Summary of CNS infections
Meningitis
-Bacterial/ Viral/ TB/ Cryptococcus/ Neonatal
Encephalitis
Brain abscesses
VPS & EVD infections
Which CNS infection is called by Viral (HSV1), Bacteria or autoimmune?
Encephalitis
What are the 3 components of meningism?
Neck stiffness
Headache
Photophobia
Which CNS infection presents as meningism, acute fever, +/- rash and no focal neurology?
MENINGITIS
Which CNS infection presents as +/- meningism, acute fever, CHANGE IN MENTAL STATE, +/- focal neurology?
ENCEPHALITIS
What type of fever do you get with a brain abscess?
other symptoms?
Gradual fever
Headache
+/- neck stiffness/ focal neurology
Causes of brain abcesses?
Bacteria
parasites
Which CNS infections have altered conciousness?
ENCEPHALITIS
BRAIN ABSCESS
State the 4 causes of meningitis
Viral
Bacterial
TB
Cryptococcus
What test would you do to analysis a patient’s CSF?
Lumbar puncture
Patient in foetal position - L3-L4
What type of infection does the following CSF analysis suggest: Cell count > 200 WBC present Low glucose Increase protein
Bacterial infection
Bacterial meningitis can be caused by which 3 organisms?
N. Meningitidis
H. Influenzae
S. pneumoniae
How would you treat Bacterial meningitis?
Ceftriaxone
Cefotaxime
Penicillin
Would you give prophylaxis to the contacts of the bacterial meningitis patient?
YES
Rifampicin
Neonatal meningitis is caused by E.Coli, Listeria monocytogenes, Group B strep.
How were they exposed?
Preg
Birth canal
How would you treat neonatal meningitis?
Cefotaxime
Ampicillin + Gentamicin
Which type of meningitis is a MEDICAL EMERGENCY + NOFTIABLE?
VIRAL MENINGITIS
Viral meningitis is common in which age group?
Neonates
Children
State 5 common causes of viral meningitis.
ENTEROVIRUS* HSV - diff= Mollarets M.. VSV Mumps HIV
“V” for Viral Meningitis
Kernig’s and Brudzinski’s sign would be found on examination of a patient with bacterial meningitis.
T/F?
F
+ve in patient with VIRAL meningitis
Describe Kernig’s sign.
When hip & knee flexed –> pain/stiff in hamstrings, when EXTEND knee
Describe Brudzinski’s sign.
Flexing neck causes hip & knee to flex
patient lying down
What investigations would you do in a case of suspected viral meningitis?
Blood tests - esp Clotting LP CT head Throat/stool - enterovirus Serology - Mumps, HSV, EBV, HIV
Treatment for Viral meningitis?
Supportive
What test do you need to do before performing a Lumbar puncture?
Clotting
In order to compare the glucose CSF: blood, what should be taken simultaneously?
Blood glucose
TB meningitis is gradual onset. (Bacteria slow to grow). What are the risk factors?
Same as TB
Immunocompromised
Alcoholics
What cell type would you see in a LP confirming TB meningitis?
Lymphocytes
Treatment of TB meningitis?
12 month standard TB treatment
Cryptococcus meningitis is seen especially in whom?
HIV
Cryptococcus meningitis has the same CSF findings as TB M. What is the treatment?
Fluconazole
Amphotericin
List the complications of Meningitis
Sepsis Increased ICP Deafness Delayed development Seizures Stroke Hydrocephalus
Which CNS infection should you treat on clinical suspicion?
ENCEPHALITIS
With suspected Meningitis/Encephalitis, What should you alwyas ask the patient?
TRAVEL HISTORY
90% of Encephalitis is caused by…?
HSV1
Presentation of Encephalitis?
(Meningism) Acute fever CHANGE IN MENTAL STATE \+/- focal neurology (weakeness, ataxia, dysphagia, CN palsy..) Seizures ALTERED CONCIOUSNESS
Investigations of Encephalitis?
FULL NEUROLOGICAL EXAM Bloods CT MRI - typical changes LP EEG - abnormal tempora activity
How do the LP results of Encephalitis compare to Viral Meningitis?
The same
Treatment of Encephalitis?
IV Aciclovir (14-21 days)
Repeat LP
Which autoimmune CNS demyelination condition presents the same and has same CSF fidnings as encephalitis?
ADEM
Acute disseminated Encephalomyopathy
Are brain abscess monomicrobial or polymicrobial?
POLYMICROBIAL
How do brain abscesses occur?
Direct spread (ear, sinus, teeth)
Blood- Endocarditis, Bronchiectasis
Trauma
Idiopathic
Clinical presentation of brain abcesses?
Headache Neck stiffness Gradual fever Seizures Nausea/Vomiting Focal neurology
State 2 complications of brain abscesses.
Increased ICP –> mass effect
Rupture –> Ventriculitis
What is the main way of managing brain abscesses?
Drainage
What is an example of a brain abscess
Subdural empyema
Neurosurgical patients have a VP shunt/EVD shunt to treat hydrocephalus/monitor CSF respectively. How does infection occur?
Tubes become colonised
How would you manage VP shunt/EVD infection to avoid ventriculitis?
Remove drain
IV antibiotics