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Neurology > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Common organisms causing meningitis in neonates

A

Listeria
Group B strep
E coli

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2
Q

What is the commonest organism causing meningitis in young children?

A

Haemophilus influenza

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3
Q

What is the commonest organism causing meningitis in adolescents (10-21y/o)

A

Neisseria Meningitidis

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4
Q

What are some early clinical symptoms of meningitis?

A

Headache
Leg Pain
Cold hands
Abnormal skin colour

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5
Q

List some later symptoms of meningitis

A 
Neck stiffness
Photophobia
Kernig's sign  
Decreased consciousness 
Seizures 
Petechial rash
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6
Q

What is significant about a meningitis rash?

A

Non-blanching

Petechia

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7
Q

List the main investigations done for bacterial meningitis:

A 
Blood cultures
FBC 
Us and E's
CT imaging 
PCR
Lumbar puncture (if appropriate)
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8
Q

Bacterial meningitis can be culture negative. True or False

A

True

10-15%

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9
Q

What three symptoms make up meningism?

A

Neck stiffness
Photophobia
Headache

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10
Q

What is the most common causative organism of meningitis in >65y/o

A

Strep Pneumoniae

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11
Q

What is the most common causative organism of meningitis in pregnant women?

A

Listeria Monocytogenes

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12
Q

What is Kernig’s sign?

A

When the patient’s hip is flexed, their knee resists extension.

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13
Q

What is Brudzinski’s sign?

A

This is when forced flexion of the neck elicits a flexion reflex in the hip

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14
Q

Why would you do a CT before a Lumbar puncture in suspecting meningitis?

A

If patient is showing any signs of raised ICP

If patient has raised ICP it is not appropriate to do an LP as this could lead to coning.

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15
Q

What would a lumbar puncture show in bacterial meningitis?

A

Cloudy turbid CSF
Increased cell count with polymorphs present
Decreased glucose
increased protein

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16
Q

What is the treatment for bacterial meningitis?

A

Ceftriaxone IV
Dexamethasone
If listeria suspected –> amoxicillin

17
Q

What prophylactic antibiotics are given to those in contact with bacterial meningitis?

A

Ciprofloxacin
OR
if contraindicated - rifampicin

18
Q

What other medication can be given alongside antibiotics to improve patient outcome in bacterial meningitis?

A

Steroids

19
Q

When should you not give steroids in bacterial meningitis?

A

If patient has developed meningitis post surgery or is in septic shock
Immunocompromised patients

20
Q

Viral meningitis is more severe than bacterial. True/false?

A

False

It is usually self limiting and lasts roughly 4-10 days

21
Q

What group of viruses are mainly responsible for viral meningitis?

A

Enteroviruses

e.g. ECHO

22
Q

What virus can cause a more severe viral meningitis that leads to encephalitis?

A

Herpes Simplex Virus

HSV

23
Q

What symptoms are seen in viral meningitis?

A

Similar to bacterial
Meningism
Fever may be less pronounced

24
Q

What would be seen on a lumbar puncture in viral meningitis?

A 
Normal opening pressure
Clear CSF
Raised cell count
Glucose normal/low
Protein high/normal
25
Q

Other than an LP what other investigations might you do for viral meningitis?

A

Viral Stool culture
CSF PCR
Throat swab

26
Q

What is the treatment for viral meningitis?

A

Supportive therapy

Can give IV acyclovir in extreme cases

27
Q

What is the characteristics of CSF in TB meningitis?

A

Opaque fluid which settles to form fibrin webs
Lymphocytes present
Decreased glucose
Increased protein

28
Q

Define encephalitis:

A

Acute inflammation of the brain parenchyma which can commonly occur following a viral infection

29
Q

What is the most common causative virus in encephalitis?

A

HSV

30
Q

List some other viruses which can cause encephalitis?

A

EBV
CMV
Mumps
Varicella Zoster

31
Q

What virus is most likely to cause focal neurological deficits e.g. aphasia in encephalitis

A

HSV

32
Q

What virus would you suspect in a patient who has not been vaccinated, with parotitis?

A

Mumps

33
Q

List some symptoms of encephalitis:

A 
Fever
Stupor and confusion
Acute onset headache
Vomiting
Photophobia
Neurological defects
Altered consciousness
34
Q

What are the main investigations for encephalitis, and what would they show?

A

CT –> cerebral oedema

MRI –> Temporal oedema in HSV

35
Q

Treatment for encephalitis?

A

IV acyclovir

36
Q

What is an uncommon but serious outcome from having the measles, which can occur years after the initial infection?

A

Subacute Sclerosing Panencephalitis

37
Q

What symptoms are demonstrated in subacute sclerosing panencephalitis

A

Personality changes
Cognitive decline
Myoclonus

38
Q

What might be seen in CSF in Subacute Sclerosing Panencephalitis?

A

Increased IgG anti-measles antibodies

Neurology (15 decks)

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