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FRCS Part 1 > Ch20-21 CNS infections > Flashcards

Ch20-21 CNS infections Flashcards

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1
Q

What is Waterhouse-Friderichsen syndrome?

A

Complication of meningococcal infection, occurs in 10-20% of children with acute meningitis. Petechial haemorrhages and haemorrhage into adrenals and DIC. Increased ICP may occur

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2
Q

What are the commonest pathogens causing meningitis in immunocompetent patients?

A

Neisseria Meningitidis
Strep Pneumoniae
H. Influenza Type B

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3
Q

Which form of meningitis is likely to present with hydrocephalus?

A

Cryptococcal meningitis

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4
Q

Usual organisms in post-neurosurgical procedure meningitis?

A

coag -ve staph aureus enterobacter pseudomonas

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5
Q

What pathogens to consider in immunocompromised with infection?

A

Cryptococcus
TB
Listeria Monocytogenes
HIV aseptic meningitis

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6
Q

How do you treat a post traumatic meningitis?

A

broad spectrum ABx with good CNS penetration e.g. Vanc and Mero.Pneumococcal vaccine as most commonly associated with a CSF leak.Consider exploration or insertion with lumbar drain. May stop spontaneously but this may be due to obscuration by encarcerated brain and high potential for CSF leak later.

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7
Q

Causes of recurrent meningitis?

A

dermal sinus, CSF fistula, neurenteric cyst

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8
Q

Causes of chronic meningitis?

A

TB
fungal infections
neurocystericosis

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9
Q

Borrelia burgdorferi causes what neurological deficit?

A

BB -> Lyme disease. Can cause facial nerve weakness. May appear weeks after the initial rash

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10
Q

WHat is the treatment for Listeria monocytogenes?

A

Ampicillin and gentamicin. (Cephalosporins are inactive against listeria) treat for 21 days

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11
Q

Commonest pathogen causing cerebral abscesses?

A

Streptococcus viridans

Klebsiella pneumoniae

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12
Q

What stage does necrosis begin in abscess formation?

A

Stage 2 - late cerebritis (day 4-9)

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13
Q

What are the stages of abscess formation?

A

Stage 1 - early cerebritis Day 1-3
Stage 2 - late cerebritis Day 4-9
Stage 3 - early capsule Day 10-14
Stage 4 - late capsule >14days

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14
Q

What stage of abscess formation do you get neovascularisation?

A

Stage 3 - early capsule - Day 10-14

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15
Q

What is different about the scarring left by an abscess?

A

Collagen scar as opposed to glial scar

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16
Q

Commonest cause of fungal abscesses?

A

Aspergillus - although uncommon to cause meningitis or meningoencephalitis

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17
Q

What organism causes neurocytercosis?

A

Taenia solium

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18
Q

child with polycystic lesion (and ?fever)

A

Echinococcus

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19
Q

What percentage of subdural empyemas occur in the spine?

A

5%

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20
Q

what is the likely pathogen in a brain abscess secondary to otitis externa?

A

Pseudomonas

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21
Q

In what condition might you see oculomasticatory myorhythmia?

A

Whipple’s disease (Tropheryma Whipplei)

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22
Q

What is the commonest neurological involvement in HIV/AIDS

A

AIDS encephalopathy

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23
Q

Commonest part of the spine to get epidural abscesses?

A

Thoracic (50%) then lumbar (35%) then cervical (15%)Most are posterior (82%)

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24
Q

Commonest source of infection in spinal epidural abscess?

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A

Haematogenous spread from skin infections. Furuncle may be found in 15% of cases.

