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Neuro week 3 > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

1
Q

What is brain parenchyma?

A

Functional tissue in the brain

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2
Q

The involvement of what structure is hallmark of encephalitis?

A

In encephalitis the brain parenchyma is inflamed

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3
Q

What are the classifications of meningitis?

A
  • Acute pyogenic (bacterial) meningitis
  • Acute aseptic (e.g. viral, non-infectious) meningitis
  • Acute focal suppurative infection (brain abscess, subdural/extradural empyema)
  • Chronic bacterial infection (TB)
  • Acute encephalitis (brain parenchyma)
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4
Q

How does pyogenic meningitis appear under a microscope?

A

Neutrophils in subarachnoid space

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5
Q

What antibiotics are given for pyogenic meningitis?

A

Ceftriaxone + Dexamethasone

If listeria add Amoxicillin 4 hourly

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6
Q

When do you give steroids in pyogenic meningitis?

A

10mg IV 15-20 mins before or with first dose of antibiotics and then every 6 hours for 4 days

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7
Q

What is a contra-indication for giving steroids to a patient with meningitis?

A
  • post-surgical meningitis
  • Meningococcal
  • Septic shock
  • Patients hypersensitive to steroids
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8
Q

What type of pyogenic meningitis benefits most from steroid treatment?

A

Pneumococcal meningitis

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9
Q

When is viral meningitis most often seen?

A

Late summer / autumn

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10
Q

What aspect of a patients history gives a big clue to viral meningitis?

A

Travel history

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11
Q

What organisms cause viral meningitis?

A

Enteroviruses e.g. ECHO virus

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12
Q

How is viral meningitis diagnosed?

A

Viral stool PCR + culture, throat swab & CSF PCR

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13
Q

What is the treatment for viral meningitis?

A

Supportive as the condition tends to be self limiting

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14
Q

What are some symptoms of encephalitis?

A
  • Mental status change
  • Confusion
  • Obtundation or coma
  • Seizure
  • Behavioral & speech disturbance
  • Focal or diffuse neurological signs
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15
Q

What are some symptoms of Meningo-encephalitis?

A
  • Headache
  • fever
  • Neck stiffness
    +
    encephalitis features
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16
Q

Is the cerebral cortex affected by encephalitis?

A

Yes

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17
Q

Does encephalitis tend to have a insidious or sudden onset?

A

Most likely insidious

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18
Q

What investigations are done for encephalitis?

A
  • Lumbar puncture (1st line)
  • EEG
  • MRI
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19
Q

If there’s a delay in encephalitis investigation what do you do?

A

Give aciclovir

20
Q

What are some general symptoms of CNS infections?

A
  • Headache
  • Vomiting
  • Pyrexia
  • Neck stiffness
  • Photophobia
  • Lethargy
  • Confusion
  • Rash
21
Q

What organisms are most likely to cause community acquired pyogenic meningitis in neonates?

A

Listeria
Group B strep
E.coli

22
Q

What organism is most likely to cause community acquired pyogenic meningitis in children?

A

H. Influenza

23
Q

What organisms are most likely to cause community acquired pyogenic meningitis in over 65s?

A
  • Strep pneumoniae
  • Listeria
24
Q

If a patient has decreased cell mediated immunity what organism is most likely to cause community acquired pyogenic meningitis?

A

Listeria

25
Q

If a patient has a fractured cribriform plate what organism is most likely to cause community acquired pyogenic meningitis?

A

Strep pneumoniae

26
Q

If a patient has had neurosurgery or head trauma what organism is most likely to cause community acquired pyogenic meningitis?

A
  • Staphylococcus
  • G-ve bacili
27
Q

What patients with meningitis should undergo a CT before lumbar puncture?

A
  • Immunocompromised
  • History of CNS disease
  • New onset seizure
  • Papillodema
  • Abnormal level of consciousness
  • Focal neurological deficit
28
Q

CSF 99% predictive of bacterial meningitis if what readings are seen?

A
  • WBC >200
  • Neutrophils >1180
  • Protein >220mg/dl
  • Glucose <34mg/dl
  • Glucose (CSF/serum) <0.23
29
Q

What viruses commonly cause viral meningitis in immunosuppressed patients?

A

EBV
CMV

30
Q

What viruses commonly cause meningitis in regular patients?

A
  • Enteroviruses
  • HSV 1&2
  • M. tuberculosis
  • Pneumococci
  • Meningococci
  • H. influenzae
31
Q

What organism causes meningococcal meningitis?

A

N. Meningitidus

32
Q

What group of patients is meningococcal meningitis most common in?

A

young kids

33
Q

What is the mortality rate of localized meningitis?

A

5%

34
Q

What is the mortality rate of meningitis with septicemia?

A

15%

35
Q

What is the mortality rate of fulminant (severe) septicaemia?

A

15-40%

36
Q

Which of the 12 capsular groups of meningococcus are most common in the UK?

A

B, C, W & Y

37
Q

What medication is first line for meningitis?

A

Ceftriaxone (not useful for listeria infections) + dexamethasone

38
Q

What is the most common cause of meningitis in children under 6 years old?

A

H. Influenzae type b

39
Q

Who’s is most at risk of strep pneumoniae meningitis?

A
  • Hospitalized patients
  • Patients with CSF skull fractures
  • Diabetics/alcoholics
  • Young children
40
Q

What antibiotic is given for listeria infection meningitis?

A

IV ampicillin/amoxicillin

41
Q

What medication is given for tuberculous meningitis?

A

Isonazid + rifampicin

Add pyrazinamide + ethambutol

42
Q

What medication is given for cryptococcal meningitis?

A

Fluconazole

43
Q

If a patient has meningitis and is over 60 what medication do you add

A

Amoxicillin

44
Q

If patient is pen allergic and has meningitis what do you give?

A

chloramphenicol + dexamethasone

45
Q

If a meningitis patient is pen allergic and is over 6o what medication do you add?

A

co-trimoxazole

46
Q

What drugs can be used for meningitis prophylaxis?

A
  • Rifampicin
  • Ciprofloxacin
  • Ceftriaxone
47
Q

What drug is given to close contacts of meningitis patients?

A

ciprofloxacin

Neuro week 3 (8 decks)

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