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NEUROLOGICAL DISEASE > MENINGITIS > Flashcards

MENINGITIS Flashcards

1
Q

What are the different ways that infective agents reach the meninges resulting in meningitis?

A

Haematogenous (most common)
Direct - sinuses or inner ear
Fractures of skull

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2
Q

What are the most common bacterial agents that causes meningitis?

A

Haemophilus influenzae
Neisseria meningitidis - gram negative diplococci
Streptococcus Pneumoniae - gram positive pairs/short chains

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3
Q

What is are the triad of clinical features associated with meningitis?

A

Headache
Photophobia
Neck stiffness

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4
Q

What are the two signs that are used to look for neck stiffness in someone with suspected meningitis?

A

Kernig’s sign

Brudzinski’s sign

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5
Q

How do you test for Kernig’s sign?

A

Extend knee with hip flexed at 90˚

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6
Q

How do you test for Brudzinski’s sign?

A

With patient supine, the neck is flexed passively. You are looking for involuntary lifting of the legs.

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7
Q

What symptoms might be seen in someone with suspected meningitis where there is raised intracranial pressure?

A

Confusion
Fluctuating levels of consciousness
Seizures
Cranial nerve palsies

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8
Q

What additional symptom may be seen in a patient who is suspected of having meningococcal septicaemia?

A

Rapidly progressing petechial/purpuric non-blanching rash

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9
Q

What are the major causes of aseptic meningitis?

A

Viruses

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10
Q

What is the leading causes of viral meningitis?

A

Enteroviruses - including echoviruses and coxsackieviruses.

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11
Q

What organism is most likely to be responsible for a chronic meningitis, developing over weeks to months?

A

Tuberculosis

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12
Q

What is the organism associated with meningitis is those with advanced HIV?

A

Cryptococcal meningitis (fungal)

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13
Q

What is the main investigations that should be done with someone who has suspected meningitis?

A

LP

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14
Q

When should a CT be done before a lumbar puncture?

A

Immunocompromised patients
Those with a history of central neurological disease
Those with new-onset seizures
Those with papilloedema
Those with abnormal levels of consciousness
Those with a focal neurological deficit

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15
Q

Why is important to do a CT on a patient with suspected meningitis if they have symptoms associated with raised intracranial pressure?

A

To assess the risk of coning

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16
Q 
Give a description of the appearance of the CSF in each of the following situations:
Normal
Bacterial meningitis
Viral meningitis
Tuberculous meningitis
A

Normal - clear
Bacterial - Turbid/pus
Viral - clear/turbid
Tuberculous - Turbid/viscous

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17
Q 
What are the levels of neutrophils in the CSF in each of the following situations:
Normal
Bacterial meningitis
Viral meningitis
Tuberculous meningitis
A

Normal - none
Bacterial - 200-10,000/mm3
Viral - none
Tuberculous - 0-200/mm3

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18
Q 
What are the levels of lymphocytes in the CSF in each of the following situations:
Normal
Bacterial meningitis
Viral meningitis
Tuberculous meningitis
A

Normal -

19
Q 
What are the levels of protein in the CSF in each of the following situations:
Normal
Bacterial meningitis
Viral meningitis
Tuberculous meningitis
A

Normal - 0.2-0.4g/L
Bacterial - 0.5-2.0g/L
Viral - 0.4-0.8g/L
Tuberculous - 0.5-3.0g/L

20
Q 
What are the levels of glucose in the CSF in each of the following situations:
Normal
Bacterial meningitis
Viral meningitis
Tuberculous meningitis
A

Normal - >1/2 blood glucose

Bacterial -

21
Q

What are the normal pressures of the CSF?

A

10 to 18 mmHg

22
Q

What are the complications associated with meningitis?

A 
Hydrocephalus
Cerebral oedema
Venous sinus thrombosis
Subdural empyema
Cerebral abscess
Arteritis
23
Q

What is the treatment of bacterial meningitis?

A

Treatment should be started immediately after LP, unless there is going to be a 30 minute delay prior to LP.
Cefotaxime or ceftriaxone
Cover with ampicillin with or without gentamicin where Listeria is suspected.

24
Q

When should steroids be used in the treatment of meningitis?

A

In all adults with suspected or proven pneumococcal meningitis.
In tuberculous meningitis
Must be given within 12 hours of start of antibiotics

25
Q

How is viral meningitis managed?

A

Largely supportive

Acyclovir is controversial

26
Q

What must a doctor do by law if bacterial meningitis is diagnosed?

A

It is a notifiable disease

27
Q

What is the treatment plan for tuberculous meningitis?

A

At least 9 months standard TB therapy:

Isoniazid, Rifampicin and Pyrazinamide and possibly ethambutol.

28
Q

What is encephalitis?

A

Inflammation of the brain parenchyma.

29
Q

What type of pathogen is normally responsible for encephalitis?

A

Viruses

30
Q

What are the viruses most commonly associated with encephalitis?

A

Echovirus
Coxsackie virus
Mumps virus
Herpes simplex

31
Q

Which virus causes the most severe cases of viral encephalitis in the UK and is also the most common cause?

A

Herpes simplex 1 and 2

32
Q

What are the most common clinical features of encephalitis?

A

Most common:
Headache
Drowsiness

Also:
Focal signs
Seizures
Severely depressed levels of consciousness

33
Q

What are the clinical features of Herpes simplex encephalitis?

A 
Headache
Pyrexia
Myalgia
Malaise
Meningism
Confusion
Dysphasia
Hemiparesis
Seizures
Ataxia
Cranial nerve palsies
Autonomic dysfunction
34
Q

What investigations should be ordered for someone with suspected encephalitis?

A 
FBC
CRP
CT scan
MRI
EEG
Viral serology
35
Q

What would a CT scan of someone with encephalitis reveal?

A

Cerebral oedema

36
Q

What would a MRI scan of someone with encephalitis reveal?

A

Very distinctive pattern of Herpes simplex virus in one or both temporal lobes.

37
Q

What might an EEG of someone with encephalitis reveal?

A

Non-specific slow wave changes and/or periodic changes - if findings are restricted to temporofrontal regions very suggestive of herpes simplex.

38
Q

What is the management of someone diagnosed with herpes simplex encephalitis?

A

Acyclovir
Anticonvulsants for seizures
Control of cerebral oedema

39
Q

What is a cerebral abscess?

A

A focal encapsulated area of infection with the cerebrum. Also possible to have cerebellar abscesses.

40
Q

What are the diseases that predispose someone to brain abscesses?

A

Chronic lung infection - bronchiectasis, chronic sinusitis
Congenital heart disease - shunts
Bacterial endocarditis
Immunocompromised patients with infection

41
Q

What are the usual causative organisms of a cerebral abscess in non-immunodeficient patients?

A

Bacteria - mainly anaerobes

Streptococcus viridans and milleri
Bacteroides species
Enterobacteria - E coli, Proteus species
Staph aures

42
Q

What are the usual causative organisms of a cerebral abscess in immunocompromised patients?

A 
Toxoplasma
Aspergillus
Candida
Listeria
Strongyloides
43
Q

What are the classic clinical features of cerebral abscess?

A 
Short (less than 1 month) history
Headache
Vomiting
Deterioration in consciousness level
Papilloedema

NEUROLOGICAL DISEASE (21 decks)

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