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Flashcards in CNS infections Deck (57)
1

What is acute encephalitis an infection of?

The brain parenchyma

2

What cells would you see in the CSF of a patient with acute bacterial meningitis?

Neutrophils

3

What is the most common cause of viral meningitis?

Enteroviruses such as ECHO

4

What is the treatment for viral meningitis?

Supportive treatment - generally a self limiting condition

5

How do you confirm a diagnosis of viral meningitis?

Viral stool culture Throat swab CSF PCR

6

List some causes of viral encephalitis?

Herpes Simples Varicella zoster CMV HIV Measles West Nile Virus Tick borne encephalitis Rabies

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What is the treatment of herpes simplex encephalitis?

High dose IV aciclovir

8

What is the treatment for varicella zoster viral meningitis?

High dose aciclovir

9

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night.

Viral encephalitis due to varicella zoster virus

10

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night What investigations would you want?

Lumbar puncture MRI If she has had a seizure then EEG

11

A 20 year old girl who has just recovered from shingles comes to a & e with her Mum. She is confused and is having trouble sleeping. Her mum says this started last night. There is going to be a four hour wait to get any investigations. What do you do?

Start aciclovir

12

A 32 year old women presents to a & e with confusion. She also had a widespread blistering rash. This is the MRI of her brain; describe it and give the most likely diagnosis.

Viral encephalitis due to varicella zoster virus.

MRI shows an inflamed portion of the temporal lobe involving the uncus and parahippocampus (the birght white section) 

13

A patients presents with syptoms suggestive of viral encephalitis. You are concerned that the patient has raised ICP. What investigation is best to perform.

CT scan. In a normal case a lumbar punture should be performed but if there is a concern about raised ICP a CT scan should be given first. 

14

What is the first line investigation for a patient with suspected viral encephalitis (Normal ICP)

LP

15

What are the three most common causes of bacteria meningitis in neonates?

Listeria

Group B stre

E coli

16

What is the most common cause of bacterial meningitis in children?

H. Influenzae

17

What is the most common cause of bacterial meningitis in people aged 10 - 21?

Meningococcoal

18

What are the two most common causes of bacterial meningitis in people over 21?

Pneumococcal

Meningococcal

19

What are the two most common causes of meningitis in the elderly?

Pneumococcal

Listeria

20

What kind of bacterial meningitis is someone who has had a fracture of the cribriform plate at risk of?

Pneumococcal

21

What kind of bacterial meningitis is someone who has had open head trauma or open neurosurgery at risk of?

Staphylococcus

Gram Negative rods

22

List 4 things that can be predisposing factors for bacterial meningitis

1. Immunocompromised state

2. Basilar skull fracture

3. Head trauma/Post neurosurgery

4. CSF shunt

23

List three possible ways in which a bacterial meningitis can start. Explain briefly the pathogenesis of each one.

1. Nasopharyngeal colonization (this can then spread)

2. Direct extension of bacteria (from parameningeal foci such - sinusitis, mastoiditis or brain abscess)

3. From a remote infection site (endocarditis, pneumonia, UTI)

24

In meningococcal meningitis what actually causes the symptoms?

Endotoxins

25

A gram positive bacilli then causes meningitis in neonates, elderly and immunocompressed patients

Listeria monocytogenes

26

What antibiotic would you give in a patient with listeria meningitis?

IV ampicillin/amoxicillin

(NOT Ceftriaxone as listeria is intrinsically resistant to this!)

27

What is the treatment for tuberculous meningitis?

Isoniazid

Rifampicin

Pyrazinamide

Ethambutol

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How many tubes do you send for CSF interpretation? What are they?

1. Haematology - cell count & differential

2. Microbiology - gram staina & culture

3. Biochemistry - glucose & proteins

32

What antibiotics do you give for a suspected actute bacterial meningitis?

IV Ceftriaxone

33

What investigations should someone with suspected meningitis get who also has papilloedema.

Urgent CT or MRI

34

List 6 groups of people that should undergo a CT scan before an MRI in suspected bacterial meningitis?

1. Immunocomprimised

2. History of CNS disease eg stroke

3. New onset seizure

4. Papilloedema

5. Abnormal level of consciousness

6. Focal neurological deficit such a dilated non reactive pupil or abnormal eye movements

35

 A patients presents with a stiff neck fever and a non blanching rach into a & e. They are drowsy and confused. What do you do first?

Give antibiotics (Ceftriaxone)

36

What two antibiotics should prescribes for people over the age of 55 presenting with symtpoms suggestive of meningitis? Why?

Ceftriaxone

Ampicillin (to cover listeria infections)

37

What other drug could you give with the first dose of antibiotics in bacterial meningitis?

Dexamethasone

38

What is the first line treatment for a patient with meningitis who has a severe penicillin allergy

Chloramphenicol IV & Vancomycin

39

What is the treatment of penicillin resistant meningitis?

Vancomycin  +/- Rifampicin

40

What would you give to a penicillin allergic patient with meningitis caused by listeria?

Co - trimoxazole

41

Is dexamethasone useful in pneumococcal or meningococcal meningitis?

Pneuomococcal

42

Give a treatment plan for a patient with bacterial meningitis with low GCS of fluctuating conscious level.

1. Admit to HDU

2. Secure airway and start oxygen

3. IV Cefriaxone (+ ampicillin if over 55)

4. IV corticosteroids

DO NOT wait for CT scan or LP

43

What prophylactic treatment should be given to close contacts of someone who has meningitis?

1. Rifampicin

OR

2. Ciprofloxacin

OR 

3. Ceftriaxone

44

What prophylactic treatment is recommended for contacts of someone who has meningitis who is under 12?

Ceftriaxone

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