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NEURO > Infections of the nervous system > Flashcards

Infections of the nervous system Flashcards

1
Q

what is meningitis

A

inflammation/ infection of the meninges

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2
Q

what is encephalitis

A

inflammation/infection of the brain substance

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3
Q

what is myelitis

A

inflammation/infection of the spinal cord

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4
Q

what is the classic triad presentation for meningitis

A

classic triad

- fever, neck stiffness, altered mental state

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5
Q

what are other signs and symptoms of meningitis

A

short history of progressive headache

fever

meningism - neck stiffness, photophobia, vomiting, nausea

cerebral dysfunction

GCS <114

cranial nerve palsy, seizures

rash - petechial

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6
Q

what can cause meningitis

A

infective - bacrerial, viral, fungal

inflammatory - sarcoidosis

drug induced - NSAIDS, IVIG

malignant - metastatic, haematological

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7
Q

what bacteria can cause meningitis

A

neisseria meningitidis

streptococcus pneumoniae

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8
Q

what are viral causes of meningitis

A

enteroviruses

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9
Q

what are the clinical features of encephalitis

A

flu-like prodrome (4-10 days)

progressive headache with fever

+/- meningism

progressive cerebral dysfunction

seizures

focal symptoms/signs

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10
Q

what is the difference between onset of viral encephalitis and bacterial meningitis

A

viral encephalitis slower than bacterial meningitis

cerebral dysfunction more prominent in viral encephalitis

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11
Q

what can cause encephalitis

A

infective - viral - HSV

inflammatory - limbic encephalitis (anti VGKC, anti NMDA receptor)

metabolic - hepatic, uraemic, hyperglycaemic

malignant - metastatic, paraneoplastic

can occur in migraine

can occur after seizure

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12
Q

what are the two antibodies involved in auto-immune encephalitis and how do they present

A

Anti-VGKC

  • frequent seizure
  • amnesia
  • altered mental state

Anti-NMDA

  • flu like prodrome
  • psychiatric features
  • altered mental state
  • seizures
  • progresses to a movement disorder and coma
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13
Q

what investigations can be done for meningitis

A

blood cultures (bacteraemia)

lumbar puncture (CSF culture/microscopy)

no need for imaging if no contraindications to LP

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14
Q

what investigations can be done for encephalitis

A

blood cultures

imaging (CT scan +/- MRI)

LP

EEG

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15
Q

what are contraindications for LP and why

A

Focal symptoms or signs - suggest a focal brain mass

Reduced conscious level - suggests raised intracranial pressure

papilloedema

severe immunocompromised state

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16
Q

what can be found in the CSF in meningitis

A

high cell count - neutrophils, lymphocytes

reduced glucose

high protein

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17
Q

what is the best treatment for bacterial meningitis from S pneumoniae

A

penicillin

18
Q

how would you diagnose and treat HSV encephalitis

A

lab diagnosis = PCR of CSF for viral DNA

treat with acyclovir on clinical suspicion

19
Q

what group of viruses commonly cause CNS infections

A

enteroviruses

spread by faecal oral route

include - polioviruses, coxsackieviruses, echoviruses

20
Q

what is another cause of viral encephalitis

A

arbovirus encephalitis

transmitted to man by vector (e.g. mosquito or tick) from non-human host

travel history relevant here

21
Q

what is a brain abscess

A

localised area of pus in the brain

22
Q

what is a subdural empyema

A

thin layer of pus between the dura and arachnoid membranes over the surface of the brain

23
Q

what are the clinical features of brain abscess and empyema

A

fever
headaches
focal signs (seizure, hemiparesis)
signs of raised ICP - papilloedema, depressed consciousness
meningism
features of underlying source - dental, sinus, ear infection

24
Q

what can cause brain abscess and empyema

A

Penetrating head injury

Spread from adjacent infection

Dental, Sinusitis, Otitis media

Blood borne infection
e.g. Bacterial endocarditis

Neurosurgical procedure

25
Q

what are the differential diagnosis for abscess and empyema

A

focal lesion - most commonly tumour

subdural haematoma

26
Q

how are brain abscess and empyema diagnosed

A

imaging - CT, MRI
investigate source
blood cultures
biopsy - drainage of pus

27
Q

what bacteria most commonly cause brain abscess

A

often polymicrobial

streptococci - eps penicillin resistant gorup
- strep anginosus, intermedius, constellatus

anaerobes
- bacteroides, prevotella

28
Q

what s the management of brain abscess

A

Surgical drainage if possible

Penicillin or ceftriaxone to cover streps

Metronidazole for
anaerobes

High doses required for penetration

29
Q

what brain infections are common in patients with HIV (low CD 4 counts)

A

Cryptococcus neoformans

Toxoplasma gondii

Progressive multifocal leukoencephalopathy (PML)

Cytomegalovirus (CMV)

HIV-encephalopathy (HIV-associated dementia)

30
Q

how can HIV associated infections be diagnosed

A

Cryptococcal antigen
Toxoplasmosis serology
CMV PCR
HIV PCR

31
Q

what diseases can spirochetes in the CNS cause

A

lyme disease
syphilis
leptospirosis

32
Q

what is the first stage of lyme disease

A

early localised infection

  • expanding rash at the site of the tick bite - erythema migrans
  • flu like symptoms days - 1 week
33
Q

what is the second stage of lyme disease

A

early disseminated infection

  • one or more organ systems become involved - haematological or lymphatic spread
  • musculoskeletal and neurologic involvement most common
  • neurologic involvement PNS>CNS
34
Q

what is the third stage of lyme disease

A

chronic infection
- months to years after a period of latency

  • musculoskeletal and neurologic involvement most common
35
Q

what is included in the neurologic involvement of stages 2 and 3 of lyme disease

A 
2/3
Mononeuropathy			
Mononeuritis multiplex		
Painful radiculoneuropathy	 	
Cranial neuropathy
Myelitis
Meningo-encephalitis

3
Subacute encephalopathy
Encephalomyelitis

36
Q

what are the investigations for lyme disease

A

Serological tests

CSF lymphocytosis

PCR of CSF

MRI brain / spine (if CNS involvement)

Nerve conduction studies / EMG (if PNS involvement)

37
Q

what is the treatment of lyme disease

A

prolonged antibiotics

  • IV ceftriaxone
  • oral doxycycline
38
Q

how does neurosyphilis present

A

similar 3 state presentation
primary - secondary - latent

tertiary disease years/decades later not common

39
Q

what are the investigations for neurosyphilis

A

treponema specific and non-treponema specific antibody tests

LP

  • CSF lymphocytes increased
  • evidence of intrathecal antibody production
40
Q

what is the treatment of neurosyphilis

A

high dose penicillin

NEURO (51 decks)

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