A

Occurs in immunocompromised patients
Fungus found in soil and pigeon
Primary respiratory infection which reaches brain via hematogenous spread

28
Q

Clinical manifestations of cryptococcosis x4

A

Cranial nerve palsies
Impaired level of consciousness
Raised ICP and papilledema
Headache and meningeal irritation

29
Q

CSF characteristics of cryptococcosis x5

A

High pressure
Elevated lymphocytes
Increased proteins
Low sugar
Indian ink - clear halo around yeast wall

30
Q

Treatment of cryptococcosis x3 and duration

A

Duration 6 weeks
Amphotericin B 1mg/kg/d
Fluorocytosine 15mg/kg/d
Fluconazole - prophylaxis in HIV

31
Q

Describe the Kernigs sign

A

Position the patients supine with their hips flexed to 90°. This test is positive if there is pain on passive extension of the knee

32
Q

Describe Brudzinskis sign

A

Position the patients supine and passively flex their neck. This test is positive if this manoeuvre causes reflex flexion of the hip and knee.

33
Q

Risk factors of acute bacterial infection in neonates x4

A

Low birth weight
Male babies
Premature rupture of membranes
Difficulty delivery with extensive manipulations

34
Q

Normal csf parameter ranges x3

A

White cells : 0 neutrophils, 0-6 lymphocytes
Glucose : 3.6-5.6 mmol/dL
Protein : 0.15-0.45 mg/L

35
Q

CSF parameter ranges for bacterial infection x3

A

White cells : 100-50000 neutrophil predominant
Glucose : 1.1-1.6 mmol/dL
Protein : mild to moderately increased

36
Q

CSF parameter ranges in viral meningitis

A

White cells: 25-500 lymphocytes predominant
Glucose: 3.6-5.6 normal
Proteins : mildly increased

37
Q

Csf parametric ranges for Tb meningitis

A

White cells : 25-500, lymphocyte predominant
Glucose : 2.2-2.7
Proteins: moderately increased

38
Q

Prophylaxis for N meningitidis close contacts x2

A

Rifampicin 10mg/kg twice a day for 2 days
Ceftriaxone 125mg imi stat

39
Q

Prophylaxis for H influenza

A

Rifampicin 20mg/kg twice a day for 4 days

40
Q

Clinical features of HSV x6

A

Fever and malaise
Mucosal lesions
Memory and behavioral changes
Focal fits and focal neurological signs
Lethargy, coma

41
Q

CT characteristics of HSV infection x3

A

Attenuation in temporal lobes
Temporal lobe atrophy
Temporal lobe cysts

42
Q

State 4 CT scan findings in cryptococcosis

A

Hydrocephalus
Mass lesions- granulomas
Cerebral edema
Basilar enhancement

43
Q

State 3 CT scan findings for neutocysticercosis

A

Solitary or multiple cysts
Single multiple calcified lesions
Patches of hypodensity with ring enhancement

PAEDIATRICS (20 decks)

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