CNS Infections

Question 1

What is infected in meningitis?

Answer 1

Infection of pia mater and pus in subarachnoid space

Question 2

What are the causes of meningitis in the elderly?

Answer 2

Listeria, TB and gram negatives

Question 3

What are the causes of meningitis in neonates?

Answer 3

E-Coli
Beta Haemolytic Strep
Listeria

Question 4

What are the viral causes of meningitis?

Answer 4

HIV
Mumps
Herpes
Coxsackie

Question 5

What are non infectious causes of meningitis?

Answer 5

Tumours
Cysts
NSAIDs
SLE
Vasculitis
Parameningeal infections

Question 6

What is the presentation of meningitis?

Answer 6

Meningismus
Headache
Fever
Kernigs sign
Bradzinki's sign
Photophobia
Rash?

Question 7

What is Bradzinki’s sign?

Answer 7

Neck flexion causes knee flexion

Question 8

What is Kernig’s sign?

Answer 8

Hip flexion and knee extension causes pain

Question 9

How do you investigate meningitis?

Answer 9

CT then LP

CSF culture

Question 10

What is CSF like in viral meningitis?

Answer 10

Clear
Raised lymphocytes
Raised protein
Normal Glucose

Question 11

What is CSF like in TB meningitis?

Answer 11

Fibrin web
Raised WCC
Raised Protein
Low Glucose

Question 12

What is CSF like in bacterial meningitis?

Answer 12

Turbid
Raised Neutrophils (& polymorphs)
Very raised protein
Low Glucose

Question 13

How is meningitis treated?

Answer 13

ABCD
IV fluid
IV Ceftriaxone (Amoxicillin if pregnant or immunocompromised) & Isolate
Dexamethasone if pneumococcal

Question 14

What prophylaxis do you give close contacts and what is your other responsibilty?

Answer 14

Notifiable disease

Rifampicin or Cipro and meningococcal vaccine

Question 15

How do you treat meningitis in primary care or if the patient is in shock?

Answer 15

IV Benzylpenecillin

Question 16

How do you treat aseptic or viral meningitis?

Answer 16

No treatment its self limiting

ABC & maintain fluids

Question 17

Where do brain abscesses from direct invasion come from & what organisms?

Answer 17

Middle ear- S. pyogenes or S milleri
Sinus
Tooth

Question 18

Where do brain abscesses that occur after haematologous spread originate?

Answer 18

Endocarditis
Right to left Cardiac shunts
Bronchiectasis (anaerobes)

Question 19

What investigations do you do for a brain abscess?

Answer 19

CT
MRI
WCC
ESR

Question 20

What are the symptoms of a potential brain abscess?

Answer 20

Fever
Headache
Focal Neurological signs
Seizures

Question 21

What treatment options are there for brain abscesses?

Answer 21

Surgical excision/drainage
Ceftriaxone and Flucloxacillin and Metronidazole
Reduce ICP with dexamethasone

Question 22

What toxin mediated causes of CNS infection are there?

Answer 22

Tetanus

Botulinism

Question 23

Is Encephalitis usually viral or bacterial?

Answer 23

Viral

Question 24

What are the common causative agents in encephalitis?

Answer 24

Enteroviruses
Mumps
HSV
VZV
HIV
Rabies
Japanese encephalitis

Question 25

Symptoms of encephalitis

Answer 25

``` Headache Fever Altered consciousness Hallucinations and delusions Focal signs Hemiparesis etc ```

Question 26

How do you diagnose encephalitis?

Answer 26

``` High contrast CT Blood culture Viral ABs EEG LP ```

Question 27

How do you treat encephalitis?

Answer 27

High dose IV Acyclovir

Question 28

How is rabies spread?

Answer 28

Saliva

Question 29

How do you treat rabies in vaccinated and non vaccinated individuals?

Answer 29

5 IM vaccine shots and Ig to bite site if not vaccinated | Ditto, but 2 shots if vaccinated

Question 30

How is rabies diagnosed?

Answer 30

Nape of neck biospy

Question 31

How does rabies affect the brain?

Answer 31

Spreads up peripheral nerves and forms Negri bodies.

Question 32

Symptoms of rabies

Answer 32

``` Fever Heachache Malaise Hallucination and excitation with lucent periods Salivation ```

Question 33

What symptoms are classic of Tetanus?

Answer 33

Trismus (lockjaw) Sustained muscle contraction (bent back) Facial muscle involvement and spasms

Question 34

How is tetanus diagnosed?

Answer 34

Wound culture

Question 35

How is Tetanus treated?

Answer 35

Benzlypenecillin and IVIg

Question 36

How does botulinism present?

Answer 36

Descending paralysis starting with cranial neuropathy

Question 37

How is Botulinism treated?

Answer 37

Antitoxin

Question 38

How is Polio spread?

Answer 38

Faeco Oral

Question 39

What kind of vaccine is the polio vaccine?

Answer 39

Live attenuated

Question 40

How do polioenteroviruses cause disease?

Answer 40

They cross the BBB and cause encephalitis with motor nuclei destruction in the anterior horn or brainstem and spinal cord causing paralytic poliomyelitis