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CLS > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Define Meningitis

A

inflammation of the meninges

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2
Q

Define encephalitis

A

inflammation of the brain

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3
Q

Define myelitis

A

inflammation of the spinal cord

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4
Q

Deine neuritis

A

inflammation of the peripheral nerves

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5
Q

Name 4 routes of meningitis infection

A

Blood borne
Parameningeal supparation ( otis media, sinisitis
Direct spread through defect in the dura (surgery or trauma)
Direct spread though cribiform plate (rare)

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6
Q

What characteristics of the CSF make it unusual to treat

A

Low protein/complement
Low IgG
no lymphatics
BBB

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7
Q

How does bacteria get into the blood stream from the naspharynx

A

IgA protease
pili
endocytosis
separate tight junctions

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8
Q

In the blood how does the bacteria avoid attack

A

Capsules resistlysis/phagocytosis

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9
Q

In the CSF how does bacteria avoid the immune system

A

no ig C3/4 or professional phagocytes

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10
Q

Once in the CSF what does the presence of bacteria trigger

A

Mononuclear and glial cells
migration of neutrophils- release of cyto-toxic oxygen metabolites
cerebral capillary endothelium so allow entry of plasme proteins = oedema

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11
Q

What are meningism symptoms

A

Global severe headache
neck and back stiffness
nausea and vomiting
photophobia

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12
Q

What are some physical signs

A

Fever ( also can be low )

rash-purpuric/petechial in menginococcal but also streptococcal, hib spp and enterovrius

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13
Q

What is the constellation of symptoms in bacterial meningitis

A 
97% fever
82% meningism
66% impaired consiousness
52% rash
30% seizures
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14
Q

For an adult what symptoms suggest they have a more than 50% chance of death or permanent damage

A

Hypotension
serizures
and altered consiousnes

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15
Q

What signs of bacterial meningitis are specific to children

A

Flaccid or later opisthotonus
bulging fontanelle
strange cry
convulsions

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16
Q

What is the most rapid diagnostic test for bacterial meningitis

A

Lumbar puncture but there is a risk of herniation with raised ICP

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17
Q

When is a CT scan indicated

A

When the diagnosis is in doubt
with focal abnormalities
with coma or seizures

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18
Q

Name 6 causes of lymphocytic CSF

A 
TB
partially treated bacterial infection
intracranial abcesses
Leptospirosis
Lyme borreliosis
Viral meningo-enceohalitis
syphillis
lymphocytic leukaemias
19
Q

What tests can be done on CSF for menigitis

A

Gram stain
Zn
Agglutination
PCR

20
Q

Name 6 organisms that cause bacterial meningitis

A 
Neisseria meningitidis
streptococcus pneumoniae
Heamophilus influenzae type B 
group B streptococcus
e.coli
listeria monocytogenes
21
Q

Which bacteria are most likely to affect children and young adults

A

n. meningitidis

22
Q

Which bacteria are likely to affect neonates

A

Group B streptococcus
e.coli
Listeria monocytogenes

23
Q

Which bacteria is it unlikely to be now because of vaccination

A

Heamophilus influenzae type B

24
Q

Which bacteria are you worried about in the elderly and children under 2

A

streptococcus pneumoniae

25
Q

What are the predisposing factors or pnuemococcal meningitis

A

Alcohol, diabetes, immunocompromised, hyposplenism, myeloma

26
Q

What are characteristic signs of pneumococcal meningitis

A

Pneumonia +/- otis media in 50%

neurological signs, seizures and imparied consiousness

27
Q

What gram stain is listeriosis

A

negative

28
Q

What characterises listeriosis

A

Effets brainstem, ataxia and movement disorders

29
Q

What are the complications of meningitis

A 
Death
subdural collection
cerebral vein thrombosis
hydrocephallus
deafness
convulsions
visual/motor/sensory deficits
30
Q

What are the management strategies for meningitis

A 
Antibiotics
oxygen
decrease ICP
prevention of hypoglycaemia and hyponatreamia
anticonvulsants
31
Q

For which meningitis are steroids indicated

A

Hib species

32
Q

When is chemoprophylaxis indicated

A

Hib and meningococcal for kissing or household contacts

33
Q

What can myelitis cause

A

transverse- acute transection of the spinal cord

34
Q

What are some causes of myelitis

A

vasculitis of anterior spinal artery- primary infection=VZV TB Syphilis
post infection=measels mumps rubella
direct invasion of cord= VZV borrelia HTVL-1

35
Q

What are some symptoms of myelitis

A

Flaccid paralysis, sensory loss

36
Q

What are some symptoms of encehalitis

A 
irritability
altered personality
drowsiness
cerebral/brainstem failure
ataxia
excessive brisk tendon reflexes 
sluggish pupil reflexes
signs of brain swelling
37
Q

What causes primary encephalomyeltis and what is their entry to the body

A

HSV-1 mucosa
enteroviruses gi tract
listeria gi tract
measels and mumps resp tract

38
Q

What things cause encephalomyelitis post infection

A

Chicken pox
flu A+B
measels

39
Q

How do you treat HS encephalitis

A

aciclovir

40
Q

How do you treat most viral mengintis

A

self-limting, so only supportive treatment

41
Q

Comparing bacterial, viral and TB mengitis what is the difference in

a) predominant cell
b) cell count
c) protein
d) glucose

A

a) bacterial =polymorphs and viral and tb = lymphocytes
b) high cell count, slight to mod, mod to high
c) high, normal/raised, high
d) low, normal/low, low

42
Q

Other than cellular picture of CSF what indicates bacterial rather than viral meningitis

A 
systemic inflammation ( CRP marker) 
rash
43
Q

What is the commonest cause of viral meningitis

A

Enterovirus

44
Q

What antibiotics are mostly used for bacterial menginitis

a) in adults
b) neonates

A

a) Cefriaxone + amoxycilin if listeria?

b) benzylpenicillin and gentamicin

CLS (12 decks)

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