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Flashcards in CNS Deck (48):
1

Summary of CNS infections

Meningitis
-Bacterial/ Viral/ TB/ Cryptococcus/ Neonatal

Encephalitis

Brain abscesses

VPS & EVD infections

2

Which CNS infection is called by Viral (HSV1), Bacteria or autoimmune?

Encephalitis

3

What are the 3 components of meningism?

Neck stiffness
Headache
Photophobia

4

Which CNS infection presents as meningism, acute fever, +/- rash and no focal neurology?

MENINGITIS

5

Which CNS infection presents as +/- meningism, acute fever, CHANGE IN MENTAL STATE, +/- focal neurology?

ENCEPHALITIS

6

What type of fever do you get with a brain abscess?

other symptoms?

Gradual fever

Headache
+/- neck stiffness/ focal neurology

7

Causes of brain abcesses?

Bacteria

(parasites)

8

Which CNS infections have altered conciousness?

ENCEPHALITIS

(BRAIN ABSCESS)

9

State the 4 causes of meningitis

Viral
Bacterial
TB
Cryptococcus

10

What test would you do to analysis a patient's CSF?

Lumbar puncture

Patient in foetal position - L3-L4

11

What type of infection does the following CSF analysis suggest:
Cell count > 200
WBC present
Low glucose
Increase protein

Bacterial infection

12

Bacterial meningitis can be caused by which 3 organisms?

N. Meningitidis
H. Influenzae
S. pneumoniae

13

How would you treat Bacterial meningitis?

Ceftriaxone
Cefotaxime
Penicillin

14

Would you give prophylaxis to the contacts of the bacterial meningitis patient?

YES

Rifampicin

15

Neonatal meningitis is caused by E.Coli, Listeria monocytogenes, Group B strep.
How were they exposed?

Preg
Birth canal

16

How would you treat neonatal meningitis?

Cefotaxime
Ampicillin + Gentamicin

17

Which type of meningitis is a MEDICAL EMERGENCY + NOFTIABLE?

VIRAL MENINGITIS

18

Viral meningitis is common in which age group?

Neonates
Children

19

State 5 common causes of viral meningitis.

ENTEROVIRUS*
HSV - diff= Mollarets M..
VSV
Mumps
HIV

"V" for Viral Meningitis

20

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

21

Describe Kernig's sign.

When hip & knee flexed --> pain/stiff in hamstrings, when EXTEND knee

22

Describe Brudzinski's sign.

Flexing neck causes hip & knee to flex

(patient lying down)

23

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

24

Treatment for Viral meningitis?

Supportive

25

What test do you need to do before performing a Lumbar puncture?

Clotting

26

In order to compare the glucose CSF: blood, what should be taken simultaneously?

Blood glucose

27

TB meningitis is gradual onset. (Bacteria slow to grow). What are the risk factors?

Same as TB
Immunocompromised
Alcoholics

28

What cell type would you see in a LP confirming TB meningitis?

Lymphocytes

29

Treatment of TB meningitis?

12 month standard TB treatment

30

Cryptococcus meningitis is seen especially in whom?

HIV

31

Cryptococcus meningitis has the same CSF findings as TB M. What is the treatment?

Fluconazole
Amphotericin

32

List the complications of Meningitis

Sepsis
Increased ICP
Deafness
Delayed development
Seizures
Stroke
Hydrocephalus

33

Which CNS infection should you treat on clinical suspicion?

ENCEPHALITIS

34

With suspected Meningitis/Encephalitis, What should you alwyas ask the patient?

TRAVEL HISTORY

35

90% of Encephalitis is caused by...?

HSV1

36

Presentation of Encephalitis?

(Meningism)
Acute fever
CHANGE IN MENTAL STATE
+/- focal neurology (weakeness, ataxia, dysphagia, CN palsy..)
Seizures
ALTERED CONCIOUSNESS

37

Investigations of Encephalitis?

FULL NEUROLOGICAL EXAM
Bloods
CT
MRI - typical changes
LP
EEG - abnormal tempora activity

38

How do the LP results of Encephalitis compare to Viral Meningitis?

The same

39

Treatment of Encephalitis?

IV Aciclovir (14-21 days)

Repeat LP

40

Which autoimmune CNS demyelination condition presents the same and has same CSF fidnings as encephalitis?

ADEM

Acute disseminated Encephalomyopathy

41

Are brain abscess monomicrobial or polymicrobial?

POLYMICROBIAL

42

How do brain abscesses occur?

Direct spread (ear, sinus, teeth)

Blood- Endocarditis, Bronchiectasis

Trauma

Idiopathic

43

Clinical presentation of brain abcesses?

Headache
Neck stiffness
Gradual fever
Seizures
Nausea/Vomiting
Focal neurology

44

State 2 complications of brain abscesses.

Increased ICP --> mass effect

Rupture --> Ventriculitis

45

What is the main way of managing brain abscesses?

Drainage

46

What is an example of a brain abscess

Subdural empyema

47

Neurosurgical patients have a VP shunt/EVD shunt to treat hydrocephalus/monitor CSF respectively. How does infection occur?

Tubes become colonised

48

How would you manage VP shunt/EVD infection to avoid ventriculitis?

Remove drain

IV antibiotics