25
What is the risk of treating spinal epidual abscess with antibiotics alone?
Can develop rapid neurological deterioration (mechanism may be compression, venous infarcts or direct infiltration of infection into spinal cord)
26
Which patients should have abx treatment only with spinal epidural abscess?
Antibiotic treatment should be reserved for 1. patients unfit for GA2. Involvement of extensive length of spinal canal3. Complete paralysis >3days
27
Commonest pathogen to cause vertebral osteomyelitis and spinal epidural abscess?
Staph Aureus
28
In VB osteomyelitis what is the yield from blood cultures versus needle biopsy?
50% for blood cultures60-90% for needle biopsy15% get different organisms from BC vs needle Bx!
29
Pathogen that is most likely to cause discitis in IVDU?
Pseudomonas
30
What are the risk factors for shunt infection in myelomeningocoele patients?
Age - evidence that waiting until child is 2 weeks old reduces risk of infection Longer procedure - shunting at same time as repair associated with higher risk of infection Open defect more likely to get infected.
31
Which pathogens most likely to cause infections in neonates?
E Coli Strep haemolyticus
32
What is an additional complication of a ventriculovascular shunt?
shunt nephritis - immune complex deposition in renal glomeruli
33
How does gram -ve bacillus infection differ from staph CSF infection
More severe clinical course higher protein and lower glucose with more neutrophils on CSF analysis
34
What antibiotics would you start a patient with shunt infection on?
IV Vancomycin and Meropenem
35
Organism associated with haemolytic uraemic syndrome?
E.Coli
36
How do you differentiate viral meningitis and TB on LP?
Both have high lymphocytes, but TB has high protein and low glucose. These are normal with viral infections.
37
What is the classical pattern of CNS cryptococcus?
Multifocal gelatinous cysts within the basal ganglia bilaterally in an immunocompromised patient
38
What infection causes multiple haemorrhagic infarcts in a patient with AIDs?
Aspergillosis
39
Which infection is associated with thin walled cysts and a solid nodule (scolex)?
Neurocysticercosis
40
What are the gross pathological features of progressive multifocal leukoencephalopathy?
A confluence of multiple areas of demyelination forming a WM lesion that spares the cortical ribbon in an immunocompromised patient due to JC virus.
41
What are the side effects of isoniazid?
Optic neuritis Peripheral neuropathy Hepatitis
42
What type of meningitis results from freshwater swimming?
Amoebic meningoencephalitis (Naegleria fowleri). Enters through the cribiform plate and is almost always fatal.
43
Which organism cause rhombencephalitis in the elderly/immunocompromised with mild CSF pleocytosis. Cultures are negative.
Listeria monocytogenes
44
What are the stages of abscess formation?
Early cerebritis (d1-3), late cerebritis (d4-9), early encapsulation (d10-13) has a collagen capsule and late encapsulation has extracapsular gliosis (d>14). Necrosis begins in the late cerebritis stage.
45
When should abscess be excised or aspirated?
Superficial, non-eloquent, multiiloculated, failure to resolve after multiple aspirations, fungal, foreign body associated, gas-forming organisms and CSF fistula associated should be excised.
46
What imaging finding is associated with toxoplasma abscess?
Eccentric target sign
47
What is the most common cause of fungal abscess?
Aspergillus. Associated with black exudate.
48
What drugs are given for neurocystercicosis?
Albendazole and praziquantel
49
What does CSF EBV PCR positive suggest in a patient with AIDS?
Primary CNS lymphoma
50
What organism causes encephalic hydatidosis?
Echinococcus from ingesting animal fecal matter. Mutlple cysts with compartments.
51
What is the most sensitive and specific finding of TB meningitis?
Linear enhancement of the MCA cisterns and basal leptomeningeal enhancement.
52
What is Pott's puffy tumour?
Rare osteomyelitis of the frontal bone leading to development of a subperiosteal abscess. Mostly caused by Step, haemophilus and staph spp.
53
What is the commonest cause of pyogenic brain abscess?
Strep viridans
54
What is the commonest cause of post-neurosurgery abscess?
Staph aureus
55
What is the commonest cause of abscess following otitis externa?
Pseudamonas
56
Which organism causes parietal lobe lesions resulting in alien hand syndrome?
JC virus
57
Which infection causes an increase in gamma globulins and the presence of oligoclonal bands
Measles, causes demyelination in subacute sclerosing panencephalitis
58
What finding is pathognomonic of Whipple's disease?
Oculomasticatory myorhythmia = pendular convergence movement of the eyes in association with contraction of the masticatory muscles. Also have supranuclear gaze palsy, myoclonus, ataxia, hypothalamic dysfunction and dementia.

FRCS Part 1 (85 decks)

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